Rash

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Rash
Severerash.jpg
A diffuse rash on the back of a human
Specialty Dermatology

A rash is a change of the skin that affects its color, appearance, or texture.

Contents

A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell, and may be painful. The causes, and therefore treatments for rashes, vary widely. Diagnosis must take into account such things as the appearance of the rash, other symptoms, what the patient may have been exposed to, occupation, and occurrence in family members. The diagnosis may confirm any number of conditions. The presence of a rash may aid diagnosis; associated signs and symptoms are diagnostic of certain diseases. For example, the rash in measles is an erythematous, morbilliform, maculopapular rash that begins a few days after the fever starts. It classically starts at the head, and spreads downwards.

Differential diagnosis

Common causes of rashes include:

Uncommon causes:

Conditions

Skin diseaseSymptomsUsual area of body
Acne vulgaris Comedones, papules, pustules and nodules.Face, chest and back.
Acne rosacea Flushed appearance or redness.Cheeks, chin, forehead or nose.
Boil Painful red bump or a cluster of painful red bumpsAnywhere
Cellulitis Red, tender and swollen areas of skinAround a cut, scrape or skin breach
Insect bite Red and/or itchy bumps on the skinAnywhere and can be sprinkled randomly
Erythema migrans / Lyme disease Expands over days or weeks to 5–70 cm (median 16 cm), circular or oval, red or bluish, may have an elevated or darker center, may have a central or ring-like clearing, may feel warm, not painful or itchy [4] [5] Armpit, groin, back of knee, on the trunk, under clothing straps, or in children's hair, ear, or neck [6] [7]
Allergic reaction Irregular, raised or flat red sores that appeared after taking medicine/drugs or eating certain foodsAnywhere
Hidradenitis Suppurativa Deep sebum filled cystic condition of apocrine gland overstimulation, caused by many internal and external factors e.g., stress, toxic environmental overload and immune impairment.See Hidradenitis.
Hives Bumps formed suddenlyAnywhere but usually first noticed on face
Seborrheic dermatitis Bumps and swellingNear glands
Cradle cap Dry, scaly skinScalp of recently born babies
Irritant contact dermatitis Red, itchy, scaly, or oily rashEyebrows, nose, edge of the scalp, point of contact with jewellery, perfume, or clothing.
Allergic Contact Dermatitis caused by poison ivy, poison oak, sumac, or Balsam of Peru [3] Red, itchy, scaly or oily rash; can also be weeping or leathery.Anywhere that came in contact with the irritant either directly or via transfer (e.g. from contaminated clothing.)
Allergic purpura Small red dots on the skin, or larger, bruise-like spots that appeared after taking medicineAnywhere
Pityriasis Rosea Started with a single scaly, red and slightly itchy spot, and within a few days, did large numbers of smaller patches of the rash, some red and/or others tanChest and abdomen
Dermatitis herpetiformis Intensely itchy rash with red bumps and blistersElbows, knees, back or buttocks
Erythema nodosum Large red bumps that seem to bruise and are tender to touchAnywhere
Psoriasis White, scaly rash over red, flaky, irritated skinElbows and knees
Erythema multiforme Red, blotchy rash, with "target like" hives or sores.Anywhere
Measles Red rash that is raised with a fever or sore throat.Usually starts first on the forehead and face and spreads downward.
Chickenpox Multiple blisters with a fever, cough, aches, tiredness and sore throat.Usually starts first on the face, chest and back and spreads downward.
Shingles Red blisters that are very painful and may crustAnywhere
Fifth Disease Started as a fever and then developed a bright red rashCheeks
Warts Soft bumps forming that do not itch and have no other symptomsAnywhere
Ringworm Bald spot on the scalp or a ring of itchy red skinAnywhere
Syphilis Rash that is red but not itchyPalms of hands or soles of feet
Jock itch, yeast infection or diaper rash Red itchy rashGroin
Tinea versicolor Light coloured patchesAnywhere
Impetigo Crusted, tan-colored soresNear nose or lip
Scabies Bite-like sores that itch and spread intenselyUsually start on hands or feet and spread everywhere
Rocky Mountain spotted fever A fine rash with a fever and headacheUsually start on arms and legs including the hands and feet
Lupus erythematosus A butterfly rash with achy jointsForehead and cheeks
Jaundice or sign of hepatitis YellowishSkin, whites of eyes and mouth
Bruise Blue or black area after being hitAnywhere
Actinic keratoses Scaly, pink, gray or tan patches or bumpsFace, scalp or on the backs or the hands
Keloid or hypertrophic scar Scar that has grown larger than expectedAnywhere
Lipoma Soft or rubbery growthAnywhere
Milia Many white spotsOn the face of a baby
Molluscum or contagiosumSmall, firm, round bumps with pits in the center that may sit on tiny stalksAnywhere
Scarlet fever Becomes confluent and forms bright red lines in the skin creases of the neck, armpits and groins (Pastia's lines)Face, chest and back, whole body, armpits, inside elbows, groins
Sebaceous cyst Bump with a white dome under the skinScalp, nape of the neck or upper back
Skin tag Soft, fleshy growth, lump or bumpFace, neck, armpits or groin
Xanthelasma Yellow area under the skinUnder eyelids
Melanoma Dark bump that may have started within a mole or blemish, or, a spot or mole that has changed in color, size, shape or is painful or itchyAnywhere
Basal cell carcinoma Fleshy, growing massAreas exposed to the sun
Squamous cell carcinoma Unusual growth that is red, scaly or crustedFace, lip or chin
Kaposi's sarcoma Dark or black raised spots on the skin that keep growing or have appeared recentlyAnywhere
Erythema annulare centrifugum (EAC)Pink-red ring or bullseye marksAnywhere

Diagnostic approach

Patch test for identifying possible allergens Epikutanni-test.jpg
Patch test for identifying possible allergens

The causes of a rash are numerous, which may make the evaluation of a rash extremely difficult. An accurate evaluation by a provider may only be made in the context of a thorough history, i.e. medications the patient is taking, the patient's occupation, where the patient has been and complete physical examination.[ citation needed ]

Points typically noted in the examination include:[ citation needed ]

A patch test may be ordered, for diagnostic purposes. [9]

Treatment

Treatment differs according to which rash a patient has been diagnosed with. Common rashes can be easily remedied using steroid topical creams (such as hydrocortisone) or non-steroidal treatments. Many of the medications are available over the counter in the United States. [10]

The problem with steroid topical creams i.e. hydrocortisone; is their inability to penetrate the skin through absorption and therefore not be effective in clearing up the affected area, thus rendering the hydrocortisone almost completely ineffective in all except the most mild of cases. [11]

Related Research Articles

<span class="mw-page-title-main">Dermatitis</span> Inflammation of the skin

Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is often called eczema, and the difference between those terms is not standardized.

<span class="mw-page-title-main">Corticosteroid</span> Class of steroid hormones

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.

<span class="mw-page-title-main">Folliculitis</span> Human and animal disease of follicles

Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head.

<span class="mw-page-title-main">Contact dermatitis</span> Human disease

Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.

<span class="mw-page-title-main">Rosacea</span> Skin condition resulting in redness, pimples and swelling, usually on the face

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

<span class="mw-page-title-main">Juvenile dermatomyositis</span> Medical condition

Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy (IMM) of presumed autoimmune dysfunction resulting in muscle weakness among other complications. It manifests itself in children; it is the pediatric counterpart of dermatomyositis. In JDM, the body's immune system attacks blood vessels throughout the body, causing inflammation called vasculitis. In the United States, the incidence rate of JDMS is approximately 2-3 cases per million children per year. The UK incidence is believed to be between 2-3 per million children per year, with some difference between ethnic groups. The sex ratio is approximately 2:1. Other Idiopathic inflammatory myopathies include; juvenile polymyositis (PM), which is rare and not as common in children as in adults.

Tick-borne diseases, which afflict humans and other animals, are caused by infectious agents transmitted by tick bites. They are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. The economic impact of tick-borne diseases is considered to be substantial in humans, and tick-borne diseases are estimated to affect ~80 % of cattle worldwide. Most of these pathogens require passage through vertebrate hosts as part of their life cycle. Tick-borne infections in humans, farm animals, and companion animals are primarily associated with wildlife animal reservoirs. many tick-borne infections in humans involve a complex cycle between wildlife animal reservoirs and tick vectors. The survival and transmission of these tick-borne viruses are closely linked to their interactions with tick vectors and host cells. These viruses are classified into different families, including Asfarviridae, Reoviridae, Rhabdoviridae, Orthomyxoviridae, Bunyaviridae, and Flaviviridae.

<span class="mw-page-title-main">Pityriasis rosea</span> Skin disease

Pityriasis rosea is a type of skin rash. Classically, it begins with a single red and slightly scaly area known as a "herald patch". This is then followed, days to weeks later, by an eruption of many smaller scaly spots; pinkish with a red edge in people with light skin and greyish in darker skin. About 20% of cases show atypical deviations from this pattern. It usually lasts less than three months and goes away without treatment. Sometimes malaise or a fever may occur before the start of the rash or itchiness, but often there are few other symptoms.

<span class="mw-page-title-main">Miliaria</span> Medical condition

Miliaria, commonly known as heat rash, sweat rash, or prickly heat, is a skin disease marked by small, itchy rashes due to sweat trapped under the skin by clogged sweat-gland ducts. Miliaria is a common ailment in hot and humid conditions, such as in the tropics and during the summer. Although it affects people of all ages, it is especially common in children and infants due to their underdeveloped sweat glands.

<span class="mw-page-title-main">Allergic conjunctivitis</span> Medical condition

Allergic conjunctivitis (AC) is inflammation of the conjunctiva due to allergy. Although allergens differ among patients, the most common cause is hay fever. Symptoms consist of redness, edema (swelling) of the conjunctiva, itching, and increased lacrimation. If this is combined with rhinitis, the condition is termed allergic rhinoconjunctivitis (ARC).

Vulvitis is inflammation of the vulva, the external female mammalian genitalia that include the labia majora, labia minora, clitoris, and introitus. It may co-occur as vulvovaginitis with vaginitis, inflammation of the vagina, and may have infectious or non-infectious causes. The warm and moist conditions of the vulva make it easily affected. Vulvitis is prone to occur in any female especially those who have certain sensitivities, infections, allergies, or diseases that make them likely to have vulvitis. Postmenopausal women and prepubescent girls are more prone to be affected by it, as compared to women in their menstruation period. It is so because they have low estrogen levels which makes their vulvar tissue thin and dry. Women having diabetes are also prone to be affected by vulvitis due to the high sugar content in their cells, increasing their vulnerability. Vulvitis is not a disease, it is just an inflammation caused by an infection, allergy or injury. Vulvitis may also be symptom of any sexually transmitted infection or a fungal infection.

<span class="mw-page-title-main">Geographic tongue</span> Tongue disorder

Geographic tongue, also known by several other terms, is a condition of the mucous membrane of the tongue, usually on the dorsal surface. It is a common condition, affecting approximately 2–3% of the general population. It is characterized by areas of smooth, red depapillation which migrate over time. The name comes from the map-like appearance of the tongue, with the patches resembling the islands of an archipelago. The cause is unknown, but the condition is entirely benign, and there is no curative treatment. Uncommonly, geographic tongue may cause a burning sensation on the tongue, for which various treatments have been described with little formal evidence of efficacy.

<span class="mw-page-title-main">Perioral dermatitis</span> Medical condition

Perioral dermatitis, also known as periorificial dermatitis, is a common type of skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly the eyes and genitalia may be involved. It can be persistent or recurring and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.

<span class="mw-page-title-main">Alclometasone</span> Chemical compound

Alclometasone is a synthetic corticosteroid for topical dermatologic use, possessing anti-inflammatory, antipruritic, and vasoconstrictive properties.

<span class="mw-page-title-main">Mometasone</span> Steroid medication

Mometasone, also known as mometasone y 3 s, is a steroid medication used to treat certain skin conditions, hay fever, and asthma. Specifically it is used to prevent rather than treat asthma attacks. It can be applied to the skin, inhaled, or used in the nose. Mometasone furoate, not mometasone, is used in medical products.

<span class="mw-page-title-main">Discoid lupus erythematosus</span> Autoimmune skin condition

Discoid lupus erythematosus is the most common type of chronic cutaneous lupus (CCLE), an autoimmune skin condition on the lupus erythematosus spectrum of illnesses. It presents with red, painful, inflamed and coin-shaped patches of skin with a scaly and crusty appearance, most often on the scalp, cheeks, and ears. Hair loss may occur if the lesions are on the scalp. The lesions can then develop severe scarring, and the centre areas may appear lighter in color with a rim darker than the normal skin. These lesions can last for years without treatment.

Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash and eczema. Topical steroids have anti-inflammatory properties and are classified based on their skin vasoconstrictive abilities. There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties but essentially differ in base and price.

Pruritic folliculitis of pregnancy is a skin condition that occurs in one in 3000 people, about 0.2% of cases, who are in their second to third trimester of pregnancy where the hair follicle becomes inflamed or infected, resulting in a pus filled bump. Some dermatologic conditions aside from pruritic folliculitis during pregnancy include "pruritic urticarial papules and plaques of pregnancy, atopic eruption of pregnancy, pemphigoid gestationis, intrahepatic cholestasis of pregnancy, and pustular psoriasis of pregnancy". This pruritic folliculitis of pregnancy differs from typical pruritic folliculitis; in pregnancy, it is characterized by sterile hair follicles becoming inflamed mainly involving the trunk, contrasting how typical pruritic folliculitis is mainly localized on "the upper back, shoulders, and chest." This condition was first observed after some pregnant individuals showed signs of folliculitis that were different than seen before. The inflammation was thought to be caused by hormonal imbalance, infection from bacteria, fungi, viruses or even an ingrown hair. However, there is no known definitive cause as of yet. These bumps usually begin on the belly and then spread to upper regions of the body as well as the thighs.

Senile pruritus is one of the most common conditions in the elderly or people over 65 years of age with an emerging itch that may be accompanied with changes in temperature and textural characteristics. In the elderly, xerosis, is the most common cause for an itch due to the degradation of the skin barrier over time. However, the cause of senile pruritus is not clearly known. Diagnosis is based on an elimination criteria during a full body examination that can be done by either a dermatologist or non-dermatologist physician.

<span class="mw-page-title-main">Topical hydrocortisone</span> Pharmaceutical drug

Topical hydrocortisone is a drug under the class of corticosteroids, which is used for the treatment of skin inflammation, itchiness and allergies. Some examples include insect bites, dermatitis and rash.

References

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  2. "Zolpidem" (PDF). F.A. Davis. Retrieved April 15, 2017.
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  5. "Lyme disease: erythema migrans". Lyme disease NICE guideline [NG95]. National Institute for Health and Care Excellence. Retrieved May 8, 2019.
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  11. "Hydrocortisone for mild inflammatory skin conditions". patient.info.