Rashes

[moreoreo]

(I know this exact topic has been posted before; I've read a few but am wondering if there are any other nuggets of wisdom out there to receive!)

When to dismiss for a "rash"??

I've had teachers write "rash" for things that to me looked like or were clearly bug bites. Or for one small area of what to me just looked like irritated/inflamed skin.

Of course I look for dismissal if the issue is all over the body, or if skin is oozing/crusting/raw/raised/blistering, or if it is accompanied by systemic issues like fever, headache, stomachache, etc.

However, there are times when my instinct says it's no biggie but it's not like I can answer teachers' questions with a confident, "No, it's not contagious!"

What kind of steps do you follow in your decision-making process?

(Pink eye is a similar issue; for this I used to dismiss left and right but then I read public health recommendations and have also learned better to discern between irritation vs. a possibly infectious case)

[OhioBPH]

We only dismiss for open rashes and rash with a fever. I know with many rash causing illnesses by the time the rash pops up, they've already shared those germs.

[nursetlm, ADN]

We exclude for undiagnosed rashes (that appear to be beyond a simple contact irritation.) Usually I call the parent right away and they already know and "forgot" to tell me or send a note in.

[moreoreo]

I know with many rash causing illnesses by the time the rash pops up, they've already shared those germs.

That's true.

I was surprised once by a case of Fifth's Disease because it avoided my other parameters except that the child was uncomfortable enough to be sent home and had a mild temp. His parents thought his skin had been irritated by swimming pool water, and he did have a hx of sensitive skin with other irritation before. (His face was really not as red as pictures of that specific rash!)

[ruby_jane, BSN, RN]

It will depend on district policy. Here, in the land of mountain cedar, pink eye is excludable.

We cannot "diagnose" rashes. Having said that, I can tell what's likely insect or plant-like rash in nature and what might be helped with hydrocortisone (if I have permission to apply).

Viral rashes usually come with fever - instant go home.

Impetigo rash with the crusty, honey color - that's excludable in my state, off you go.

The rest...well, is the kid ABLE to perform in the learning environment? Can you cover whateveritis and just have a parent look at it later? Is it something the parent can verify?

What I think you're saying is that the teacher is "sure" something is wrong and is perturbed when his/her mom judgment is met with evidence-based practice. Which, you know, happens.

[WineRN]

We exclude for undiagnosed rashes (that appear to be beyond a simple contact irritation.) Usually I call the parent right away and they already know and "forgot" to tell me or send a note in.

We do to, but I will admit to being more flexible than I should be. Like RubyJane said, we can't diagnose, but as someone with super sensitive skin, if I am confident it is contact dermatitis, I will just call home and no request a pick up.

[ruby_jane, BSN, RN]

I was surprised once by a case of Fifth's Disease

I wish I was like Davey Do and could make a GIF with the Monty Python guys saying "Nobody expects THE FIFTHS DISEASE".

[JenTheSchoolRN, BSN, RN]

I rarely dismiss for an isolated rash with no other symptoms other than "it itches."

Now if a new rash appears, is widespread, has other symptoms (such as fever), and is interfering with student's ability to learn, sure.

Otherwise, I do have a standing order for hydrocortisone. I will actually often cover the area, even if it is a suspect bug bite because kids will scratch it. Even the older ones. The bandaid or non-adherent dressing is reminder not to scratch and has the plus of preventing any spread.

Because I hate the "what is this rash" game. It is a hard game.

[Flare, ASN, BSN]

There are always a lot of factors at work here. I've had teachers march in with students claiming that they need to go home and be seen right away. These students were known to have eczema or psoriasis and were simply having a flare up - and the teacher was not making them feel better. My tube of Aquaphor and a few minutes of chilling with me in my office was a good start. Then there are the "undiagnosables" -i had one just this am. Looks just like varicella - not acting quite like it, no fever but itchy pustules around kiddo's face -is it varicella - i don't know. it's not how it typically presents, take her to the doc, bring me the documentation. Mom was less than happy, expected her to be in school all day. (too bad)

[Windchaser22]

Fever with anything gets a ticket home. Crusty, oozing, purulent, spreading get a ticket home with a referral. For conjunctivitis I use a differential approach and take into account whether or not the particular kiddo has a hx of allergic conjunctivitis and what time of year it is. I think it's silly to exclude for bacterial when viral is more contagious and not excludable. If after my assessment the SS point to bacterial, I refer and kiddo must be picked up.

[Amethya]

We are having that sort of issue here but the 1st grade teacher is the one who starts it. We had this one student with Ringworm, and left for at least a week and came back with a hat on a doctor's note that states what he has and he has to keep his hat on while on treatment. Everything was fine, and he was taken care of, but then we had another student, he had raised, bumps on his forehead, wasn't itchy, but it looked white (African American child). I did call mother, explained that we don't know what it is, but the teacher is concerned because we already had a case of Ringworm and we just want to rule out that possibility, so we asked her to pick him up and take him to the doctor.

Mother comes and says it's Eczema and she has cream for it. We ask her again to take him to the doctor, but she says will. Teacher is livid and keeps pushing it that he has Ringworm and he has to cover it up. The child feels embarrassed to have a band-aid on his forehead but his teacher wants it on him. (SPED student as well, kinda defiant at times).

I checked him today, and looks smaller than it did, no white edges. But his teacher says that shouldn't he not be here until we can confirm what it is? And his mother hasn't taken him to the doctor (She has a lot of children, and doesn't seem to take care of them at all. The one who does is his older sister.)

I'm not sure what to do at this point.