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Rashes In Children | Children's Hospital Colorado

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Red or pink rash over large parts or most of the body (widespread)
Sometimes, just on hands, feet and buttocks - but same on both sides of body
Small spots, large spots or solid red skin

Causes of Widespread Rash or Redness

Viral Rash. Most rashes are part of a viral illness. Viral rashes usually have small pink spots. They occur on both sides of the chest, stomach and back. Your child may also have a fever with some diarrhea or cold symptoms. They last 2 or 3 days. More common in the summer.
Roseola. This is the most common viral rash in the first 3 years of life. (See details below).
Chickenpox. A viral rash with a distinctive pattern. (see that Care Guide)
Hand-Foot and-Mouth Disease. A viral rash with a distinctive pattern. It starts with tiny red spots and blisters on the palms and soles. (see that Care Guide)
Monkeypox. A rare viral rash that often starts on the face or genital area. It then spreads to the arms and legs. Not usually seen in children unless someone in the home has monkeypox.
Scarlet Fever. Scarlet Fever is a speckled, red rash all over. Has a sandpaper feel. Caused by the Strep bacteria. Starts on upper chest and quickly spreads to lower chest and stomach. No more serious than a Strep throat infection without a rash.
Drug Rash. Most rashes that start while taking an antibiotic are viral rashes. Only 10% turn out to be allergic drug rashes. (see details below)
Hives. Raised pink bumps with pale centers. Hives look like mosquito bites. Rashes that are bumpy and itchy are often hives. Most cases of hives are caused by a virus. Hives can also be an allergic reaction. (See that Care Guide for details)
Heat Rash. A fine pink rash caused by overheating. Mainly involves neck, chest and upper back.
Insect Bites. Insect bites cause small red bumps. Flying insects can cause many bumps on exposed skin. Non-flying insects are more likely to cause localized bumps.
Hot Tub Rash. Causes small red bumps that are painful and itchy. Mainly occurs on skin covered by a bathing suit. Rash starts 12-48 hours after being in hot tub. Caused by overgrowth of bacteria in hot tubs.
Petechiae Rash (Serious). Petechiae are purple or dark red colored tiny dots. They come from bleeding into the skin. Scattered petechiae with a fever are caused by Meningococcemia until proven otherwise. This is a life-threatening bacterial infection of the bloodstream. Peak age is 3 to 6 months old. Unlike most pink rashes, petechiae don't fade when pressed on.
Purpura Rash (Serious). Purpura means bleeding into the skin. It looks like purple or dark red larger spots. Widespread purpura is always an emergency. It can be caused by a bacterial bloodstream infection. Rocky Mountain Spotted Fever is an example.
Blister Rash (Serious). Widespread blisters on the skin are a serious sign. It can be caused by infections or drugs. Stevens Johnson Syndrome is an example.
Caution. All widespread rashes with fever need to be seen. They need to be diagnosed. Reason: some serious infections that can cause this type of rash.

Drugs and Rashes

Prescription medicines sometimes cause widespread rashes. Some are allergic, but most are not.
Non-prescription (OTC) medicines rarely cause any rashes.
Most rashes that occur while taking an OTC medicine are viral rashes.
Fever medicines (acetaminophen and ibuprofen) cause the most needless worry. Reason: most viral rashes start with a fever. Hence, the child is taking a fever medicine when the rash starts.
Drug rashes can't be diagnosed over the phone.

Roseola - A Classic Rash

Most children get Roseola between 6 months and 3 years of age.
Rash: pink, small, flat spots on the chest and stomach. Then spreads to the face.
Classic feature: 3 to 5 days of high fever without a rash or other symptoms.
The rash starts 12 to 24 hours after the fever goes away.
The rash lasts 1 to 3 days.
By the time the rash appears, the child feels fine.
Treatment: the rash is harmless. Creams or medicines are not needed.

Localized Versus Widespread Rash: How to Decide

Localized means the rash occurs on one small part of the body. Usually, the rash is just on one side of the body. An example is a rash on 1 foot. Exceptions: athlete's foot can occur on both feet. Insect bites can be scattered.
Widespread means the rash occurs on larger areas. Examples are both legs or the entire back. Widespread can also mean on most of the body surface. Widespread rashes always occur on matching (both) sides of the body. Many viral rashes are on the chest, stomach and back.
The cause of a widespread rash usually spreads through the blood stream. Examples are rashes caused by viruses, bacteria, toxins, and food or drug allergies.
The cause of a localized rash usually is just from contact with the skin. Examples are rashes caused by chemicals, allergens, insect bites, ringworm fungus, bacteria or irritants.
This is why it's important to make this distinction.

Call 911 Now

Purple or blood-colored spots or tiny dots with fever within the last 24 hours
Trouble breathing or swallowing
Not moving or too weak to stand
You think your child has a life-threatening emergency

Go to ER Now

Purple or blood-colored spots or tiny dots without fever
Not alert when awake ("out of it")

Call Doctor or Seek Care Now

Bright red skin that peels off in sheets
Large blisters on skin
Bloody crusts on the lips
Taking a prescription medication within the last 3 days
Fever
Your daughter is having her period and using tampons
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

Widespread rash, but none of the symptoms above. Reason: all widespread rashes need to be checked by a doctor.

Care Advice for Widespread Rashes

What You Should Know About Widespread Rashes:
- Most rashes with small pink spots all over are part of a viral illness.
- This is more likely if your child has a fever. Other symptoms (like diarrhea) also point to a viral rash.
- Here is some care advice that should help until you talk with your doctor.
Non-Itchy Rash Treatment:
- If you suspect a heat rash, give a cool bath.
- Otherwise, no treatment is needed.
Itchy Rash Treatment:
- Wash the skin once with soap to remove any irritants.
- Steroid Cream. For relief of itching, use 1% hydrocortisone cream (such as Cortaid). Put it on the most itchy areas. No prescription is needed. Do this 3 times per day.
- Cool Bath. For flare-ups of itching, give your child a cool bath. Do not use soap. Do this for 10 minutes. Caution: avoid any chill. Option: Can add 2 ounces (60 mL) of baking soda per tub.
- Scratching. Try to keep your child from scratching. Cut the fingernails short. Reason: prevents a skin infection from bacteria.
- Allergy Medicine for Itching. If itching becomes severe, give an allergy medicine, such as Benadryl. No prescription is needed. Age limit: 1 and older. If needed longer than a few days, switch to a long-acting antihistamine, such as Zyrtec. Age limit: 2 and older.
Fever Medicine:
- For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Note: Fevers less than 102° F (39° C) are important for fighting infections.
- For all fevers: Keep your child well hydrated. Give lots of cold fluids.
Return to School:
- Most viral rashes can be spread to others (especially if a fever is present).
- If your child has a fever, avoid contact with other children. Also, avoid pregnant women until a diagnosis is made.
- For minor rashes, your child can return after the fever is gone.
- For major rashes, your child can return to school after the rash is gone. If your doctor has given medical clearance, your child can return sooner.
What to Expect:
- Most viral rashes go away within 48 hours.
Call Your Doctor If:
- You think your child needs to be seen
- Your child becomes worse

Care Advice for Widespread Rashes

The Chickenpox rash can occur on all body surfaces. The rash is raised, red and itchy.

The rash is no longer contagious when all of the spots are crusted over and no new spots are appearing. This usually takes 7 days after the rash first appears.

This child's right hand and wrist show the spotted rash of Rocky Mountain spotted fever.

Rocky Mountain spotted fever is caused by a bacteria. The disease is spread by ticks.

This child with measles is showing the common red blotchy rash on his buttocks and back. It is the 3rd day of the rash.

Measles is a very contagious viral disease. Symptoms include fever, red eyes, runny nose, cough, and spots on the inside cheeks.

A red blotchy rash appears around day 3 of the illness, first on the face, and then on other areas.

This patient had a widespread rash from an allergy to penicillin. The picture shows the arm.

This photo shows a child with measles.

Measles is a very contagious disease. It is caused by a virus. Symptoms include fever, red eyes, runny nose, cough, and spots on the inside cheeks (inside of mouth). A red, blotchy rash appears around day 3 of the illness. It first appears on the face and then spreads to other areas.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

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Skin rashes in children - Injuries & first aid

Childhood rashes are common and aren't usually a cause for concern. Most rashes are harmless and disappear without the need for treatment.

However, see your GP if your child has a rash and seems unwell, or if you're worried. They'll be able to investigate the cause and recommend any necessary treatment.

This page may give you a better idea about what could be causing the rash, but don't use this to self-diagnose your child's condition – always see a GP for a proper diagnosis.

The most common causes of rashes in children are:

cellulitis
chickenpox
eczema
erythema multiforme
hand, foot and mouth disease
impetigo
keratosis pilaris ("chicken skin")
measles
molluscum contagiosum
pityriasis rosea
prickly heat
psoriasis
ringworm
scabies
scarlet fever
slapped cheek syndrome
urticaria (hives)

Although meningitis has become less common over recent years, it's important to be aware of the rash and the other signs and symptoms of meningitis.

Cellulitis

Cellulitis is an infection of the deeper layers of skin and underlying tissue. The affected area will be red, painful, swollen and hot. It often affects the legs, but can occur anywhere on the body. Your child will probably also have a fever.

See your GP immediately if an area of your child's skin suddenly turns red, hot and tender. If you can't see your GP on the same day, go to a walk-in centre or minor injuries unit.

Cellulitis can usually be diagnosed by assessing the symptoms and examining the skin. It usually responds well to treatment with antibiotics.

Chickenpox

Chickenpox is a viral illness that most children catch at some point. It most commonly affects children under 10 years of age.

A rash of itchy spots turns into fluid-filled blisters. They crust over to form scabs, which after a while drop off. Some children only have a few spots, whereas others have them over their entire body. The spots are most likely to appear on the face, ears and scalp, under the arms, on the chest and belly, and on the arms and legs.

There's no specific treatment for chickenpox, but you can take steps to relieve the symptoms. For example, paracetamol can help relieve fever (don't give aspirin to children under 16), and calamine lotion and cooling gels can be used to ease itching.

Eczema

Eczema is a long-term condition that causes the skin to become itchy, red, dry and cracked. The most common type is atopic eczema, which mainly affects children but can continue into adulthood.

Atopic eczema commonly develops behind the knees or on the elbows, neck, eyes and ears. It isn't a serious condition, but if your child later becomes infected with the herpes simplex virus, it can cause the eczema to flare up into an outbreak of tiny blisters called eczema herpeticum, and will cause a fever.

About one in five children in the UK has eczema, and in eight out 10 cases it develops before the age of five, often before a child's first birthday.

Read about treating atopic eczema.

Erythema multiforme

Erythema multiforme is a skin rash (usually mild) that's caused by an allergic reaction to the herpes simplex virus.

The spots look like targets, with a dark red centre and paler ring around the outside. The hands or feet tend to be affected first, followed by the limbs, upper body and face.

Your child will probably feel unwell and may have a fever, which you should be able to treat with over-the-counter medicine. It may take from two to six weeks before they feel better. See your GP if your child has a rash and seems unwell.

In rare cases, erythema multiforme can be triggered by a reaction to certain medications, such as an antibiotic or anticonvulsant. This more severe form is called Stevens-Johnson syndrome and it can be life-threatening.

Hand, foot and mouth disease

Hand, foot and mouth disease is a common, contagious infection that causes mouth ulcers and spots and blisters on the palms of the hands and soles of the feet.

It's most common in young children (particularly those under 10), but it can also affect older children and adults.

There's no cure for hand, foot and mouth disease and it's easily spread, so you should keep your child away from school or nursery until they're better. Your child's immune system will fight the virus and it should clear up after about seven to 10 days.

Make sure your child drinks plenty of fluid, and if eating and swallowing is uncomfortable, give them soft foods, such as mashed potatoes, yoghurt and soup.

Impetigo

Impetigo is a common and highly contagious skin infection that causes sores and blisters. It isn't usually serious and often improves within a week of treatment. There are two types of impetigo – bullous and non-bullous.

Bullous impetigo typically affects the trunk (the area of the body between the waist and neck), and causes fluid-filled blisters that burst after a few days to leave a yellow crust.

Non-bullous impetigo typically affects the skin around the nose and mouth, causing sores that quickly burst to leave a yellow-brown crust.

See your GP if you think your child has impetigo. Antibiotics, in the form of a cream or tablets, will be prescribed. This should reduce the length of the illness to around seven to 10 days.

Keratosis pilaris ("chicken skin")

Keratosis pilaris is a common and harmless skin condition. The skin on the back of the upper arms becomes rough and bumpy, as if covered in permanent goose pimples. Sometimes, the buttocks, thighs, forearms and upper back can also be affected.

Keratosis pilaris typically begins in childhood and gets worse during puberty. Some people find it improves after this and may even disappear in adulthood.

There's no cure for keratosis pilaris, and it often gets better on its own without treatment. However, there are some measures you can take that may improve your child's rash, such as using non-soap cleansers rather than soap, and an emollient to moisturise their skin. Your GP or pharmacist will be able to recommend a suitable cream.

Measles

Measles is a highly infectious illness that most commonly affects young children. It's now rare in the UK because of the effectiveness of the measles, mumps and rubella (MMR) vaccine.

The measles rash is red-brown blotches. It usually starts on the head or upper neck and then spreads outwards to the rest of the body. Your child may also have a fever and cold-like symptoms.

Call your GP surgery immediately if you think your child has measles. It's best to phone before visiting because the surgery may need to make arrangements to reduce the risk of spreading the infection to others.

Measles usually passes in about seven to 10 days without causing further problems. Paracetamol or ibuprofen can be used to relieve fever, aches and pains (don't give aspirin to children under 16). Also, make sure your child drinks plenty of water to avoid dehydration.

Molluscum contagiosum

Molluscum contagiosum is a viral skin infection that causes clusters of small, firm, raised spots to develop on the skin.

It commonly affects young children aged one to five years, who tend to catch it after close physical contact with another infected child.

The condition is usually painless, although some children may experience some itchiness. It usually goes away within 18 months without the need for treatment.

Molluscum contagiosum is highly infectious. However, most adults are resistant to the virus, which means they're unlikely to catch it if they come into contact with it.

Pityriasis rosea

Pityriasis rosea is a relatively common skin condition that causes a temporary rash of raised, red scaly patches to develop on the body. Most cases occur in older children and young adults (aged between 10 and 35).

The rash can be very itchy. In most cases, it clears up without treatment in 2 to 12 weeks, although in rare cases it can last up to five months.

Emollients, steroid creams and antihistamines can be used to help relieve the itchiness. The rash doesn't usually leave scars, although the skin can sometimes be discoloured afterwards.

Prickly heat (heat rash)

Prickly heat (heat rash), also known as miliaria, is an itchy rash of small, raised red spots that causes a stinging or prickly sensation on the skin.

It occurs when the sweat ducts in the outer layer of skin (epidermis) are obstructed. You can get a heat rash anywhere on your body, but the face, neck, back, chest or thighs are most often affected.

Infants can sometimes get a prickly heat rash if they sweat more than usual – for example, when it's hot and humid or if they're overdressed. It isn't a serious condition and rarely requires any specific treatment.

Psoriasis

Psoriasis is a long-lasting (chronic) skin condition that causes red, flaky, crusty patches of skin covered with silvery scales.

The severity of psoriasis varies greatly from person to person. For some people, it's just a minor irritation, but for others it can have a major impact on their quality of life.

There's no cure for psoriasis, but there are a number of treatments that can help improve the symptoms and appearance of skin patches. For example, topical corticosteroids are creams and ointments that can be applied to the skin.

Ringworm

Ringworm is a highly infectious fungal skin infection that causes a ring-like red or silvery patch on the skin that can be scaly, inflamed or itchy.

Ringworm often affects the arms and legs, but it can appear almost anywhere on the body. Other similar fungal infections can affect the scalp, feet, groin and nails.

Ringworm can usually be easily treated with antifungal medicines, which are available from a pharmacy. Ringworm of the scalp can cause scaling and patches of hair loss. It's treated with antifungal tablets, often combined with antifungal shampoo.

Scabies

Scabies is a contagious skin condition that's intensely itchy. It's caused by tiny mites that burrow into the skin.

In children, scabies is usually spread through prolonged periods of skin-to-skin contact with an infected adult or child – for example, during play fighting or hugging.

The mites like warm places, such as skin folds, between the fingers, under fingernails, or around the buttock creases. They leave small red blotches, which are often found on the palms of the hands or soles of the feet. In infants, blisters are commonly found on the soles of the feet.

See your GP if you think your child has scabies. It's not usually a serious condition, but it does need to be treated. Your GP will prescribe a lotion or cream. Read more about treating scabies.

Scarlet fever

Scarlet fever is a highly contagious bacterial infection that usually affects children between two and eight years of age. It causes a distinctive pink-red rash, which feels like sandpaper to touch and may be itchy.

It often starts with a sore throat, fever and headache, with the rash developing two to five days after infection. The rash usually occurs on the chest and stomach before spreading to other areas of the body, such as the ears and neck.

Scarlet fever usually clears up after about a week, but see your GP if you think your child may have it. Antibiotics are used to treat it (liquid antibiotics, such as penicillin or amoxicillin, are often used to treat children).

Slapped cheek syndrome

Slapped cheek syndrome – also known as fifth disease or parvovirus B19 – is a viral infection that's common in children aged six to 10.

It causes a distinctive bright red rash to develop on both cheeks. This can look alarming, but it usually clears up by itself in one to three weeks.

Unless your child is feeling unwell, they don't need to stay away from school. Once the rash appears, the infection is no longer contagious. However, it's a good idea to notify your child's school about the infection.

Urticaria (hives)

Urticaria – also known as hives, weals, welts or nettle rash – is a raised, itchy rash that can affect one part of the body or be spread across large areas. It's a common skin reaction that often affects children.

Urticaria occurs when a trigger causes high levels of histamine and other chemical messengers to be released in the skin. These substances cause the blood vessels in the skin to open up, resulting in redness or pinkness, and swelling and itchiness.

There are many possible triggers of urticaria, including allergens, such as food or latex, irritants, such as nettles, medicines, and physical factors, such as heat or exercise. Sometimes, a cause can't be identified.

The rash is usually short-lived and mild, and can often be controlled with antihistamines.

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Causes of a rash in children

Naturally, only a pediatrician, dermatologist or allergist can correctly determine the cause of the rash , diagnose and prescribe treatment for a child. But parents themselves can provide initial assistance, relieve itching and help the baby, knowing the main signs and causes of occurrence rashes . At the first stage, it is important to determine the nature of the rash - infectious , allergic or none of the above.

Causes of rashes in children:

1. Newborn acne . For the first time may occur in newborns at the age of 1 - 2 months. As a rule, such rashes are hormonal in nature, are not contagious and are not allergies . A rash in the form of pimples, sometimes with a white dot in the middle, appears on the head, body of the baby. If there are no purulent compartments, then the rash goes away on its own and does not require treatment. Acne can also occur in teenagers. They most often appear on the face as black dots and are associated with hormonal changes in the body of a teenager and increased work of the sebaceous glands. To prevent acne, there are cosmetic lotions, washing gels and other products. In case of inflammation, it is better to seek advice from a pediatric dermatologist or cosmetologist, because. antibiotic treatment may be needed;

2. Urticaria is an allergic reaction on the skin of a child, accompanied by itching and blisters on various parts of the body, in some cases fever and disturbed chair child. The blisters appear suddenly and can disappear just as quickly, but sometimes they disappear only after a few days. The causes of urticaria can be various factors: hormonal disorders, malfunctions of the liver, kidneys, consumption of foods that caused an allergic reaction (fish, eggs, citrus fruits, etc.), insect bites, reaction to sunlight, temperature changes, emotional stress etc. Urticaria can be chronic and not go away for a long time, and acute - disappearing after a few hours. For the treatment of urticaria, it is important to identify the underlying cause that caused it;

3. Food allergy manifests itself as spots pinkish red. It is slightly convex, edematous in places of scratching and is accompanied by itching. It is localized, as a rule, on the baby's cheeks, but can also appear on other parts of the body. It can occur in both infants and adolescents. If the baby is breastfed, then the allergy that has arisen is associated with the products consumed by the mother. If the newborn is artificially fed, then an allergic reaction may appear on the mixture. In older children, food allergies can be caused by fish, eggs, nuts, chocolate, strawberries, and other foods;

Allergy, as a rule, is accompanied by edema, which in turn, if not properly treated and provided with untimely assistance, causes suffocation . If an allergy of any nature occurs, a pediatrician's consultation is required to help in choosing the optimal mixture for the baby, or a pediatric dermatologist - allergist for referral to laboratory tests of older children ;

4. Household allergies . It can occur in both newborns and older children. It usually appears as pimples all over the body and is accompanied by lachrymation, sneezing. The causes of such a reaction of the body can be washing powder and other detergents, dust, plants, animal hair, etc. An allergic rash differs from an infectious rash in that the child does not have a temperature with it, he does not have general ailments, there is no loss of appetite, drowsiness;

5. Prickly heat . It occurs mainly in infants. It manifests itself in the form of red pimples all over the body, especially in the inguinal zone. The affected areas must be smeared with a special baby cream, air baths more often for the baby and a diaper change;

6. Roseola (erythema infectiosum) is an acute childhood viral disease affecting only children under 2 years of age. Very often, roseola is confused with SARS or rubella . At the beginning of the illness, the baby's temperature rises sharply, which lasts 3-5 days, and after that the child becomes covered with a red-pink rash that disappears in 5-7 days. This is not a dangerous disease, it does not require treatment, and if it occurs, the child should be given only antipyretic drugs;

7. Windmill . This is a common childhood infectious disease that requires treatment. The incubation period of this disease can last from 11 to 21 days. Occurs at any age. It is accompanied by a rash on the skin and mucous membranes in the form of red spots, in the center of which blisters with a yellowish liquid are localized. Accompanied by itching. As the disease progresses, the blisters burst, crusts form, leaving scars if the child has scratched the blister and brought the infection. The disease can also cause fever and headache;

8. Measles is an acute infectious disease that is quite rare due to the use of vaccinations. In addition, this virus is rarely activated in babies under 8 months old, because. they are protected by their mother's immunity. The disease begins with symptoms of a common cold - coughing, lacrimation, sneezing and fever up to 40 C. Then the child develops white spots on the mucous surface of the cheeks, nasal discharge, severe headache, photophobia. Then, within a few days, red spots of various shapes appear on the face, neck, near the head and further throughout the body. The disease is contagious within a week of the onset of the first symptoms. The virus is dangerous with complications such as: meningitis , pneumonia , development of deafness, brain damage and even death;

9. Scarlet fever is an acute infectious streptococcal disease. Begins with sore throat, high fever, enlarged tonsils , in some cases with plaque. Then a small dotted rash appears on the back, chest, knees, armpits, groin and quickly spreads throughout the body and face. Only the area around the mouth remains white. Throat and tongue become very red. By the end of the disease, peeling of the skin on the toes and hands begins;

10. Rubella is an acute infectious disease . The disease begins with a slight increase in temperature and enlargement of the lymph nodes in the parotid and cervical region. A small rash also appears on the face and behind the ears, and then all over the body. Rubella is very dangerous for pregnant women, and complications can occur in older children and adolescents. In children, the disease proceeds in a fairly mild form;

11. Meningitis is an inflammation of the membranes of the brain and spinal cord. Rash in meningitis is not the main symptom. However, with this disease, rashes appear on the back of the throat, as well as on the hips, back, buttocks in the form of a red rash of various shapes. Symptoms of meningitis include very high fever, severe headache, vomiting, photophobia, and neck muscle tension. At the slightest suspicion of meningitis, parents should immediately consult a doctor. Timely help with this disease will save the child's life;

12. Streptoderma is a skin infection caused by Staphylococcus aureus. The disease affects, as a rule, the paranasal and perioral region. In the beginning, redness appears around the nose and mouth, then small bubbles with liquid. When they burst, yellow crusts remain. The disease may be accompanied by fever;

13. Herpes is an infectious disease accompanied by the appearance of blisters on the skin and mucous membranes, in children it is most often located on the lips. This disease is extremely rare in newborns, because. they are given maternal immunity. It affects children from 3 to 4 years of age. In addition to a rash, the disease may be accompanied by a sore throat, fever.

There are a lot of skin rashes and diseases in children, they can be very similar, but some are completely harmless to your child's health, while others pose a threat not only to the general condition, but also to the child's life! Do not take risks, and if you have any doubts, if any spots, rashes and other symptoms appear, contact your pediatrician, who, if necessary, will refer you and your child to a pediatric dermatologist, allergist, neurologist or other highly specialized specialist, depending on the nature of the rash and the severity of the skin disease.