What are the common causes of rashes that spread when scratched. How can you identify different types of itchy rashes. When should you seek medical attention for a spreading rash. What are effective treatments for itchy, spreading rashes.

Understanding Rashes That Spread When Scratched

Rashes that spread when scratched can be both uncomfortable and concerning. These types of rashes, often referred to as “spreading rashes,” can have various causes and may indicate different underlying conditions. Understanding the nature of these rashes is crucial for proper management and treatment.

Why do some rashes spread when scratched? The act of scratching can cause micro-tears in the skin, allowing irritants or allergens to penetrate deeper into the skin layers. This can trigger an inflammatory response, leading to the expansion of the affected area. Additionally, scratching can introduce bacteria from your fingernails, potentially causing secondary infections that exacerbate the rash.

Common Types of Spreading Rashes

• Hives (Urticaria)
• Eczema (Atopic Dermatitis)
• Contact Dermatitis
• Scabies
• Fungal Infections

Hives: A Common Cause of Spreading Rashes

Hives, medically known as urticaria, are a frequent culprit behind rashes that spread when scratched. These raised, itchy welts can appear suddenly and spread rapidly across the skin. Chronic hives, defined as occurrences lasting more than six weeks, can be particularly troublesome.

How long do individual hives typically last? Each hive usually persists for less than 24 hours before fading, though new ones may continue to appear. This cycle can repeat for days, weeks, or even months in chronic cases.

Characteristics of Hives

• Appear as raised, red or skin-colored welts
• Intensely itchy
• Can change shape, size, and location rapidly
• May be triggered by allergens, stress, or unknown factors
• Do not typically leave bruising or scarring

When to Seek Medical Attention for Spreading Rashes

While many rashes can be managed at home, certain symptoms warrant professional medical evaluation. Recognizing these signs is crucial for timely intervention and preventing potential complications.

When should you consult a healthcare provider for a spreading rash? Seek medical attention if:

• The rash persists for more than a few days without improvement
• You experience fever, severe pain, or signs of infection
• The rash covers a large portion of your body
• You have difficulty breathing or swallowing
• The rash appears suddenly and spreads rapidly

For chronic hives lasting more than a month or recurring over time, it’s advisable to consult an allergist. These specialists can perform a thorough evaluation to determine the underlying cause and develop an appropriate treatment plan.

Diagnostic Approaches for Spreading Rashes

Identifying the cause of a spreading rash often requires a combination of clinical assessment and diagnostic tests. Healthcare providers employ various methods to pinpoint the underlying trigger or condition.

Common Diagnostic Procedures

1. Medical History Review: Detailed discussion of symptoms, potential triggers, and medical background
2. Physical Examination: Thorough inspection of the affected areas and overall skin condition
3. Skin Tests: May include patch tests, prick tests, or intradermal tests to identify allergens
4. Blood Tests: To check for systemic causes or allergic reactions
5. Skin Biopsy: In some cases, a small sample of skin may be analyzed

Is allergy testing always necessary for diagnosing spreading rashes? Not always. While allergy testing can be valuable in some cases, especially for suspected food allergies or chronic hives, many rashes can be diagnosed through clinical examination and patient history alone.

Treatment Options for Itchy, Spreading Rashes

Managing rashes that spread when scratched often involves a multi-faceted approach. Treatment strategies aim to alleviate symptoms, prevent further spread, and address underlying causes when possible.

Common Treatment Modalities

• Topical Treatments: Creams, ointments, or lotions containing corticosteroids, antihistamines, or anti-inflammatory agents
• Oral Medications: Antihistamines, corticosteroids, or immunomodulators for severe cases
• Cool Compresses: To relieve itching and inflammation
• Lifestyle Modifications: Avoiding triggers, using gentle skincare products, and maintaining proper hygiene
• Phototherapy: Light therapy for certain chronic skin conditions

How effective are over-the-counter antihistamines for treating spreading rashes? While OTC antihistamines can provide relief for mild cases, particularly those caused by allergic reactions, they may not be sufficient for all types of spreading rashes. Persistent or severe cases often require prescription-strength medications or combination therapies.

Understanding Angioedema: A Related Condition

Angioedema is a condition often associated with or mistaken for hives. Unlike hives, which affect the surface of the skin, angioedema involves swelling beneath the skin’s surface. This condition can occur alongside hives or independently.

Key Symptoms of Angioedema

• Swelling of the eyes, mouth, hands, feet, or throat
• Difficulty breathing
• Stomach cramps
• Swelling of the lining of the eyes

Can angioedema be life-threatening? In some cases, yes. Severe angioedema affecting the throat or tongue can potentially obstruct airways, leading to a medical emergency. It’s crucial to seek immediate medical attention if you experience difficulty breathing or swallowing along with swelling.

Preventive Measures for Spreading Rashes

While not all spreading rashes can be prevented, certain strategies can help reduce the risk of occurrence or recurrence. Understanding and avoiding triggers is key to managing these skin conditions effectively.

Preventive Strategies

1. Identify and Avoid Triggers: Keep a diary to track potential allergens or irritants
2. Maintain Good Skin Hygiene: Use gentle, fragrance-free cleansers and moisturizers
3. Manage Stress: Practice relaxation techniques, as stress can exacerbate certain skin conditions
4. Wear Protective Clothing: When exposed to potential irritants or allergens
5. Stay Hydrated: Proper hydration supports overall skin health

How effective is dietary modification in preventing spreading rashes? For some individuals, especially those with food-related hives or allergies, dietary changes can be highly effective. However, it’s important to work with a healthcare provider or registered dietitian to ensure any dietary modifications are safe and nutritionally balanced.

Long-Term Management of Chronic Spreading Rashes

For individuals dealing with chronic conditions that cause spreading rashes, long-term management strategies are essential. These approaches focus on minimizing flare-ups, maintaining skin health, and improving quality of life.

Long-Term Management Techniques

• Regular Follow-ups: Maintain ongoing communication with healthcare providers
• Medication Adherence: Consistently use prescribed treatments as directed
• Lifestyle Adaptations: Incorporate skin-friendly habits into daily routines
• Support Groups: Connect with others experiencing similar conditions for emotional support and practical tips
• Alternative Therapies: Explore complementary approaches like acupuncture or meditation, under medical guidance

What role does stress management play in controlling chronic spreading rashes? Stress can be a significant trigger for many skin conditions, including chronic hives and eczema. Implementing effective stress management techniques, such as mindfulness, regular exercise, or counseling, can help reduce the frequency and severity of flare-ups.

Understanding and managing rashes that spread when scratched requires patience, diligence, and often professional medical guidance. By recognizing symptoms, identifying triggers, and adhering to treatment plans, individuals can effectively manage these conditions and minimize their impact on daily life. Remember, while self-care measures are important, persistent or severe symptoms always warrant consultation with a healthcare provider or dermatologist.

Hives – ACAAI Patient

Chronic hives occur almost daily for more than six weeks and are typically itchy. Each hive lasts less than 24 hours. They do not bruise nor leave any scar. They typically do not have an identifiable trigger.

If your hives last more than a month or if they recur over time, see an allergist, who will take a history and perform a thorough physical exam to try and determine the cause of your symptoms. A skin test and challenge test may also be needed to identify triggers.

Therapies range from cool compresses to relieve itching to prescription antihistamines and other drugs, such as anti-inflammatory medications and medications that may modify your The immune system plays a role in the control of cancer and other diseases, but also is the culprit in the phenomena of allergies, hypersensitivity and the rejection of transplanted organs, tissues and medical implants."}" data-sheets-userformat="{"2":8963,"3":{"1":0},"4":[null,2,16777215],"11":4,"12":0,"16":10}">The immune system is a collection of cells and proteins that works to protect the body from potentially harmful, infectious microorganisms (microscopic life-forms), such as bacteria, viruses and fungi. The immune system plays a role in the control of cancer and other diseases, but also is the culprit in the phenomena of allergies, hypersensitivity and the rejection of transplanted organs, tissues and medical implants.</span>” rel=”tooltip”>immune system.

Is It Hives or Angioedema?

Angioedema – swelling of tissue beneath the surface of the skin – can be mistaken for, or associated with hives. It can be caused by allergic reactions, medications or a hereditary deficiency of some enzymes. The following symptoms may indicate angioedema:

• Swelling in the eyes or mouth
• Swelling of the hands, feet or throat
• Difficulty breathing, stomach cramps or swelling of the lining of the eyes

The best way to identify your symptoms is to talk to an allergist who can diagnose and treat both hives and angioedema.

Diagnosis

In some cases, the trigger is obvious – a person eats peanuts or shrimp, and then breaks out within a short time. Other cases require detective work by both the patient and the physician because there are many possible causes. If the hives have gone on for a long time, the cause is not usually identified.

A single episode of hives does not usually call for extensive testing. If a food allergy is suspected, consider keeping track of what you eat. This will help you discover whether there is a link between what you’re eating and when you break out with hives.

Chronic hives should be evaluated by an allergist, who will ask about your and your family’s medical history, substances to which you are exposed at home and at work, exposure to pets or other animals and any medications you’ve taken recently. If you have been keeping a food diary, show it to your allergist.

Your allergist may want to conduct skin tests, blood tests and urine tests to identify the cause of your hives. If a specific food is the suspected trigger, your allergist may do a skin-prick test or a blood test to confirm the diagnosis; once the trigger is identified, you’ll likely be advised to avoid that food and products made from it. In rare instances, the allergist may recommend an oral food challenge – a carefully monitored test in which you’ll eat a measured amount of the suspected trigger to see if hives develop. If a medication is suspected as the trigger, your allergist can conduct similar tests, and a cautious drug challenge – similar to an oral food challenge, but with medications – may also be needed to confirm the diagnosis. Because of the possibility of </span>” rel=”tooltip”>anaphylaxis, a life-threatening allergic reaction, these challenge tests should be done only under strict medical supervision, with emergency medication and equipment at hand.

In cases where vasculitis (inflammation of the blood cells) may be the cause, your allergist may conduct a skin biopsy and send it to a specialist to examine under a microscope.

Management and Treatment

Researchers have identified many – but not all – of the factors that can cause hives. These include food and other substances you take, such as medications. Some people develop hives just by touching certain items. Some illnesses also cause hives. Here are a few of the most common causes:

• Some food (especially peanuts, eggs, nuts and shellfish)
• Medications, such as antibiotics (especially penicillin and sulfa), aspirin and ibuprofen
• Insect stings or bites
• Physical stimuli such as pressure, cold, heat, exercise or sun exposure
• Latex
• Blood transfusions
• Bacterial infections, including urinary tract infections and strep throat
• Viral infections, including the common cold, infectious mononucleosis and hepatitis
• Pet dander
• Pollen
• Some plants

Antihistamines – available either over the counter or by prescription – are a frequently recommended treatment for hives. They work by blocking the effect of </span>” rel=”tooltip”>histamine, a chemical in the skin that can cause allergy symptoms, including welts. Antihistamines that don’t make you drowsy are preferred. They are effective and long-lasting (may be taken once a day) and have few side effects. Your allergist may recommend a combination of two or three antihistamines to treat your hives, along with cold compresses or anti-itch balms to ease the symptoms.

Severe episodes of urticaria may require temporary treatment with prednisone, a similar corticosteroid medication or an immune modulator, which can reduce the severity of the symptoms.

If your reaction involves swelling of your tongue or lips, or you have trouble breathing, your allergist may prescribe an epinephrine (adrenaline) auto-injector for you to keep on hand at all times. These can be early symptoms of anaphylaxis, a potentially fatal allergic reaction that impairs breathing and can send the body into shock. The only treatment for anaphylaxis is It is one of two chemicals (the other is norepinephrine) released by the adrenal gland. Epinephrine increases the speed and force of heart beats and thereby the work that can be done by the heart. It dilates the airways to improve breathing and narrows blood vessels in the skin and intestine so that an increased flow of blood reaches the muscles and allows them to cope with the demands of exercise. Epinephrine has been produced synthetically as a drug since 1900. It remains the drug of choice for treatment of anaphylaxis."}" data-sheets-userformat="{"2":8963,"3":{"1":0},"4":[null,2,16777215],"11":4,"12":0,"16":10}">Epinephrine is a naturally occurring hormone, also called adrenaline. It is one of two chemicals (the other is norepinephrine) released by the adrenal gland. Epinephrine increases the speed and force of heart beats and thereby the work that can be done by the heart. It dilates the airways to improve breathing and narrows blood vessels in the skin and intestine so that an increased flow of blood reaches the muscles and allows them to cope with the demands of exercise. Epinephrine has been produced synthetically as a drug since 1900. It remains the drug of choice for treatment of anaphylaxis.</span>” rel=”tooltip”>epinephrine. If you develop hives and your injector is not nearby – or if using the auto-injector doesn’t cause the symptoms to immediately improve – call 911 or go to an emergency room immediately. Emergency medical services carry epinephrine and can provide prompt treatment. You should also go to the emergency room after using an auto-injector.

If the cause of hives can be identified, the best treatment is to avoid the trigger or eliminate it:

• Foods: Don’t eat foods that have been identified to cause your symptoms.
• Rubbing or scratching: Avoid harsh soaps. Frequent baths may reduce itching and scratching – beneficial because itching and scratching can make the hives feel worse.
• Constant pressure: Avoid tight clothing. Pressure hives can be relieved by wearing loose-fitting clothes.
• Temperature: If you develop hives when exposed to cold, do not swim alone in cold water and always carry an epinephrine auto-injector. Avoid exposure to cold air and use a scarf around your nose and mouth in cold weather. If you must be out in the cold, wear warm clothing.
• Sun exposure: Wear protective clothing; apply sunblock.
• Medications: Notify your physician or pharmacist immediately if you suspect that a specific medication is causing your hives.

Chronic hives

Some cases of hives last for more than six weeks and can last months or years. This condition is known as chronic hives.

If the cause cannot be identified, even after a detailed history and testing, the condition is called chronic idiopathic urticaria. (“Idiopathic” means “unknown.”) About half these cases are associated with some immune findings. Chronic hives may also be associated with thyroid disease, other hormonal problems or, in very rare instances, cancer. Even this condition usually dissipates over time.

Physical urticaria

In physical urticaria, the hives have a physical cause, such as exposure to heat, cold or pressure.

Common triggers include:

• Rubbing or scratching. This is the most frequent cause of physical urticaria. Symptoms appear within a few minutes in the place that was rubbed or scratched and typically last less than an hour.
• Pressure or constriction. Delayed pressure urticaria can appear as red swelling six to eight hours after pressure (belts or constrictive clothing, for example) has been applied. Symptoms can also occur in parts of the body under constant pressure, such as the soles of the feet.
• Change in temperature. Cold urticaria is caused by exposure to low temperatures followed by re-warming. This can be severe and life-threatening if there is a general body cooling – for example, after a plunge into a swimming pool.
• Higher body temperature. Cholinergic urticaria is due to an increase in body temperature because of sweating, exercise, hot showers and/or anxiety.
• Sun exposure. Solar urticaria may occur within a few minutes after exposure to the sun.

Inflammation of the blood vessels, or vasculitis, can also cause hives. These hives are more painful than itchy, may leave a bruise on the skin and often last more than a day.

Life’s too short to struggle with hives. Find answers with an allergist.

Causes, Symptoms, Treatment & Prevention

Overview

Impetigo on the lower lip.

What is impetigo?

Impetigo (im-pa-TIE-go) is an itchy, sometimes painful, skin infection.

Who gets impetigo?

Impetigo usually happens to children between ages 2 and 6. Older children and adults can also get it.

You may also be at higher risk if you:

• Live in a tropical climate, with hot, humid summers and mild winters.
• Have a scabies infection.
• Do activities or sports where cuts and scrapes are common.
• Live in close contact or crowded situations. Infections often happen to people living in the same house or children in day care.

How does someone get impetigo?

When you get a cut, bite or scratch that opens the skin, bacteria can enter and cause an impetigo infection. But impetigo can infect the skin even if it’s not broken or punctured.

Impetigo happens more often in warmer months when children are outside more.

Where does impetigo occur?

Typically, the first signs of impetigo are sores and blisters on the mouth and nose. Impetigo can also appear on the legs and arms.

What is bullous impetigo?

Bullous impetigo is a rare type of impetigo. It has larger blisters that don’t break open as easily. It often appears on the neck, torso, armpits or groin.

How common is impetigo?

Impetigo is the most common skin infection in kids ages 2 to 5. It happens much less in adults. Every year, Staphylococcus aureus, the bacteria that causes impetigo, causes 11 million skin and soft tissue infections.

Symptoms and Causes

What causes impetigo?

The main cause of impetigo is a bacterial infection. The bacteria usually enters the skin through a cut, scrape, rash or insect bite.

Most of the time, the cause is the Staphylococcus aureus (“staph” bacteria). Sometimes, group A Streptococcus bacteria can cause it. This type of bacteria also leads to strep throat and fever.

Certain strains of strep bacteria that cause impetigo can also cause glomerulonephritis. This inflammatory kidney disease can produce high blood pressure and blood in the urine.

Is impetigo contagious?

Impetigo is mild but highly contagious. You can spread impetigo by coming into contact with the sores or mucus or nasal discharge from someone who has it. People can also spread impetigo by sharing items such as towels, clothing or other personal items with someone who’s infected.

When do impetigo symptoms start?

Typically, once the infection happens, symptoms occur within three days. Scratching the sores can spread the infection. Symptoms first start around the mouth and nose.

What are the symptoms of impetigo?

Symptoms of impetigo include:

• One or more pus-filled blisters that burst easily, causing red, raw skin.
• Itchy blisters containing fluid (yellow or tan) that seeps out and forms a crust.
• A rash that spreads.
• Skin lesions (wounds) on the lips, nose, ears, arms and legs. The lesions can spread to other parts of the body.
• Swollen lymph nodes near the infected area.

If you or your child has impetigo caused by staph bacteria, you may notice:

• Reddish skin surrounding red blisters, full of liquid or pus that eventually looks cloudy.
• Blisters that burst easily and leak.
• Raw, shiny areas that scab over with a yellow/brown crust.

Diagnosis and Tests

How is impetigo diagnosed?

A healthcare provider can diagnose impetigo based on how the sores look. The provider may take a skin sample to send to a laboratory. Pathologists can figure out which bacteria is causing the disease, which can help determine the right antibiotic to use.

If you notice or your child notices any blood or odd color in urine, tell your healthcare provider right away.

Management and Treatment

How is impetigo treated?

Antibiotics can treat impetigo. A provider may prescribe topical antibiotics to put on the skin. Your child may need to take oral antibiotics (a liquid or pill) if the condition covers a large area of skin or multiple body parts.

Examples of antibiotic treatments include:

• Topical mupirocin (Bactroban® or Centany®) ointment.
• Oral antibiotics such as cephalosporins, clindamycin (Cleocin®) and sulfamethoxazole (Bactrim™).

Will impetigo go away on its own?

Impetigo often disappears within about three weeks, even without treatment. But it may take longer. Until it goes away, your child is contagious.

Are there complications of impetigo?

Complications are rare. They include:

• Rash that spreads to deeper skin layers.
• Kidney problems, called post-streptococcal glomerulonephritis.

Prevention

Can I prevent impetigo?

The best ways to prevent infection are to stay clean and healthy. Other tips to avoid impetigo include:

• Keep hands clean: Wash hands regularly. Use alcohol-based sanitizer if you don’t have soap and water.
• Practice good hygiene: Clip your (and your child’s) fingernails regularly to avoid scratching. Sneeze into a tissue and then throw the tissue away. Bathe daily (or as often as possible), especially for children with eczema or sensitive skin.
• Avoid scratching: Don’t scratch cuts or wounds. If your child gets a cut, scratch or wound, keep them from scratching it.
• Clean wounds: Clean cuts, scrapes and injuries with soap and water. Then put an antibiotic cream or ointment on the wound.
• Keep linens clean: Wash underwear, towels and sheets in hot water.

Outlook / Prognosis

What’s the outlook for someone who gets impetigo?

Antibiotics can cure impetigo, but the condition can return, especially in small children. Getting it once doesn’t protect someone from getting it again.

How long until the sores go away?

The sores may take some time to heal completely. The good news: The infection rarely leaves scars.

How long is impetigo contagious?

Without treatment, impetigo can be contagious for weeks. After starting impetigo treatment, the condition is contagious until:

• The rash disappears.
• Scabs fall off.
• You have finished at least two days of antibiotics.

Can a person get re-infected?

Re-infection happens. Children are especially prone to scratching and opening their scabs, putting them at a higher risk of re-infection.

Living With

How can I take care of myself if I have impetigo?

If your healthcare provider diagnosed you or your child with impetigo, these treatment tips can help:

• Keep sores covered: Bandage sores or wear long sleeves and pants.
• Take all medication: Use your antibiotics for the full length of me your provider prescribed them to prevent re-infection.
• Stay clean: Wash the skin gently a few times a day using antibacterial soap. Doing so will remove crusts and drainage.
• Avoid touching the rash: If you do touch it, wash your hands and the exposed area with soap and water.
• Isolate children: If your child has impetigo, keep them away from other children until they finish treatment. They shouldn’t go to school or day care.
• Avoid hot tubs and swimming pools: The rash can spread if others come into contact with your child’s skin, swimsuit or towel.

A note from Cleveland Clinic Impetigo is a common skin condition that mostly affects young children. Impetigo symptoms include blisters and red sores that typically start around the mouth and nose. If you notice signs of impetigo, talk to your healthcare provider. Impetigo treatment is usually antibiotics, either oral or topical (a cream). Impetigo is very contagious, so keep children home until they’ve had at least two days of antibiotics. The medicine will clear up the rash. To prevent impetigo, practice good hygiene. Clean and cover any cuts or scratches to keep them from getting infected.

8 Management of allergy, rashes, and itching

The vast majority of skin problems that present in the community are minor in nature. Unfortunately, very occasionally, the development of seemingly innocuous symptoms such as a rash and/or itching can be the presenting symptoms of a life threatening condition—namely anaphylaxis or meningococcal septicaemia. While other clinical conditions can mimic both anaphylaxis and meningitis, especially in the early stages, there are usually clues in the presentation that help to minimise the delays in administering appropriate therapy. It is not possible in this article to cover all potential causes of a rash and/or itching. Rather, this chapter aims to focus on important conditions that require recognition, treatment, and possible referral in the acute prehospital setting. Box 1 lists the objectives of this article.

Box 1

Article objectives

With regard to the presentation of a rash and/or itching:

• To understand the basic physiology and pathology underlying allergic causes of rashes and itching

• To perform a primary survey of the patient and treat any immediately life threatening problems

• To identify any patients who have a normal primary survey but have an obvious need for hospital admission

• To perform a secondary survey incorporating other body systems that may be affected by a rash and/or itching

• To consider a list of differential diagnoses

• Discuss treatment based on the probable diagnosis(es)

• Discuss appropriate patient follow up

• Describe who can be safely considered for home treatment

BASIC PHYSIOLOGY AND PATHOLOGY UNDERLYING ALLERGIC CAUSES OF RASHES AND ITCHING

Allergic reactions are linked to the release of chemical mediators, which are released from mast cells in a process known as degranulation. ¹ This occurs when an allergen cross links with immunoglobulin E (IgE) bound to receptors on mast cells. These chemicals are either released immediately (immediate allergic reaction), or after a few hours (late phase response). This timing helps to guide appropriate treatment.

PRIMARY SURVEY

Assess for an ABC problem in patients with itching and/or a rash (see box 2):

Box 2

Primary survey

Arrange immediate treatment and transfer to hospital if any of the following are present:

• Signs of airway obstruction

• Respiratory rate<10 or >29

• Oxygen saturation<92% on air

• Pulse rate<50 or >120

• Systolic BP<90

• Glasgow coma score<12

The recognition of developing airway obstruction is critical, particularly in the presence of anaphylaxis. Patients may complain initially of a feeling of tightening in the throat, be unable to complete sentences, or have audible airway noise (stridor or wheeze). If airway obstruction becomes complete, then prompt initiation of a surgical airway will be required.

PATIENTS WITH A NORMAL PRIMARY SURVEY WITH OBVIOUS NEED FOR HOSPITAL ADMISSION

The following conditions may present initially with a normal primary survey but immediate treatment (if appropriate) and hospital admission should be initiated:

• Suspected rash of meningococcal septicaemia

• Definite exposure to a trigger that has previously lead to an anaphylactic reaction

• Self administration of adrenaline (epinephrine) by a patient for a suspected anaphylactic reaction

• A suspected anaphylactic reaction that has not fully developed

• Cellulitis—patient clinically toxic or affecting the peri-orbital tissues

The history and findings on examination should help to establish whether you are faced with such a scenario. Although these patients may not have abnormal clinical signs at the time of assessment, this should not lull you into a false sense of security as they may deteriorate rapidly. In the case of suspected meningococcal septicaemia, early administration of appropriate antibiotic therapy is safe and associated with an improved prognosis.² Whenever there is a suspicion of anaphylaxis, adrenaline for intramuscular injection should be readily available.³ If the above situations present, based on the history and examination findings as described in this article, then appropriate treatment should be administered and hospital admission arranged.

SECONDARY SURVEY (INCLUDING HISTORY TAKING)

Having ensured that your patient has no immediately life threatening problems on their primary survey or the need for immediate hospital admission, you will be left with a patient for whom a careful history and examination should elucidate whether further treatment is required and whether or not the patient can be safely left at home. A history of the presenting complaint should be taken, any other information noted, and an examination performed as described earlier in this series. Remember that the skin is the largest organ in the body and adequate exposure may be required to permit a thorough examination to be completed. Obviously, the degree of exposure will be dictated by the prevailing circumstances and nature of the presenting complaint(s).

HISTORY

The following will be helpful in establishing the diagnosis in someone presenting with a rash or itching. Unfortunately, there are few clinical tests that can help in the diagnostic process, which relies heavily on the use of a logical process to identify and eliminate serious problems.

Onset of symptoms

Did the symptoms come on suddenly over the course of a few minutes/hours or more gradually over the course of several days? Has there been recent injury to the area affected (especially a laceration)? Can symptoms be related to a particular event? In particular, the patient may be able to associate the symptoms with a specific trigger, for example, consumption of a particular meal, use of a new shampoo, etc. Table 2 lists the common potential triggers for an anaphylactic reaction.

Table 1

 Timing of release of chemical mediators and appropriate treatment

Table 2

 Potential triggers for anaphylaxis

Pitfall

Nuts are increasingly being used as a “filler” in a wide range of foods. The patient may not therefore be aware that they have consumed nut products

Rash/swelling

If a rash is present then is it localised or generalised? What colour is the rash? Does the area of the rash itself itch or is it actually painful to touch? Does the rash change colour when pressed against the edge of a glass? If swelling is present, which part(s) of the body are affected? Pay particular heed to any swelling involving the mouth, tongue, or eyes.

Associated symptoms

Of utmost importance is whether the patient feels generally well in him/herself. Does the patient have a generalised itch all over? Is there disturbance of another bodily system—for example, gastrointestinal upset? Specific inquiry should be made about the presence of vomiting, headache, neck pain, cough, and eye discomfort. The patient should be asked whether they have recently had an upper respiratory tract infection, or tonsillitis, or both.

Progress of symptoms

It is important to ascertain whether the symptoms have continued to worsen since their onset. Anaphylaxis and meningococcal septicaemia are progressive conditions that will steadily deteriorate with time. However, if a patient with an allergic reaction but without signs of anaphylaxis has remained stable for more than an hour they are unlikely to deteriorate further.

Previous episodes

Ask whether a similar episode has affected the patient before. Previous episodes of anaphylaxis are unlikely to be easily forgotten! Unfortunately, a history of a previous allergic reaction (mild or severe) does not predict the likelihood of an anaphylactic reaction—a reaction can still occur despite a long history of previous safe exposure.⁴

Pitfall

Someone who has had previous safe exposure to a potential trigger (for example, peanuts, seafood, specific drugs, etc) may still experience an anaphylactic reaction to it in the future.

Risk factors

Exposure to certain triggers is associated with an increased incidence of allergic reactions (table 2).

Medical history/drug history

Any history of similar events should be noted. Many drugs can be implicated in the development of allergic reactions and anaphylaxis. Aspirin accounts for about 3% of anaphylactic reactions and symptoms may occur hours after ingestion. ⁵ Those allergic to aspirin may also be sensitive to NSAIDs, which may cause a similar reaction. A similar allergic association can occur with penicillins and cephalosporins. Even people who have had no previous problems with penicillins may experience an anaphylactoid reaction after taking them. Diabetics are at a higher risk of cellulitis.

Family history

A positive family history of similar episodes suggests hereditary angio-neurotic edema (HANE), which is inherited as an autosomal dominant trait.

Social history

Has the patient been in contact with anyone who has had similar symptoms or felt unwell? Is the patient worried about a particular diagnosis? If so, this should be excluded if possible so that the patient may be reassured.

Examination

See the earlier article in this series relating to patient examination. It is always advisable to check and record the vital signs of any patient who presents with a possible allergic reaction or rash. This includes the measurement of temperature, pulse, blood pressure, and respiratory rate. An increased temperature and/or the presence of enlarged (and often painful) lymph glands in the submandibular and/or cervical regions suggest the possibility of an infective process. It is sensible to test for neck stiffness in any patient who presents with a rash and systemic upset. The patient’s neck should be passively flexed forwards towards the chest wall, a manoeuvre that should not be painful to complete. If neck flexion causes pain, then Kernig’s and Brudzinski’s signs should be tested.

• Kernig’s sign—extend the knee with the hip flexed. Positive test if hamstrings contraction occurs as a result

• Brudzinski’s sign—flex the neck passively. Test is positive if the knees and hips flex as a result.

Pitfall

Although a positive response to Kernig’s or Brudzinski’s tests is diagnostic of meninigism, the absence of a positive response does not rule out meningitis

General examination

Note the patient’s overall demeanour. Do they appear well, at ease, and able to converse normally or are they anxious, sweaty, confused, or making abnormal noises as they breathe? If this is the case, go back and reassess their primary survey and consider whether further treatment and/or onward referral are required.

Examination of the skin

As previously mentioned, it is important to ensure adequate exposure of the skin, especially in younger children who may be less able or likely to bring the presence of a rash to your attention. In a significant proportion of patients with meningococcal septicaemia, the rash starts on the palms of the hands and/or the soles of the feet so be sure to examine these carefully. Is the rash painful to the touch? Record any swelling of the tissues, especially around the face and the eyes. Gently examine inside the mouth looking for swelling of the tongue. Note the presence of any scratch marks on the body. Note the colour associated with any rash—does the rash disappear or change colour when pressure is applied? (Ideally this should be done with the base of a clear glass). Table 3 lists the common terms used to describe physical changes in the skin associated with the presence of a rash.

Table 3

 Common terms used to describe physical changes in the skin associated with the presence of a rash

Pitfall

Although a non-blanching purpuric rash should be considered to be indicative of meningococcal septicaemia in the prehospital setting, neither the absence of a rash nor the fact that a rash blanches should be considered as ruling out meningitis or septicaemia

Investigations

There are few investigations that will quickly confirm the diagnosis of a rash or itching in the acute prehospital setting. The diagnosis usually requires a clinical interpretation of the symptoms and signs presented.

Differential diagnosis

Table 4 lists the main important conditions to be distinguished in a patient presenting with a rash and/or itching. Further information is given later in this article specific to each condition.

Table 4

 The main important conditions to be distinguished in a patient presenting with a rash and/or itching

Management plan

Depending on the suspected diagnosis and clinical condition of the patient, the usual management plan can be summarised as one of the following four choices

• Plan 1—admit and treat immediately as an emergency

• Plan 2—admit as a semi-urgent case for further assessment and treatment

• Plan 3—advisable to seek further advice from hospital

• Plan 4—can be treated at home, assuming no features of concern

Where indicated, appropriate home management options are discussed for each condition

IMMUNE SYSTEM MEDIATED CONDITIONS

Anaphylaxis and anaphylactoid reactions

Anaphylaxis refers to a severe generalised allergic reaction, whereby specific triggers (for example, insect stings, peanuts) stimulate the release of IgE immunoglobulin. This IgE release causes vasodilatation, airway swelling, and capillary leakage leading to hypotension. An anaphylactoid reaction results in an identical situation, but does not entail the release of IgE. An example of this is the reaction that can be seen to radiography dye.⁶ While no universally accepted definition exists, a good working definition is “a severe allergic reaction to any stimulus, (usually) having sudden onset and generally lasting less than 24 hours, involving one or more body systems and producing one or more symptoms such as hives, flushing, itching, angio-oedema, stridor, wheezing, shortness of breath, vomiting, diarrhoea or shock”.⁷ The rate of anaphylaxis in the UK has risen from 6 per million in 1990/91 to 41 per million in 2000/01.⁸

Symptoms and signs of anaphylaxis

The diagnosis of anaphylaxis is clinical. Symptoms usually begin within minutes of exposure to the trigger(s), but may be delayed by several hours. Many of the symptoms and signs of anaphylaxis may mimic other clinical conditions, thus leading to a delay in diagnosis (table 5). For this reason, the first attack is particularly dangerous. Having experienced the symptoms once, a surviving patient is likely to recognise their occurrence in the future thus aiding earlier diagnosis and treatment. Over 90% of patients with anaphylaxis will develop cutaneous symptoms such as urticaria (see later), itching, and angio-oedema that can help to distinguish the condition from other diagnoses. A vasovagal reaction, perhaps the commonest mimic of an anaphylactic episode, does not involve cutaneous changes, tachycardia, or bronchospasm. Patients often describe a non-specific but frightening feeling of “impending doom”. Untreated, anaphylaxis will steadily worsen and a progressive deterioration in the patient’s clinical condition should alert an observer to the possibility of this diagnosis. Patients with significant cardiovascular collapse may be unable to give a coherent history, adding to the potential for diagnostic delay.

Table 5

 Symptoms and signs of anaphylaxis with differential diagnosis(es)

Management of anaphylaxis

The management of suspected anaphylaxis is a medical emergency and is summarised in figures 1 and 2.

Figure 1

 Anaphylactic reactions: treatment algorithm for adults by first medical responders (reproduced with permission of the Resuscitation Council UK http://www.resus.org.uk/pages).

Figure 2

 Anaphylactic reactions: treatment algorithm for children in the community (reproduced with permission of the Resuscitation Council UK http://www.resus.org.uk/pages).

Early recognition of symptoms, removal of the triggering source (if possible), and prompt administration of adrenaline (epinephrine) are the fundamentals of successful management.

ABCs

Airway patency must be maintained and 100% oxygen should be applied to all patients as soon as it is available. If the patient has developed signs of complete airway obstruction then a surgical airway must be initiated. Intravenous access should be established as large volumes of fluid may be required to treat the severe hypotension often seen in anaphylaxis, if it does not correct rapidly with drug treatment. A rapid infusion of 1–2 litres of crystalloid or colloid, given in 250–500 ml boluses, may be required if the radial pulse is lost. Children should receive an initial bolus of 20 ml/kg with boluses repeated until a response is noted.

Adrenaline

Adrenaline 0.5 mg (0.5 ml of 1:1000) should be injected intramuscularly, preferably into the antero-lateral aspect of the upper arm or thigh. This route of administration has been shown to be superior to subcutaneous injection.⁹ Adrenaline should be re-administered every five minutes until clinical improvement occurs. People taking β blockers may have a suboptimal response to adrenaline, with possible persistent severe hypotension and bradycardia.¹⁰ The latter can be treated with atropine (0.3–0.5 mg intramuscularly every 10 minutes to a maximum of 2 mg). Glucagon (as a 1 mg intravenously bolus) may also be effective for patients taking β blockers although it is not licensed for this indication.^6,10

Antihistamines

Histamine is one of the prime chemical mediators of the anaphylactic reaction. Antihistamine drugs may therefore provide rapid relief of distressing symptoms. A H₁ antagonist drug such as chlorpheniramine (10–20 mg intramuscularly or slow intravenously) may be combined with a H₂ antagonist such as ranitidine (150 mg orally, if able to take) to effect maximal histamine block.¹¹

Corticosteroids

Corticosteroids, in the form of hydrocortisone 200 mg (intravenously or intramuscularly) or prednisolone (oral) 50 mg should be administered to minimise the likelihood and severity of second phase reactions. The benefits of administering corticosteroids can take 6–12 hours to be realised, and it is emphasised that their main therapeutic influence is upon recurrent or protracted episodes. Even so, it is recognised that patients who have received corticosteroids may still develop severe biphasic or prolonged reactions.^12,13

Pitfall

Rapid administration of intravenous chlorpheniramine or corticosteroids can cause hypotension

β

₂ agonists

Bronchospasm is often a prominent symptom of anaphylaxis and commonly manifests itself as shortness of breath and/or wheezing. It should be treated with a β₂ agonist such as salbutamol (Ventolin) or terbutaline (Bricanyl). Depending on resources available, these may be administered via a standard inhaler device or through a nebuliser (oxygen driven if possible). β₂ agonist therapy can be repeated as required or given continuously en route to hospital according to the degree of response achieved.

Pitfall

Bronchospasm should improve with the administration of a β₂ agonist, but this does not mean that the anaphylactic process is resolving or that adrenaline is not required

Admission to hospital

Although most episodes of anaphylaxis will occur and recover within one to eight hours, the potential for a second phase reaction remains. As a consequence, all patients who have sustained an anaphylactic reaction should be observed and monitored in a hospital setting. Local hospital policies may vary, but second phase reactions can occur up to 24 hours after the initial episode, regardless of the response to treatment.^10,14 For the next 48 hours after discharge, it is recommended that the patient remains in an environment that permits easy access to medical attention should symptoms recur. This has important implications for those patients who live in isolated rural communities.

Follow up arrangements

After an episode of anaphylaxis, there are two important issues to address with the patient. Firstly, an attempt should be made to identify the precipitating cause and reduce the likelihood of further exposure. The possible cause may be obvious from the original clinical presentation or otherwise confirmation requires referral to an allergist for a skin prick test. Those who subsequently have a confirmed IgE mediated allergy may be amenable to specific and potentially curative immunotherapy. Secondly, patients need to be aware of the correct actions in the event of a recurrence. They should be prescribed a self injection device for the administration of adrenaline (for example, Epi-Pen), be instructed in its appropriate use, and advised to obtain a Medic-Alert bracelet or necklace. Close relatives, friends, and/or neighbours should also be considered for education as deemed appropriate to the individual circumstance.

Allergic reactions—local

A far more common occurrence than anaphylaxis is the development of a localised reaction to an allergen without the development of serious generalised symptoms. The reaction seen after an insect bite (see fig 3) is a classic example of this. There is usually (but not always) a history of exposure to a potential allergen, after which the patient may notice the development of skin changes such as rash, itching, swelling, and/or pain. If the affected area involves the mouth or neck then the potential for airway compromise must be considered. There are three simple but important differentiations to be made that help to distinguish these less serious local reactions from those that may lead to a patient’s deterioration:

Figure 3

 Rash caused by an insect bite. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

• The patient’s symptoms are generally localised to the affected area

• The patient has no symptoms or signs of systemic upset

• The patient’s symptoms do not progressively worsen

Treatment

Simple measures such as the application of ice may help with swelling and pain. The use of an oral antihistamine such as cetirizine (which can be bought over the counter by the patient and used in patients from the age of 2 upwards) will alleviate most of the patient’s symptoms within one to three days. If the reaction is more severe, then a three day course of oral corticosteroids, for example, prednisolone EC (1 mg/kg/d for children, 30 mg/d for adults) may be administered to help reduce the reaction. The patient should be advised to seek medical attention again if their symptoms worsen, become generalised, or have not resolved after three days.

Urticaria (“hives”) and angio-oedema

Urticaria and angio-oedema are related conditions and occur together in about 50% of cases, with urticaria a single entity in 40% and the remaining 10% being angio-oedema alone. The British Association of Dermatologists offers useful online information for both patients and doctors.¹⁵

Simple urticaria

This condition typically produces an itchy “wheal and flare” reaction anywhere on the body. The lesions usually have a raised central area and blanch on direct pressure (see figs 4 and 5).

Figure 4

 Rash caused by hives. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Figure 5

 Rash on the leg caused by uticaria. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Angio-oedema and urticaria

This condition, which is more common in female patients, tends to affect the extremities (for example, lips, eyelids, and digits) and is often painful rather than itchy. Most episodes are acute and self limiting but up to 10% will become chronic in nature. In most cases, no definite causal agent is found although any of the substances in table 2 may be implicated in some cases. Most symptoms will settle by six weeks and the patient can be reassured about the benign nature of the condition. Treatment in the acute phase entails avoidance of any obvious trigger(s) and the use of an oral H₁ antihistamine agent such as chlorpheniramine or cetirizine. In the event that one agent is ineffective, another should be substituted.¹⁶ In the longer term, other agents including oral corticosteroids may be required if the condition becomes chronic.

Angio-oedema without urticaria

The commonest cause of isolated angio-oedema is hereditary angio-neurotic edema (HANE)—this condition is characterised by recurrent acute swelling affecting the cutaneous tissues and mucous membranes of any part of the body. Most patients inherit the condition as an autosomal dominant gene and experience their first episode in childhood. The defect is a lack of C’1 esterase inhibitor protein that leads to inappropriate activation of the complement pathway. Triggers may include allergens but a reaction can also occur after fright or physical trauma. Patients are usually familiar with the pattern of their symptoms, which makes the diagnosis easier as their experience grows. Although the symptoms of swelling usually develop gradually over many hours, involvement of the upper airway tissues can cause concern. Management of an acute episode depends on its severity. While peripheral swelling does not require active treatment, airway involvement requires active management including the administration of C’1 inhibitor concentrate.¹⁷ Some patients may carry an auto-injector containing this drug, which should be administered immediately if available. Otherwise, urgent transfer to an alerted hospital is indicated.

Other causes of isolated angio-oedema may be linked to the use of certain medications (ACE inhibitors in particular). Angiotension₂ receptor antagonists (for example, losartan) can be substituted as these are not associated with the condition. If no cause can be identified, the condition is deemed to be idiopathic.

Idiopathic thrombocytopaenic purpura (ITP)

This is a condition where the body’s immune system attacks platelets, the blood cells that help form blood clots. This leads to a low platelet count in the blood (detected through a full blood count). As a result, ITP causes small amounts of bleeding into the skin tissues. Its cause is unknown, but there are two forms—one that affects children (usually between 2–4 years old and commonly after a viral infection) and one that affects adults (usually women). It results in a non-blanching purpuric rash, sometimes with more extensive patches of bruising, but is not acutely life threatening. Usually, people with ITP show no other signs of illness other than their rash—in contrast with patients with meningococcal disease. If in doubt as to the cause of purpura in the prehospital setting, further medical advice should be obtained or hospital admission arranged.

INFECTIVE CONDITIONS

(1) Bacterial

Meningococcal septicaemia

Meningococcal septicaemia is a life threatening condition with high morbidity and mortality. In 2003, 732 cases were reported in England and Wales.¹⁸ Unfortunately, particularly in its early stages, its symptoms are fairly non-specific and may mimic those of a common viral illness. Although it may not occur at all, the development of a rash is an important clinical sign, especially in the presence of systemic upset (for example, headache, vomiting and/or altered mental status). The Meningitis Research Foundation (http://www.meningitis.org.uk) is one of many resources with practical advice and information for health professionals and lay persons.

The classic rash of meningococcal septicaemia (see fig 6) may consist of any of the following:

The rash is usually described as “non-blanching”—that is, if a glass tumbler is pressed firmly against a septicaemic rash, the marks will not fade. In its initial phase, the rash may not have any of the classic features described. In the case of any patient with a rash, the patient and/or their carers should be educated about features of possible concern and advised to seek advice again if the nature of the rash changes. It often starts first on the sole of the feet or the palm of the hands. The rash may not be as distinct in patients with darkly coloured skin, in whom areas such as the conjunctiva and the roof of the mouth should be checked carefully. Patients with septicaemia will usually become seriously ill, often within a short time frame. Symptoms may be very subtle in infants and may include irritability, poor feeding, weak cry, and mottled skin. If in doubt, the infant should be admitted for observation. In the case of suspected meningococcal septicaemia, appropriate antibiotic treatment should be administered as soon as possible. Prehospital antibiotic administration has been shown to reduce the mortality in meningococcal meningitis by about 50%. The incidence of true anaphylactic reactions to penicillin is extremely low and treatment should not be delayed unless there is a clear personal history of such.¹⁹ In these circumstances, ceftriaxone is the preferred alternative.²⁰ Table 6 gives the recommended doses of each drug.

Table 6

 Recommended drug doses for meningococcal septicaemia

Cellulitis

Cellulitis is an acute bacterial infection of the skin and subcutaneous tissues. Most commonly it involves the lower leg although any part of the body may be affected. Untreated, infection can spread and lead to septicaemia. Cellulitis involving the peri-orbital or orbital areas is of particular concern as infection may spread to the sagittal sinuses. The commonest clinical sign initially is a hot, raised, and erythematosus area of skin that is tender to the touch (see fig 7). As the cellulitis develops, the patient may develop systemic signs of infection (raised temperature, sweats, tachycardia, and a feeling of malaise). The usual organisms involved are haemolytic streptococci and staphylococcus aureus.²¹ The history may indicate the portal of entry for the bacteria such as a laceration, abrasion, or recent surgery. The mainstay of treatment is a combination of antibiotic therapy, analgesia, elevation of affected limbs, and treatment of any underlying condition.

Figure 7

 Cellulitis rash. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Antibiotic therapy

The standard antibiotic combination for cellulitis is benzyl penicillin and flucloxacillin (both 500 mg six hourly for adults—see the BNF or MIMS for paediatric dosing). An alternative for those hypersensitive to penicillin is erythromycin 500 mg six hourly. Hospital admission for intravenous antibiotics is recommended for patients with involvement of the (peri)orbital tissues, systemic symptoms, and those unable to tolerate oral treatment.

Analgesia

Cellulitis is often painful. Adequate analgesia should be prescribed and the patient advised on minimising friction pain from clothes touching the affected area.

Elevation

An important aspect of management is to keep the affected limb elevated whenever possible. This helps to reduce tissue swelling and pain. Ideally the affected limb should be kept higher than the heart and gentle exercises promoted to encourage fluid movement and reduce the incidence of complications such as deep vein thrombosis and pressure ulceration.

Treatment of the underlying condition

Any obvious wound that may have acted as a portal of entry should be examined and treated appropriately. Embedded foreign bodies should be removed. Other predisposing factors include diabetes, pre-existing oedema or skin ulceration, and vascular disease. Cellulitis resulting from a human or animal bite can involve multiple organisms. Wounds should be thoroughly cleaned and a wide spectrum antibiotic such as co-amoxiclav prescribed.

Impetigo

Impetigo is a highly contagious bacterial infection of the superficial tissues of the skin. It is spread by direct contact and is common among children. The most commonly implicated organisms are Staphylococcus aureus and group A β haemolytic streptococcus. Although healthy skin can be affected, these bacteria usually enter the skin through a cut, scratch, or abrasion. The nose and peri-oral regions, being susceptible to minor trauma, are the usual sites of presentation. A red sore that oozes fluid or pus usually heralds the start of the infection. As the infection spreads, other lesions appear nearby that may be painful or itchy (see fig 8). The patient does not usually have a temperature but there may be swelling of the lymph glands nearby. Treatment has traditionally been with either topical or oral antibiotics. A recent meta-analysis highlighted the lack of a quality evidence base for the most effective treatment for impetigo.²² The authors concluded that the use of a topical antibiotic (such as mupirocin (Bactroban) or fucidic acid (Fucidin)) for seven days should be recommended in a patient with limited disease and no systemic upset.²² Oral antibiotics are reserved for more severe infections. The agents of choice are cephalexin, co-amoxiclav or erythromycin—all available in suspension form.²³

Figure 8

 Rash resulting from impetigo. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Scarlet fever

This condition is associated with a bacterial infection of the throat caused by group A β haemolytic streptococcus. It usually occurs in children under the age of 18. Symptoms include a sore throat, fever, swollen cervical glands, and a rash that usually lasts two to five days. This initially appears as tiny red bumps on the chest and abdomen before spreading all over the body. It has an appearance like sunburn with a rough feel (see figs 9 and 10). The diagnosis is confirmed by a throat swab, but treatment in the form of antibiotics (penicillin or erythromycin) is usually started on clinical grounds. Left untreated, complications such as nephritis or rheumatic fever can result.

Figure 10

 Scarlet fever rash. Reproduced with permission from Department of Health, Hong Kong.

(2) Viral

A rash is a clinical feature of many viral infections. Most are self limiting and require no specific treatments other than those aimed at reducing the associated symptoms, especially fever and itch. Some of the commoner infections to present (often with a rash) in the community are described in more detail below. Measles and rubella are notifiable diseases in the UK under the Public Health (Infectious Diseases) Regulations 1988; chickenpox is notifiable in Scotland only.

Varicella zoster—chickenpox and shingles

Varicella zoster presents as two clinical entities. Primary infection results in the rash known as chickenpox, a highly contagious illness, usually occurring in childhood outbreaks. The virus then lies dormant in nerve cells but may reactivate to cause herpes zoster, also known as “shingles”. The risk of developing shingles increases with age and reduced immunocompetence (for example, immunosuppressive drugs, HIV infection, cancer).²⁴

Chickenpox (notifiable in Scotland)

In Scotland in 2001 there were 21 894 notifications of chickenpox (428 per 100 000 population, http://www.show.scot.nhs.uk/scieh accessed 28 Jul 2004). The classic symptoms of chickenpox are a rash, fever, and the general feeling of malaise seen with other viral infections. The rash usually appears within two weeks of exposure to the virus, with superficial spots that soon develop into blisters that burst and crust over (see fig 11). It is often intensely itchy and (a diagnostic pointer) spreads above the face and into the hair line. The rash remains a source of infection until all the blisters have crusted over. Chickenpox can spread to any person who has not been previously infected or vaccinated. Although in childhood it is usually a mild illness, it can lead to complications including cellulitis, pneumonia, and encephalitis.

Figure 11

 Rash caused by chickenpox. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Chickenpox can also cause problems in pregnancy—mothers who have no immunity should avoid contact with people with the illness and seek urgent medical advice if contact has taken place. Specific immunoglobulin can be administered to reduce the likelihood of subsequent infection. In the absence of any complications, treatment is symptomatic and should focus on standard drugs for fever reduction, and antihistamines for associated itch. The affected person should be isolated from contact with the general public and family members with no personal history of chickenpox until the rash has completely crusted over.

Shingles

Initially, patients with shingles usually experience a non-specific prodrome similar to that of other viral infections, followed by an area of abnormal skin sensation that may last one to five days before the appearance of the rash. Clusters of vesicles then appear that ultimately may ulcerate before crusting. The rash never crosses the midline and follows the line of one or more dermatomes (see figs 12 and 13). Pain of varying severity is present in virtually all patients. The rash heals in two to four weeks but may leave areas of scarring and changed pigmentation. In the acute phase, treatment entails the administration of appropriate analgesia. Initially this may take the form of paracetamol, with or without codeine (cocodamol). Resistant cases may require the use of adjuvant pain relief such as amitriptyline, gabapentin, or carbamazepine. Antiviral therapy in the form of acyclovir, valcyclovir, or famciclovir should be targeted towards those with the highest risk of complications—the immunocompromised, the elderly population, those with a large surface area involved, and those in severe pain at presentation. Use of these agents also reduces the incidence and severity of post-herpetic neuralgia (PHN)—defined as pain that persists more than 30 days after the onset of the rash.

Figure 12

 Illustration showing shingles of the chest. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Figure 13

 Shingles on the face. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

The incidence of PHN increases with age. Patients with a shingles rash on the forehead, around the eye or the nose have a 50% risk of developing severe eye complications. All such patients should be referred to an eye specialist immediately for assessment.

Measles (notifiable)

Measles is the most frequent cause of vaccine preventable deaths in childhood.²⁵ It is primarily a viral respiratory tract infection, which can have serious or even fatal consequences for infants and small children. In 2003, there were 2488 cases notified to the Health Protection Agency.¹⁸ Protection is currently offered through the MMR vaccination. Unfortunately, since a link between this vaccine and the development of autism was suggested in 1998,²⁶ reduced public confidence has resulted in a decreased uptake in vaccination, heralding the possibility of a major measles outbreak. While subsequent studies have conclusively shown no association and some of the authors of the original study have also conceded that MMR has no causal role,²⁷ vaccine uptake remains as low as 61% in the UK.

Measles usually begins with a fever, a persistent cough, runny nose, and sore throat. Two or three days later, the characteristic Koplik’s spots appear. These are tiny red spots on the inner mucosal lining of the cheek. Subsequently, the fever increases and a more generalised red blotchy rash develops on the face, along the hairline, and behind the ears. This slightly itchy rash rapidly spreads downward to the chest and back and, finally, to the thighs and feet (see fig 14). The rash tends to fade within seven days with the illness itself lasting 10–14 days. Measles is infectious from about four days before to four days after the rash appears. Complications include ear infections, pneumonia, encephalitis, and diarrhoea/vomiting. Non-immune pregnant women should seek specialist advice. Treatment is again largely symptomatic, and entails isolating the patient from the general public and susceptible family members.

Figure 14

 Measles rash. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Rubella—German measles (notifiable)

Although caused by a different virus, rubella shares some characteristics with measles (hence its synonym—“germanus” being Latin for similar). Rubella is neither as contagious nor as serious as measles, except that it can have serious consequences for the unborn child of an unprotected mother. Protection is again provided by the MMR vaccine, which has dramatically reduced the incidence of the condition. General symptoms, although milder, tend to be similar to measles but rarely last longer than three days. A fine, pink rash usually begins on the face and quickly spreads to the trunk and then the arms and legs before disappearing (see fig 15). Aching joints may occur, as may tender enlargement of the cervical lymph nodes. Rubella very rarely causes complications outwith pregnancy, where infection in the first trimester can lead to congenital abnormalities developing in up to 90% of cases. Symptomatic treatment and isolation are the only usual requirements for rubella.

Figure 15

 Rubella rash. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

Non-specific viral rashes

Virtually any viral infection can result in the development of a rash, usually on the face, chest, or back. The rash is usually very fine, red in colour, and blanches on pressure. It usually appears several days into the illness, often around the time the fever and other symptoms are improving. It may itch slightly but should not be painful. Care should be taken to exclude more serious causes of rashes (as outlined above). The person affected may have symptoms such as a sore throat, runny nose, cough, or lethargy but has no symptoms of concern. The rash itself is not infectious and symptomatic treatment only is required.

(3) Other conditions

Henoch Schonlein purpura (HSP)

Like ITP, the importance of this condition is that it while it presents with a purpuric rash, it is not an acute life threatening condition. HSP classically affects children aged 3 to 8 years and is more common in boys. It often presents with a purpuric rash over the extensor surfaces of the buttocks and legs. Other common features are haematuria, proteinuria, and joint pains. The condition is largely self limiting although a small percentage of those affected may develop renal problems.

Eczema and psoriasis

Eczema and psoriasis are both chronic skin conditions that usually present in childhood and require treatment (albeit often intermittently) for life. This is usually started by the patient’s GP, occasionally with input from a dermatologist. While both conditions can commonly adversely affect a patient’s quality of life, they rarely lead to serious complications that might present to an out of hours practitioner with two notable exceptions:

Infection

Either condition may become infected, usually as a result of the patient scratching at itchy lesions. This then requires the use of either a topical or oral antibiotic in addition to any ongoing treatment. Appropriate therapy should be initiated as described earlier (see cellulitis).

Pustular psoriasis

Acute generalised pustular psoriasis is a rare but potentially life threatening complication of psoriasis, usually requiring inpatient hospital treatment. As its name suggests, it presents in a patient with known psoriasis as widespread small pustules with areas of erythema, usually affecting the soles of the hands and/or feet (see fig 16). The pustules may coalesce to form large patches of pus. The condition may be precipitated by infection, pregnancy, or the withdrawal of corticosteroid therapy. If suspected, consultation with a dermatologist or medical registrar on call is advised.

Figure 16

 Pustular psoriasis affecting sole of the foot. Reproduced with permission from Dermatology Online Atlas (http://www.dermis.net).

OTHER CAUSES OF ISOLATED ITCHING

Itching in isolation may be the presenting feature of a wide range of other clinical conditions (table 7). All can be managed in the out hours setting by the use of basic symptomatic measures and the patient should be advised to seek medical assessment thereafter.

Table 7

 Causes of isolated itching

Basic symptomatic measures for the relief of itching

Itching in isolation is often associated with dry skin, so a moisturiser should be applied. The skin should be kept cool and the patient advised to avoid alcohol and spicy foods. Shower and bath water should be kept tepid to avoid further irritation.

No universally effective drug or cream exists for the relief of itching. Antihistamine preparations in particular are only effective for itching caused by the release of histamine (for example, insect bites). Creams containing a 1%–2% mixture of menthol or phenol with aqueous cream can be applied topically several times a day for symptomatic relief of itching.¹

FORMULATING A SAFE AND EFFECTIVE MANAGEMENT PLAN

Assess the patient’s symptoms and signs to decide whether your patient needs emergency admission, semi-urgent admission, or whether they can be safely treated at home:

Admit and treat immediately as an emergency (features of concern)

Signs

• Signs of airway obstruction

• Respiratory rate<10 or >29

• Oxygen saturation<92% on air

• Pulse rate<50 or >120

• Systolic BP<90

• Glasgow coma score<12

Symptoms

• Suspected rash of meningococcal septicaemia

• Definite exposure to a trigger that has previously lead to an anaphylactic reaction

• Self administration of adrenaline by a patient for a suspected anaphylactic reaction

• A suspected anaphylactic reaction that has not fully developed

Admit as a semi-urgent case to hospital for further assessment and treatment

• Suspected cellulitis

  • – Affecting the eyes or tissues around the eyes

  • – Patient is “unwell’ (that is, raised temperature, rigors, vomiting)

  • – Patient unable to take oral antibiotics

  • – No discernable clinical response to 24 hours of appropriate oral antibiotics

  • – Other features of concern —for example, considerable pain or swelling, adverse social circumstances (lives alone, family unable to cope, etc)

Advisable to seek further advice from hospital

Can be treated at home, assuming no features of concern (as above)

• Local allergic reactions

• Urticaria/angioedema

• Bacterial infections—mild cellulitis, impetigo, scarlet fever

• Viral infections – chickenpox*^‡, shingles^*, measles^*†‡, rubella^*†‡, non-specific viral rashes

  • – *Requires isolation to avoid spread (see text)

  • – ^† Notifiable disease in England and Wales (see text)

  • – ^‡ Notifiable disease in Scotland (see text)

Pitfall

Although this list aims to guide appropriate management, it is not foolproof. If in doubt, seek further medical advice.

REFERENCES

1. ↵

   Twycross R , Greaves MW, Handwerker H, et al. Itch: scratching more than the surface. QJM2003;96:17–26.

2. ↵

   Woodward CM, Jessop EG, Wale MC. Early management of meningococcal disease. Commun Dis Rep CDR Rev1995;5:R135–7.

3. ↵

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What Your Rash Means and When You…

Nobody wants a rash. They’re unsightly and can be irritating, but they can also be a sign of something deeper and scarier going on. Determining the cause of your rash is the quickest way to decide whether or not you need to see a doctor.

Rashes of All Kinds

A rash is often a sign that your skin came into contact with an allergen or other skin irritant. A rash is a visible notice that our skin or in some cases our entire body is reacting to negative stimulus. A lot of rashes come and go, but even a small, hardly noticeable rash can be a cause for concern. A rash can appear in a few different ways, but it’s usually characterized by redness, raised skin, and is often warm to the touch. Irritation like itching and burning are frequently associated with rashes. Most rashes are referred to as a type of dermatitis, but that is not always the case.

Dermatitis Explained

Dermatitis or eczema is the most common source of rashes. Dermatitis refers to the actual itchy, red, swollen rashes that may be accompanied by dry skin, burning and stinging, and other lesions or hives. Eczema is the name for the chronic condition of recurring dermatitis, with or without explanation. There are a few different types of dermatitis with the most common being contact dermatitis. Contact dermatitis is often caused by allergens like poison ivy or household chemicals, including bleach.

Other Rashes and Concerns

As we’ve discussed, there are countless ways a person can develop a rash. Here are a few of the most common reasons to consider.

Lyme Disease

A growing cause of concern for people throughout the Northeastern United States, this deer tick-borne illness can cause chronic health conditions if not detected and treated early. Deer ticks are small and their bites are often painless. Usually, the very first indication of lyme disease is its rash. While many people know to look for a bull’s-eye rash, this stage doesn’t last long. A bull’s-eye rash is a round rash with red or pink borders, with a ring of skin that is its normal color and then an even redder, round patch at the center. It may cause itching, burning or pain like other rashes, but Lyme disease requires immediate treatment. Its effects can be chronic and cause things conditions like arthritis and neurological issues like memory loss and dementia. Early treatment for Lyme disease is critical, so if you suspect a rash may be Lyme disease, see a doctor immediately.

Shingles or Herpes Zoster

Shingles is a form of the herpes zoster virus that affects skin. It is often experienced by older people, but anyone who has had chickenpox can develop shingles later on. Shingles episodes are often painful clusters of rashes that quickly become blisters. These cause extreme discomfort and are contagious. Treating the symptoms of shingles early can greatly reduce the hardship it has the potential to cause. People with shingles are sometimes unable to go about their lives for weeks with the virus.

Unexplained Rashes

Not every rash has a rational explanation as simple as a tick bite or contact with an allergen. Sometimes rashes are representative of a health problem far below the skin’s surface.

If you have any of the rash symptoms discussed, and listed below, you should see a doctor. If your rash is spread out over much of your body, treatment is recommended. If a fever accompanies your rash, or it’s painful(either to the touch or with movement, seek medical help. If your rash is sudden and spreads, it can be a cause for concern. Sudden, spreading rashes can indicate an allergic reaction which, if accompanied by difficulty breathing, are extremely dangerous. If your rash blisters or develops open sores, or shows signs of infection, it’s important to get treatment as soon as possible.

In short, see a doctor if you have a rash. There are always going to be symptoms you can explain away or ignore if they’re mild, but it’s important to consider your health. Even if a rash comes and goes, it doesn’t mean it won’t come back or that it doesn’t represents something internal happening. While oftentimes rashes resolve with little necessary attention, it’s well worth it to err on the side of caution.

If you’ve developed a rash, no matter how trivial it may appear, get someone to take a look at it. Call Northeast Dermatology Associates for professional care and the peace of mind it can bring.

Identifying and Treating Your Rash

What Exactly Is A Rash?

A rash is an area of irritated or swollen skin. Not exactly specific, is it? Well, that’s because rashes can be caused by so many things: allergens, chemicals, drugs, viruses, temperature—even stress.

Rashes can also be indicative of more serious skin ailments, like eczema or ringworm.

Looking for the signs will be important. Let’s get started.

Wait…What’s Eczema Then?

Eczema is Dermatitis.

Eczema is just the nonspecific name of the group of diseases that result in inflammation of the skin. 

The red, bumpy skin we associate as a rash is a symptom of eczema—of which there are many types. Atopic dermatitis is the most common, long-lasting and tends to flare periodically. It may be accompanied by asthma or hay fever.

Just remember, eczema is the itch that becomes a rash.

Contact Dermatitis

Like the name implies, this often itchy condition can be caused by contact with a substance.

There are two types:

1. Irritant Dermatitis

This is the most common type of rash. Irritants include:

• Soaps, shampoos, and detergents (can be acidic/alkaline)

• Fabric softeners

• Chemicals like hair dye and pesticides

• Rubber gloves

• Cement

• Wet diapers (Long-term Exposure)

2. Allergic Dermatitis

Produced by allergy-causing substances like:

• Adhesives (used for false eyelashes or toupees)

• Antibiotics

• Balsam of Peru

• Fabrics and certain clothing

• Fragrances (in perfumes, cosmetics, soap, moisturizers)

• Hair dye

• Nail polish

• Perm chemicals

• Metals like nickel – found in jewelry, watches, zippers, bra hooks, buttons, lipstick and makeup containers

• Plants like poison ivy, poison oak, poison sumac

• Rubber/Latex gloves

• When exposed to sunlight, certain shaving lotions or sunscreens, sulfa ointments, some perfumes, coal tar or lime oil.

Dermatitis Symptoms

• Itchy bumps on skin

• Red skin rash

• Blisters that may weep

• Tenderness

• Oozing, draining, or crusting

• Scaly, raw, rough or thicker skin

Exam and Treatment

Depending on the severity of your rash, you may want to consider getting it examined by a medical professional. Urgent care centers, like GoHealth, are ideal for fast diagnosis and treatment.

Examination

If your rashes are recurring and are severe, consider a patch test.

A provider will apply small patches of allergens to your skin to test for reactions. Results are observed 48 hours after the exposure. A second observation another 48 hours is also recommended to check for delayed reactions.

More serious conditions may warrant a skin biopsy.

Treatment

In many cases, the best treatment is to leave the rash alone.

Your rash will likely clear up without complications in 2-3 weeks as long as you are not re-exposed to the allergen.

• After exposure, wash the area with water to remove all traces of the irritant/allergen
• Applying moisturizers will help the skin moisten and speed the healing process.
• Your provider may prescribe creams or ointments to help. Corticosteroid pills are reserved for only the most severe cases.

Contact your healthcare provider if treatment does not help, the symptoms worsen, or signs of infection such as fever, drainage or swelling occur.

Is Heat Rash Eczema?

No. Heat rash is not dermatitis but rather a temperature sensitive condition called miliaria. (Confusing, right?)

The small, red “heat rashes” typically found on the neck, groin, armpits and underneath the breasts are actually confined elevations of the skin, called papules. Nevertheless, they are skin rashes that can itch.

Miliaria is caused by blocks in your sweat glands, forcing sweat to leak deeper into the skin and provoke an inflammatory response—hence the redness.

This is why miliaria occurs more often in hot, dry climates and in children. Treating it is as easy as wearing lighter clothing to better regulate one’s temperature or applying calamine lotion.

What About Stress Rashes?

Stress can indeed cause rashes and hives.

When you are stressed, your body produces above-normal levels of cortisol and adrenaline. These hormones can affect how your skin reacts, making it more sensitive and susceptible to skin ailments.

You may have noticed your skin “breaking out” in times of high stress. Rashes and hives are just another type of reaction. Though, for unknown reasons, it is not clear why stress exacerbates chronic skin conditions like eczema, psoriasis, and rosacea.

Wait…Psoriasis? Rosacea?

These are just types of skin ailments that are related to rashes.

Psoriasis is an autoimmune disease of the skin that forms thick, red, bumpy rashes with silvery scales. Your immune system actually is the source of the inflammation that causes psoriasis and its characteristic overproduction of skin cells.

Rosacea is a condition characterized by facial redness. When triggered, blood vessels near the surface of the skin expands. It is often a non-itchy rash.

Can Hay Fever Cause A Rash?

Yes.

Similar to allergic dermatitis, hay fever rashes are caused when allergens come in contact with your skin. Careful not to confuse them with hives, which are allergic reactions caused by ingestion or inhalation of allergens.

How About A Cold Climate?

Also yes. This is known as winter skin rash.

The cold air and low humidity of winter can strip your skin of it’s moisturizing oils, leading to dry skin, irritation, and rash. Using a moisturizing lotion would be the first action toward treatment.

What else might it be?

Amongst all the common things that might happen to your skin, there are still conditions not well studied or have such rare cases that knowing they even exist as different ailments can be hard for today’s dermatologists.

Pityriasis rosea – the cause is not well understood, but it may be triggered by a viral infection. 

The condition causes an slightly itchy, flaky, skin rash and usually goes away on its own. 

Steroid creams and antihistamines can help minimalize discomfort.

Lichen planus – it is an inflammatory condition of the skin and mucous membranes.

It appears as purplish, itchy, flat-topped bumps. On mucous membranes, such as in the mouth, it forms flaky, white patches. Sometimes, painful sores resembling cold sores also appear around the mouth.

Lichen planus usually goes away on its own. If symptoms are bothersome, and topical creams and oral antihistamines can be helpful.

Kawasakis Disease – ia a condition that causes inflammation in the walls of the blood vessels.

Early stages include a rash and fever. In later stages, there may be inflammation  of the blood vessels (called vasculitis). It also affects lymph nodes, skin, and mucous membranes, such as inside the mouth.

Kawasaki disease is usually treatable. Initial treatments include aspirin and IV immunoglobulin therapy.

Shingles – is a reactivation of the chickenpox virus in the body, causing a painful rash.

Anyone who’s had chickenpox may develop shingles; it isn’t known what reactivates the virus.

Shingles causes a painful rash that may appear as blisters around the trunk of the body. Pain can persist even after the rash is gone (this is called postherpetic neuralgia).

Treatments include pain relief and antiviral medications such as acyclovir or valacyclovir.

A chickenpox vaccine in childhood or a shingles vaccine as an adult can minimize the risk of developing shingles.

Seborrheic dermatitis – is a skin condition that causes scaly patches and red skin, mainly on the scalp. It can also occur on oily areas of the body, such as the face, upper chest, and back.

In addition to red, scaly patches, seborrheic dermatitis can cause dandruff due to the scalp being the infected region.

Treatment involves self-care and medicated shampoos, creams, and lotions. 

In Summary…

Rashes may seem like simple blemishes but the causes under the skin can be extremely complex. If you get a rash that doesn’t seem to go away, consider seeing a healthcare provider at an urgent care center. Rashes are the perfect example of an ailment that can be quickly diagnosed, letting you know right away if it’s serious or not.

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Urgent Care for Rashes and Burns | Urgent Care Ocala | Covid 19 Testing Ocala

There are numerous reasons an individual may have developed a rash or suffered a burn, and as such, it can often be difficult to diagnose the exact cause of a rash or determine the level of severity of a burn.

However, it is important to be able to accurately determine both the severity of the rash or burn, as well as the exact cause in order to determine the best method of treatment. Subsequently, medical assistance is often required to effectively and efficiently treat rashes and burns. Here at our urgent care facility, we have a quality staff and all the necessary resources to help diagnose the severity of your rash or burn and help you on your path toward a full recovery.

While prevention is the best way to deal with a rash or burn, it is not always possible to avoid, which is why understanding the severity of the rash or burn and seeking urgent care when it is needed is crucial.

If you or your child are suffering from a rash or a burn, be sure to come in for a visit and allow us to determine the exact cause, as well as the level of severity, give you a treatment plan to eliminate the rash or burn and help prevent another rash or burn from developing in the future.

Facts From The World Health Organization

• Infections that cause rashes may be fungal, bacterial, parasitic or viral.
• Rashes that last more than a few days should be evaluated by a medical professional.
• Over-the-counter products may help with certain skin rashes.
• Common rashes include eczema, poison ivy and athlete’s foot.
• An estimated 180,000 deaths occur each year as a result of a severe burn.
• Burns occur mainly either at home or in the workplace.
• Burns are preventable by instilling the right precautionary measures into homes and workplaces.
• Burns are the fifth most common cause of non-fatal childhood injuries.

Questions to Ask

• What is causing my skin rash? Is it caused by an allergy?
• Can I use over-the-counter products to treat my rash, or do I need to only use prescription solutions?
• What treatment options are available for my rash?
• Should I see a skin specialist about my rashes?
• What things should I avoid to ensure the rash does not come back after treatment?
• Is there any way to make my rash feel better during treatment?
• What degree of burn did I suffer? How serious is the burn?
• How did you determine the degree of burn? What diagnostic procedures did you use?
• How long will it take for my rash or burn to go away/heal?
• If my burn does not start to feel better, how long should I wait before returning for medical assistance?
• What can I do around the house to make sure I do not get burned in the future?
• Is there a way to relieve the pain for my burn? Is it okay to take pain relief medication?

Causes of Rashes and Burns

One of the most difficult parts about treating a rash or a burn is determining which of the many different types of rashes or burns it actually is. With rashes, there are various different types, including a general rash, heat rash, blisters and hives. It is important to be able to determine the type of rash, as the treatment differs accordingly.

There are also multiple different types, or degrees, of burns as well, which are first degree burns, second degree burns and third degree burns. A first degree burn is the least severe and only damages the epidermis, which is the outermost layer of skin. The second degree burn reaches the dermis, which is the second layer, and is more painful. A third degree burn is the deepest and often reaches the deeper tissues, which can cause nerve damage and other long-term issues.

There are numerous different causes of rashes, and the only way to truly pinpoint the exact cause is to examine your lifestyle and look for areas that may lead to a rash, which can include exposure to poison ivy or sumac, chemical exposure or a bacterial infection. In some instances, individuals, especially toddlers, can develop what is known as a heat rash if exposed for too long to hot weather.

It is accurately assumed by most that the main cause of a burn is fire or skin exposure to a hot object. While this is true and burns most often occur due to fire or heated objects touching the skin, burns can also occur due to chemical exposure, electricity or even exposure to the sun. In order to successfully prevent burns, it is important to take precautionary measures for all burn types.

Symptoms and Treatment Options for Rashes

The symptoms of a rash differ depending on the type of rash that has been developed. The most common symptoms that apply to most rash types include:

• Redness of the skin
• Constant itching
• Burning sensation
• Red bumps
• Raised area of the skin

While it is quite obvious when a rash develops, understanding what the symptoms mean can help find the root cause of the rash, which ultimately allows you the ability to treat the underlying cause and prevent further rashes from developing.

For a more general rash, there is likely to only be redness of the skin and constant itching or possibly a burning sensation. For heat rashes and hives, there is likely to be more red bumps and a raised area of the skin. If red bumps start to show themselves, be sure not to pick at them and try and keep the skin clean and dry until treatment can be administered.

In most cases, mild to moderate rashes can be treated at home as long as the cause can be identified. The best way to treat a rash is to find out the underlying cause — which in many cases, is due to an allergy, heat exposure or poison ivy exposure — and treat it. If you catch a rash due to poison ivy in the early stages, you can thoroughly wash the affected area in an effort to prevent the rash from getting worse. However, after a rash develops, it is best to leave it alone until proper medical treatment can be administered.

At our urgent care facility, we have the staff and resources to quickly and accurately diagnose all different types of rashes and help you on your way to a full recovery. While prevention is the best method of dealing with rashes, they sometimes occur regardless, and it is important to know what to do if a rash develops.

Symptoms and Treatment Options for Burns

Much like rashes, the symptoms of a burn depend largely on the type of burn that occurs. However, the most common symptoms are:

• Pain
• Red skin
• Peeling skin
• Itching
• Swelling

While most burns are painful, it is important to remember that the pain level is in no way indicative to how serious the burn is. In fact, there is often no pain felt at all due to the nerve damage or adrenaline rush involved in the most serious or largest burns. Since the level of severity is such a wide range, there are different treatment procedures depending on how serious the burn is. For less serious burns, such as first degree burns and the majority of second degree burns, holding the affected area under cold water for 10 minutes, applying aloe vera lotion to the affected area and then covering the wound with a bandage is the best form of treatment. Make sure to keep the bandage dry and change it frequently, inspecting the burn for any changes.

For more severe burns, such as third degree burns and some of the more severe second degree burns, it is best to seek medical assistance at either an urgent care facility or an emergency room (see below). After a serious burn occurs, however, there are certain safety measures that should be taken to keep the affected area from becoming infected or inflicting more pain than necessary, such as elevating the burn area and removing any material that may be on or around the affected area.

Here at our urgent care facility, we can treat most burns, regardless of the level of severity, and help you on your road to recovery after the initial symptoms are treated for and the pain is brought down to a tolerable level.

When to Seek Urgent Care for a Rash or Burn

For most minor rashes or burns, the symptoms can be kept at a tolerable level and a full recovery can be had by utilizing simple home remedies and doctor-recommended over-the-counter products. However, it is important to seek urgent care for a rash or burn if any of the following are true:

• There are signs that developing an infection is a possibility.
• The burn is deep or causes a severe level of pain.
• The cause of the rash is unknown or exists on a young child.

First and foremost, the number-one reason it is crucial to treat a rash or burn promptly is to prevent an infection from developing as a result of the rash or burn. Our skin is the first line of defense from harmful bacteria and viruses. Therefore, when the skin is harmed or in danger, we are at a greater risk of developing an infection. If a burn opens up the skin in such a way where it requires medical assistance to properly bandage or a rash results from a bacterial infection, be sure to visit our urgent care facility so we can properly prevent future infections from developing.

Additionally, any burn that reaches the deeper layers of the skin or leads to an intolerable level of pain should be treated by a medical professional. As long as the burn is not life threatening, we can treat it here at our urgent care facility. However, a burn that is life threatening can be more properly treated at an emergency room inside a hospital.

Lastly, be sure to come in for a visit any time the cause of a rash cannot be explained. If a rash starts to develop on a toddler or young child, it is also highly encouraged to let us treat it here at our urgent care facility to ensure that it does not spread.

Consult With Us

In order to ensure you or your child’s rash and burn receives the proper care for you to make a full, speedy recovery, be sure to come into our urgent care facility for an accurate diagnosis and quality treatment.

While minor rashes or burns can be treated at home with little to no medical assistance, rashes or burns that show concerning symptoms or last for an extended amount of time need to be examined and treated by a medical professional to avoid the skin irritation from worsening.

At our urgent care facility, we are well equipped with a top-notch staff and all the resources necessary to help you understand the root cause of the rash or degree of burn, which ultimately allows us to help you treat the rash or burn. With the proper treatment, you can ensure your rash or burn does not hinder your ability to live your life.

If you have developed a rash or suffered a burn and do not know what to do next, come and visit us (no appointment needed) or give us a call and let us help you on your path to recovery.

FAQs

Q. Why is it so crucial to seek treatment for rashes and burns? What role does the skin play in preventing an infection?

A. The skin is the largest organ in the body, and it serves to protect our bodies from infection and injury. Our skin also works to regulate our body temperature and contains nerves that sense heat, pain, pressure and touch. When our skin becomes damaged by either a skin condition or a burn, it can leave us increasingly vulnerable to infection, as the line of defense is damaged, especially with deeper second degree burns and third degree burns. Due to this, it is important to seek medical assistance for moderate to severe burns and rashes.

Q. What are the different degrees of burns? What do they mean?

A. There are three different burn types: a first degree burn, second degree burn and a third degree burn. A first degree burn refers to a burn that only damages the epidermis, which is the outermost layer of our skin. A second degree burn typically causes damage to the dermis, which is the layer directly underneath the epidermis. A third degree burn refers to a more serious burn type that burns through both the epidermis and the dermis, and then may even cause damage to our nerves and tissue.

Q. How can I treat my child’s sunburn?

A. Although many think of burn by exposure to a hot object or substance, sunburn is also a form of burn that should be treated with urgency if it causes more severe symptoms, such as a fever. The best way to treat sunburn is to try and keep the body cool. The way to keep the body cool is to apply a cold compress (a cold, damp washcloth usually works) and a cooling substance (aloe vera, for example) to the affected area. Additionally, anti-inflammatory medications such as ibuprofen can help reduce the swelling caused by sunburn.

Q. Are there certain activities or professions that are at a higher risk of developing a rash than others?

A. There are certain professions and activity that pose a greater risk to developing contact dermatitis. Any profession that requires you to be in close proximity to harmful chemicals, plants or substances you are allergic to pose a greater risk of developing a rash. Additionally, medical professionals such as doctors, nurses and caregivers should be extra cautious around patients who have a rash, as they are contagious. On the same note, anyone who works directly with people may be at an increased risk of developing a rash and should consider taking extra caution.

Q. My rash really itches. Is it okay to scratch it?

A. The short answer is no. It is never a good idea to scratch an itch caused by a rash, as it can spread the rash and cause more pain for a longer period of time. Instead, it is best to try and take measures to minimize the itch, such as applying topical anti-itch solutions and keeping the affected area from drying out. Additionally, be sure to avoid hot water by taking colder showers than normal.

Q. My child developed a rash that will not go away. What could have caused the rash in my child?

A. Children often get rashes more than adults. A large part of this can be attributed to the fact that they are generally far more adventurous and curious about unknown substances. Subsequently, do your best to keep your child away from areas that may contain poison. Most importantly, try educating them about poison ivy, so they can make the right choice when confronted with the hazardous substance while out playing. Lastly, be sure you know how to tell the difference between a general rash and a rash that is caused by more serious conditions, such as chickenpox. When in doubt, be sure to come in for a visit and allow us to help your child recover.

Definitions

Degrees of burns There are three different types of burns: first degree, second degree and third degree. A first degree burn only burns the top layer of skin, whereas a third degree burn can go much deeper and even reach nerves and tissue.

Contact dermatitis This term is used to describe a rash that develops as a result of contact with a particular substance. The substance can either be the main cause of the rash or trigger an allergic reaction.

Eczema An itchy skin condition that often causes inflammation. Eczema, also known as atopic dermatitis, most commonly affects toddlers, and it typically appears as a rash on the arm(s).

Poison ivy One of the main causes of contact dermatitis. Poison ivy, which is found in nature, is a plant that generally causes a severe itch and can even be painful in more severe cases.

Skin condition A term used to describe various types of rashes, burns and other issues affecting the skin. A skin condition can be diagnosed here at our urgent care facility.

Dermis/epidermis The top and second layer of skin, which is generally damaged by most rashes and burns. Our dermis and epidermis serve as the body’s first line of defense from infection.

Vesicle A sac found on skin that is either filled with fluid or air. A vesicle occurs on top of a rash. Most commonly, vesicles exist as a result of a heat rash.

Partial-thickness burn A partial thickness burn is also known as a second degree burn, and it is more serious than a superficial burn, as it causes damage to layers of skin deeper than the first.

Superficial burn A superficial burn is a common term used to describe a first degree burn. A superficial burn is usually not serious and only damages the top layer of skin.

Full-thickness burn A full thickness burn, or third degree burn, is one of the most serious burn types and can cause nerve damage if the burn reaches deep enough into the skin.

Skin Conditions: J – Z

Also known as neurodermatitis or scratch dermatitis, this condition is caused by a chronic cycle of scratching and itching an area of skin that becomes rough or leathery. While it is not dangerous, Lichen Simplex Chronicus can be a difficult cycle to break because of the severity of the itchiness. It can occur anywhere on the skin, but is most commonly found on the ankles, neck, wrist, forearms, thighs, lower leg, behind the knee, or on the inner elbow. It may also be associated with other skin conditions, such as dry skin, eczema, or psoriasis.

Lichen Simplex Chronicus occurs more frequently among women than men and generally appears in people between the ages of 30 and 50. If you are unable to break a scratch and itch cycle somewhere on your skin or if the skin becomes painful, contact your dermatologist. Persistent scratching can lead to bacterial infection. The doctor may prescribe oral corticosteroids and antihistamines to reduce the inflammation and relieve the itching. In some cases, antidepressant or anti-anxiety medications provide relief to sufferers. If scratching does lead to an infection, your dermatologist will likely prescribe an oral or topical antibiotic.

Some patients gain relief from the itching by applying a moisturizing lotion and covering the area with a wet dressing. Moisture helps the skin absorb the lotion. Peeling ointments containing salycylic acid may also be recommended to soften rough skin.

Lyme Disease

Lyme disease is a bacterial illness and inflammatory disease that spreads through tick bites. Deer ticks house the spirochete bacterium (Borellia burgdorferi) in their stomachs. When one of these ticks bites the human skin, it may pass the bacteria into the body. These ticks tend to be attracted to creases in the body, so Lyme disease most often appears in armpits, the nape of the neck, or the back of knees. It can cause abnormalities in the skin, heart, joints, and nervous system.

Lyme disease was first identified in 1975 in Old Lyme, Connecticut. More than 150,000 cases have been reported to the Centers for Disease Control since 1982. Cases have been reported from every state, although it is more commonly seen in the Northeast, Upper Midwest, and Pacific Coast. Lyme disease has also been reported in European and Asian countries.

There are three phases to the disease:

Early Localized Phase: During this initial phase, the skin around the bite develops an expanding ring of redness. The ring may have a bull’s eye appearance with a bright red outer ring surrounding clear skin in the center. Most people don’t remember being bitten by a tick. More than one in four patients never gets a rash. The skin redness may be accompanied by fatigue, chills, muscle and joint stiffness, swollen lymph nodes, and/or headaches.

Early Disseminated Phase: Weeks to months after the rash disappears, the bacteria spread throughout the body, impacting the joints, heart, and nervous system. Symptoms include migrating pain in the joints, neck ache, tingling, or numbing of the extremities, enlarged lymph glands, sore throat, abnormal pulse, fever, changes in vision, or fatigue.

Late Dissemination Phase: Late in the dissemination of the disease, patients may experience an inflammation of the heart, which can lead to heart failure. Nervous system issues develop, such as paralysis of facial muscles (Bell’s Palsy) and diseases of the peripheral nerves (peripheral neuropathy). It is also common for arthritis and inflammation of the joints to appear, which cause swelling, stiffness, and pain.

Lyme disease is diagnosed through a combination of a visual examination and a blood test for Lyme bacteria antibodies. Most cases of Lyme disease are curable using antibiotics, but the longer the delay, the more difficult it is to treat. Your dermatologist may prescribe medications to help alleviate joint stiffening.

The best form of prevention is to avoid tick bites. Use insect repellent containing DEET. Wear long sleeves and pants when outdoors. Tuck the sleeves into gloves and pants into socks to keep your skin covered. After a hike, check the skin and look for any tick bites, especially on children. If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts, as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination.

Poison Ivy, Poison Oak and Poison Sumac

Poison ivy, poison oak, and poison sumac are plants that produce an oil (urushiol) that causes an allergic reaction among humans. The inflammation is a reaction to contact with any part of the plant, which leads to burning, itching, redness, and blisters. The inflammation is a form of contact dermatitis, an allergic reaction to an allergen that comes into direct contact with the skin. It is not contagious. Poison ivy is more prevalent in the eastern part of the country; poison oak is more prevalent in the southeastern part of the country.

Poison ivy is characterized by red, itchy bumps and blisters that appear in the area that came into contact with the plant. The rash begins one to two days after exposure. The rash first appears in curved lines and will clear up on its own in 14 to 21 days.

Treatment for poison ivy, poison oak, and poison sumac is designed to relieve the itching and may include oral antihistamines and cortisone creams (either over-the-counter or prescription). These treatments need to be applied before blisters appear or after the blisters have dried up to be effective. In severe cases, oral steroids, such as prednisone, may be prescribed.

The best form of prevention is to recognize and avoid contact with the plants. This can be difficult because these plants tend to grow around other vegetation. These three poisonous plants can be distinguished by their classic three-leaf formation. To avoid contact with these plants, wear long sleeves and pants when hiking outdoors and keep to the trails. Tuck the ends of your sleeves into gloves and the bottom of your pants into socks so that no area of skin on your arms or legs is exposed. If you think you have come into contact with a poison plant, wash the area of skin with cool water as quickly as possible to help limit the reaction. Also, wash the clothing you were wearing immediately after exposure.

Pruritus

Pruritus refers to the sensation of itching on the skin. It can be caused by a wide range of skin conditions, including dry skin, infection, fungus, other skin diseases, and in rare cases, cancer. While anyone can experience pruritus, it is more commonly seen among the elderly, diabetics, people with suppressed immune systems, and those with seasonal allergies, like hay fever or eczema. Additionally, there is a type of pruritus, called PUPPP (Pruritic Uticarial Papules & Plaques of Pregnancy) that affects pregnant women.

Treatment for pruritus depends on identifying the underlying cause. Your dermatologist will examine the itchy area and may make a small scrape on any rash to collect tissue for diagnostic testing. Typical treatment involves topical and/or oral steroids and antihistamines to help relieve the itch. To avoid pruritus, make sure to follow healthy skin care procedures.

Rashes

“Rash” is a general term for a wide variety of skin conditions. A rash refers to a change that affects the skin and usually appears as a red patch or small bumps or blisters on the skin. The majority of rashes are harmless and can be treated effectively with over-the-counter anti-itch creams, antihistamines and moisturizing lotions.

Rashes can be a symptom for other skin problems. The most prevalent of these are:

• Atopic Dermatitis, the most common form of eczema.
• Bacterial Infections, such as impetigo.
• Contact Dermatitis, a type of eczema caused by coming into contact with an allergen.
• Chronic skin problems, such as acne, psoriasis, or seborrheic dermatitis.
• Fungal Infections, such as ringworm and yeast infection.
• Viral Infections, such as shingles.

A rash may be a sign of a more serious illness, such as Lyme Disease, Rocky Mountain Spotted Fever, liver disease, kidney disease, or some types of cancers. If you experience a rash that does not go away on its own after a few weeks, make an appointment to see one of our dermatologists to have it properly diagnosed and treated.

Ringworm (Tinea Corporis)

Ringworm is a common fungal infection, especially among children, that appears on different parts of the body. It is characterized by ring-shaped, scaly, and itchy patches of the skin. The patches may blister or ooze fluid. Ringworm is contagious and can be passed from person to person or through contact with contaminated personal care products, clothing, or linens. Pets, particularly cats, can also pass on the infection.

The fungi are attracted to warm, moist environments, which is why the most common forms of ringworm include:

• Tinea Barbae: Occurs on bearded areas of the face and neck.
• Tinea Capitis: Occurs on the scalp.
• Tinea Cruris: Also known as Jock Itch, occurs in the groin area.
• Tinea Pedis: Also known as Athlete’s Foot, occurs between the toes.

Ringworm generally responds well to home remedies and will disappear in about four weeks. In addition to keeping the area clean and dry, you can apply over-the-counter antifungal powders, lotions, or creams. In more severe cases, your dermatologist may recommend prescription antifungal medications and antibiotics.

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever is a bacterial infection transmitted by ticks. It is relatively rare, but can cause serious damage to the heart, lungs, and brain. The difficulty lies in diagnosis because many people are unaware that they have been bitten by a tick. Three types of ticks transmit the Rickettsia rickettsii bacteria:

• Dog ticks, usually in the Eastern part of the country.
• Wood ticks, usually in the Rocky Mountain states.
• Lone star ticks, usually on the West coast.

Rocky Mountain Spotted Fever is characterized by a rash that begins as small red spots or blotches on the wrists, ankles, palms, or soles of the feet. It spreads up the arms and legs to the trunk of the body. These symptoms take between one and two weeks to appear following a tick bite. The rash is often accompanied by fever, chills, muscle ache, red eyes, light sensitivity, excessive thirst, loss of appetite, diarrhea, nausea, vomiting, and/or fatigue. While there are lab tests your doctor can use to diagnose the disease, they take time to complete, so you may be placed on a course of antibiotic treatment right away.

The best way to prevent Rocky Mountain Spotted Fever is to avoid tick-infested areas. If you spend any time in areas with woods, tall grasses, or shrubs, wear long sleeves and pants. Tuck pants legs into socks. Wear closed shoes, not sandals. Do a visual check of each member of your family upon returning home. And don’t forget to check your dog for ticks (if applicable).

If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination. Because less than one percent of tick bites transmit this bacteria, antibiotics are not generally prescribed unless there are other symptoms present.

Scabies

Scabies is a harmless but very itchy and highly contagious skin condition caused by mites that burrow into the skin and lay eggs. Symptoms include a severe itch, often worse at nighttime, and thin burrow tracks made of tiny bumps or blisters on the skin. Humans are allergic to the mites, which is what causes the itching.

Typically, scabies appear in folds of the skin, such as the armpits, around the waist, inside the wrists, between the fingers, on the soles of feet, on the back of knees, or on inner elbows. In children, they more commonly appear on the face, scalp, neck, palms, and soles. Scabies is spread through direct contact with an infected person or by sharing clothing and linens. It is so contagious that frequently when one person in a family is diagnosed with scabies, all family members are treated for it. It takes about 21 days for eggs to mature and new mites to begin burrowing through the skin.

Generally a visual examination of the skin is all that is needed to diagnose scabies. However, your dermatologist may take a small scrape of the skin to examine under a microscope. The typical treatment is prescription medicated creams applied liberally all over the body. It takes a few days of treatment before the sensation of itchiness begins to go away.

To help prevent further spreading, be sure to clean all clothes and linens in hot water and dry with high heat. Dry clean items you cannot machine wash in this manner or place the item in a sealed plastic bag and put it away for two weeks. The mites will die without a food source for this length of time.

Scleroderma

Roughly 300,000 people in the United States suffer from scleroderma. This chronic connective tissue disease results from an over-production of collagen in the skin and other organs. Scleroderma usually appears in people between the ages of 25 and 55. Women get scleroderma more often than men. The disease worsens slowly over years.

There are two types of scleroderma: localized scleroderma, which involves only the skin, and systemic scleroderma, which involves the skin and other organs, such as the heart, lungs, kidneys, intestines, and gallbladder. Typical symptoms include skin hardening, skin that is abnormally dark or light, skin thickening, shiny hands and forearms, small white lumps beneath the skin’s surface, tight facial skin, ulcerations on the fingers or toes, and changes in color of the fingers and toes from exposure to heat or cold. Other symptoms impact bones, muscles, lungs, and the digestive tract.

There is no known cause of scleroderma, nor is there a cure. There are individualized treatments that are designed to help alleviate certain symptoms and decrease the activity of the immune system to further slow down the disease.

Seborrheic Dermatitis

Seborrheic dermatitis is a very common skin disease that causes a rash. Despite its appearance, it does not result from poor hygiene.  The skin tends to have a reddish color, swollen and greasy appearance, and a white or yellowish crusty scale on the surface.  Sometimes, the affected skin itches.

Many infants get cradle cap. This is a type of seborrheic dermatitis that develops in babies. Scaly, greasy patches form on the baby’s scalp. The patches can become thick and crusty, but cradle cap is harmless. Cradle cap usually goes away on its own within a few months.

When an adult gets seborrheic dermatitis, the condition can come and go for the rest of the person’s life. Flare-ups are common when the weather turns cold and dry. Stress also can trigger a flare-up. The good news is that treatment can reduce flare-ups and bring relief.

If you think you might have seborrheic dermatitis, you should see a dermatologist for a diagnosis. This common skin condition can look like psoriasis, eczema, or an allergic reaction. Each of these skin diseases requires different treatment.

Shingles (Herpes Zoster)

Shingles is a painful rash that is caused by the varicella zoster virus. It usually appears as a band or strip of blisters on one side of the body that goes from the spine around the front to the breastbone. However, shingles can also appear on the neck, nose, and forehead.

Shingles derives from the same virus that causes chicken pox. After having chicken pox, the virus lies dormant in nerve tissue underneath the skin. Years later, and with no known reason, it reactivates and causes shingles. Shingles is contagious and can easily pass through touching from one person to another. The virus develops into shingles for people who have had chicken pox and develops into chicken pox for those who have not had it. Shingles appears most frequently among older adults (age 60+) and in people with compromised immune systems. Generally, a person only gets shingles once; it rarely recurs.

Symptoms for shingles include:

• Pain, burning, numbness, or tingling on one side of the body. The pain often precedes any other symptoms.
• A rash that appears a few days after the pain. It may be itchy.
• Blisters that break open and then crust over.
• Fever, achiness, or headache.

Some people never get a rash or blisters with shingles, but simply experience the pain.

Shingles is diagnosed based on a medical history and physical examination of the telltale rash. If you suspect you may have shingles, it is important to contact your doctor as quickly as possible. Early treatment can reduce the pain and severity of the episode. Two types of medications are prescribed to treat shingles:

• Antiviral drugs: Drugs that combat the virus, such as acyclovir, valacyclovir and famciclovir.
• Pain medicines: From oral pain pills and antidepressants to anticonvulsants and topical preparations that contain skin-numbing agents.

Shingles usually heals in about 2 to 3 weeks without any problem. However, there is a small percentage of patients (10% to 15%), predominantly over age 50, who experience pain that lasts beyond one month after the healing period. This is called postherpetic neuralgia. Catching shingles early and beginning treatment can reduce the likelihood and severity of postherpetic neuralgia. See your dermatologist for pain relief.

The U.S. Food and Drug Administration has approved a vaccine, called Zostavax, for the prevention of adult shingles. It is approved for adults age 60 or older who have had chicken pox. Essentially, the vaccine delivers a booster dose of chicken pox. The vaccine has proven to be very effective in reducing the incidence of shingles and postherpetic neuralgia.

Tanning Beds/Tanning Booths

According to the American Academy of Dermatology and the U.S. Department of Health and Human Services, ultraviolet (UV) radiation from tanning beds, tanning booths, and sun lamps is a known carcinogen (cancer-causing agent). Exposure to UV radiation during indoor tanning has been proven to increase the risk of all skin cancers, including melanomas, squamous cell carcinomas, and basal cell carcinomas. In fact, the risk of melanoma increases by 75 percent when indoor tanning devices are used before the age of 30. The UV radiation during indoor tanning also leads to skin aging, hyper – and hypopigmentation, immune suppression, and eye damage, such as cataracts.

Therefore, the use of tanning beds, tanning booths, and sun lamps is not recommended by dermatologists.

Tattoos

A tattoo is created by injecting ink into the dermis (the second layer of skin) to incorporate a form of skin decoration. Tattooing is practiced worldwide and has often been a part of cultural or religious rituals. In Western societies today, tattooing has reemerged as a popular form of self-decoration.

Technically, a tattoo is a series of puncture wounds. An electric device uses a sterilized needle and tubes to penetrate to a deeper layer of skin and inject ink into the opening it creates. The tattoo machine moves the needle up and down between 50 and 3,000 times per minute. The machine’s operator, a tattoo artist, will use a flash or stencil of the design you select. Typically the design is outlined in black, shading is filled in and then solid areas of color are completed.

Any puncture wound is susceptible to bacterial or viral infection, which is why it is imperative that you work with a licensed tattoo artist who adheres to stringent infection control standards. Single-use needles and disposable materials should be used in conjunction with sterile procedures, such as the artist wearing latex gloves, cleaning the affected area after each stage of tattooing, and using an autoclave to sterilize any materials or equipment that is re-used.

After the tattooing is completed, it is important to care for the damaged skin until it fully heals. Keep a bandage on the area for at least the first 24 hours. Wash the tattoo with antibacterial soap once daily and gently pat it dry. Avoid touching the tattoo and don’t pick at the scabs as they form. You can also use an antibiotic ointment to help prevent infection. Do not use petroleum jelly because it may cause fading. If you experience redness or swelling, put ice on the tattoo. Keep your tattoo away from water and out of the sun until it has completely healed.

Complications from tattoos generally involve either an infection or an allergic reaction to the ink. If you have a skin condition, like eczema, you should probably avoid getting any tattoo.

Tattoo Removal

A tattoo is designed to last for a lifetime. However, if your feelings about a tattoo change over time, there is laser removal technology available. The process tends to be expensive, requires multiple visits and can be painful. Essentially, the laser’s energy is aimed at pigments in the tattoo. The laser emits short zaps of targeted light that reach the deeper layers of the skin. This stimulates the body’s immune system to remove the pigment. It is critical that the procedure be handled in a sterile manner in order to prevent infection. Home care following laser removal treatments is similar to the care recommended for getting a tattoo.

Vitiligo

Vitiligo refers to the development of white patches anywhere on the skin. With this condition, pigment-forming cells (known as melanocytes) are destroyed by the immune system, causing loss of pigmentation in the skin. Vitiligo usually develops between the ages of 10 and 40. It affects both men and women and appears to be hereditary.

Vitiligo usually affects areas of skin that have been exposed to sun. It also appears in body folds, near moles, or at the site of previous skin injury. The condition is permanent and there is no known cure or prevention. However, there are some treatments that can be used to improve the appearance of the skin, such as steroid creams and ultraviolet light therapy.

Wrinkles

Wrinkles are a natural part of the aging process. They occur most frequently in areas exposed to the sun, such as the face, neck, back of the hands, and forearms. Over time, skin gets thinner, drier, and less elastic. Ultimately, this causes wrinkles – either fine lines or deep furrows. In addition to sun exposure, premature aging of the skin is associated with smoking, heredity, and skin type (there is a higher incidence among people with fair hair, blue-eyes and light skin).

Treatment for wrinkles runs the gamut from topical creams and moisturizers to cosmetic procedures. The most common medical treatments are:

• Alpha-hydroxy acids, preparations made from “fruit acids” that produce subtle improvements in the appearance of wrinkles.
• Antioxidants, creams consisting of Vitamins A, C, and E and beta-carotene that improves the appearance of wrinkles and provides some additional sun protection.
• Moisturizers, which temporarily reduce the appearance of wrinkles.
• Vitamin A Acid, which helps alleviate some of the signs of aging, including mottled pigmentation (e.g., liver spots), roughness, and wrinkling.

Cosmetic procedures include:

The best prevention for wrinkles is to keep the skin moisturized and use sunscreen and sunblock to prevent additional damage from the sun.

90,000 Scabies

Human scabies is a parasitic infestation caused by Sarcoptes scabiei var hominis. The microscopic mite invades the skin and lays eggs, eventually triggering an immune response in the host, which results in severe itching and rashes. Scabies can be aggravated by bacterial infections leading to skin ulcers, which in turn can lead to more severe complications such as sepsis, heart disease, and chronic kidney disease. In 2017scabies and diseases caused by other ectoparasites were classified as neglected tropical diseases (NTDs) in response to requests from Member States and recommendations from the WHO NTD Strategic and Technical Advisory Group.

Magnitude of the problem

Scabies is one of the most common skin diseases and accounts for a significant proportion of skin diseases in developing countries. It is estimated that more than 200 million people worldwide are infected with scabies at any given time, but more efforts are needed to more accurately estimate this burden.According to recent publications on scabies, prevalence rates range from 0.2% to 71%.

Scabies is endemic in many resource-limited tropical areas, where the average prevalence in children is estimated to be 5-10%. Re-infestations are widespread. The heavy burden of scabies and its complications comes at a high cost to health systems. In high-income countries, sporadic cases of scabies occur, but outbreaks of scabies in health facilities and vulnerable communities result in significant economic costs to national health services.

Scabies is common throughout the world, but the most vulnerable populations – young children and the elderly in resource-limited communities – are particularly susceptible to scabies and secondary complications. The highest rates of infection are observed in countries with hot tropical climates, especially in those communities where people live in conditions of overcrowding and poverty, and access to treatment is limited.

Symptoms

Scabies mites invade the top layer of the skin where adult females lay their eggs.After 3-4 days, larvae emerge from the eggs, which in 1-2 weeks develop into adult ticks. After 4-6 weeks, the patient develops an allergic reaction to the proteins and feces of the mites in the scabby passages, which causes severe itching and rash. Most people are infected with 10-15 ticks.

Patients usually experience severe itching, and tick-borne passages and vesicles appear in the interdigital spaces, on the wrists, on the upper and lower extremities and in the lumbar region. In infants and young children, the rash can spread more widely and may involve the palms, soles of the feet, ankles, and sometimes the scalp.Inflammatory scabies nodules can be found in adult men on the penis and scrotum, and in women in the area of ​​the mammary glands. Due to the fact that symptoms develop some time after the initial infection, itch moves can be detected in people who have had close contact with an infected person who have not yet developed itching.

People with crusted scabies develop thick, flaky crusts on the skin that can spread more widely, including the face.

People with weakened immune systems, including people with HIV / AIDS, can develop a special form of the disease called cortical (Norwegian) scabies. Crusted scabies is a hyperinfection, in which the number of mites reaches several thousand or even millions. The mites are widespread and crusty, but often do not cause significant itching. If untreated, this disease is characterized by a high mortality rate from secondary sepsis.

The effects of mites on the immune system, as well as the direct effects of scratching, can lead to bacterial contamination of the skin, leading to the development of impetigo (skin ulcers), especially in tropical conditions.Impetigo can be complicated by deeper skin infections, such as abscesses, or severe invasive diseases, including sepsis. In tropical settings, a skin infection associated with scabies is a common risk factor for kidney disease and possibly rheumatic heart disease. Signs of acute kidney damage can be found in 10% of children infected with scabies in resource-poor areas, and in many cases these symptoms persist for many years after infection, resulting in permanent kidney damage.

Transmission

Scabies is usually spread from person to person through close skin contact (for example, when living together) with an infected person. The risk of transmission depends on the level of infection, with the highest risk being contact with persons with crusted scabies. The chance of transmission through contact with contaminated personal items (such as clothing and bedding) is low for common scabies and may be high for crusted scabies.Given the asymptomatic period of infection, transmission can occur before the onset of symptoms in the originally infected person.

Treatment

Primary treatment of infected individuals includes the use of topical scabicides such as 5% permethrin, 0.5% water-based malathion, 10-25% benzyl benzoate emulsion or 5-10% Sulfuric ointment. Oral ivermectin is also highly effective and has been approved for use in several countries. The safety of ivermectin for pregnant women or children weighing less than 15 kg has not been established, therefore, ivermectin should not be used in these populations until more safety data are available.With effective treatment, itching usually worsens within 1–2 weeks, and people on treatment should be advised of this.

Given that early infection may be asymptomatic and because anti-scabies medications do not kill the eggs of the parasite, the best results are achieved by treating all family members at the same time and re-treating at the appropriate time for the drug of choice.

WHO activities

WHO works with Member States and partners to develop scabies control strategies and outbreak response plans.WHO recognizes that there is a need to better define the burden of disease and the risk of long-term complications, and that scabies control strategies need to be linked to interventions in order to facilitate their rapid and cost-effective implementation. WHO is working to have ivermectin on the WHO Model List of Essential Medicines when it is next updated. In addition, WHO is taking steps to ensure that quality and effective medicines are available to countries in need.

Recommendations – BUZ RA “Dermatovenerologic dispensary”

Scabies
Scabies is a highly contagious skin condition that presents with an extremely itchy rash. The disease is caused by a specific skin parasite – the itch mite, which lives on the skin and inside the skin of a person.
Signs of scabies
1) Increased itching in the evening and at night. This symptom is due to the life cycle of the scabies mite, which is most active in the evening and at night.
2) Typical lesions.Despite the fact that in clean people, rashes are rare, elements of the rash over time spread to typical places that you need to know. The appearance of the rash is less important because the rash is varied.
Typical places of a rash with scabies: in almost all – the interdigital spaces and lateral surfaces of the fingers, the area of ​​the wrist joints, in men – the genitals, trunk, arms and legs, in women – the mammary glands. And also: flexion folds of the forearms and shoulders, buttocks, thighs and popliteal hollows.
Thus, scabies without hand involvement is not common. Such scabies is possible if the patient is clean, and the mites have not yet spread to the hands (for example, during the genital tract of infection).
Scabies is characterized by the group nature of itching.
If in the evenings and nights other family members began to itch, then it’s time to run to a dermatologist.
Regarding scabies, one must firmly understand that all its manifestations (itching, rash) are the result of an allergy to the tick itself, its bites and waste products (saliva, eggs, excrement).Having understood this, it is easy to deal with other features of scabies:
• the incubation period is 1-2 weeks on average. This time is needed for ticks to master a new place of residence, and the immune system – to start reacting to scabies mites and their waste. The more mites initially hit the skin, the shorter the incubation period.
• in case of re-infection, the reaction to the pathogen appears within a day. There is no immunity to scabies, so re-infection is possible.
• the severity of the rash depends little on the number of mites in the skin, but is due to the severity of an allergic reaction to their waste products.
Due to severe itching and frequent scratching, a bacterial infection is possible, which makes the skin rash more varied, including pustules.

Ticks are inactive in the morning and afternoon. A female tick, living no more than 4-6 weeks, in the evening and at night at a rate of 2-3 mm per day digs an itch passage in the epidermis, in which it lays 2-4 eggs daily. Males form short lateral ramifications in the female’s scabies. Mites dissolve the keratin of the skin with the help of special proteolytic enzymes contained in saliva and feed on the resulting lysate (solution).At night, mites come to the surface of the skin to mate and develop new territories. On the surface of warm skin, ticks move quite briskly – at a speed of 25 mm / min. It is clear that the easiest way to get scabies is at night in a shared bed.
The typical form is characterized by itching, a typical rash and the presence of itch burrows. However, there is scabies without moves, so the absence of moves does not yet prove the absence of scabies.
A typical rash in scabies is represented by small papules (reddish nodules) that may be scattered or multiple and confluent.Over time, papules (nodules) turn into vesicles (vesicles), open up with the formation of bloody or purulent crusts. Purulent crusts are the result of a secondary bacterial infection.
Scabies can be complicated, for example, by dermatitis (mechanical scratching of the skin against the background of its allergic inflammation) or pyoderma (purulent skin lesions with pyogenic cocci – staphylococci and streptococci).
Scabies of cleanliness or “incognito”: it is possible if a person washes regularly and everything is in order with his immune system.Characterized by single rashes and severe itching in the evening and at night.
Nodular (nodular) scabies: manifests itself in the form of a few itchy round nodules (seals) with a diameter of 2-20 mm, red, pink or brown. Scabies can be found on the surface of the new nodules. Typical localization: scrotum and groin-scrotal folds, penis, inner thighs and buttocks, axillary folds, around the anus, areola.
Nodules are usually few in number.They are sometimes the only diagnostic sign of scabies.
Methods of scabies infection. Infection with scabies occurs mainly with close bodily (instead of contact-household) contact, usually with a joint stay in bed and intimate communication. A focus with scabies is defined as a group of people in which there is a patient – a source of infection and conditions for transmission of the pathogen. Children often become infected when they sleep in the same bed with sick parents. This is due to the biological characteristics of the tick:
• the scabies mite is active in the evening and at night,
• it takes about 30 minutes for the mite to penetrate the skin,
36 hours), and loses activity even earlier.
The second place in terms of epidemic significance is occupied by invasive contact groups – groups of people living together, having a common bedroom (dormitories, orphanages, boarding schools, nursing homes, barracks, etc.) in the presence of close household contacts with each other in the evening and at night …
Indirect route of infection: through household items, bedding, clothing, etc. Extra-focal cases of scabies infection (transient invasion) in baths, trains, hotels are rare and are realized indirectly with successive contact of a stream of people with objects (bedding, toilet items) used by a patient with scabies.

Principles of scabies treatment:
• All patients from the same epidemic focus should be treated at the same time.
• Rub the preparation in the evening with bare hands, as hands are most often affected by scabies. If, after rubbing in the drug, it becomes necessary to wash your hands, then they must be re-processed.
• Trim your nails: mite eggs can be found underneath due to scratching.
• After completion of therapy, it is necessary to disinfest underwear and bed linen, towels, clothes and shoes, to carry out wet cleaning in the room where the patient was: the mite is reliably killed by boiling for 5-10 minutes in a solution of soda or washing powder, you can still iron the clothes hot iron.If there are things that cannot be disinfected, then they can be packed in a plastic bag for 5 days or hung out in the open air. After 5 days, the clothes are considered to be disinfected. hungry ticks don’t survive that long.
Prevention of this disease, as well as many others and not only skin, but also infectious diseases, is quite simple: adherence to the rules of personal hygiene.

Consultation with a dermatologist Rostov – if a rash appears, what to do?

Rashes on the body disrupt the usual rhythm of life, not only because they look unpleasant.As a rule, they are accompanied by itching and the desire to constantly scratch the irritated area.

Not everyone knows what to do if a rash appears. The methods of disposal depend on what caused it. In some cases, independent home treatment in the form of ointments and pills is sufficient, while in others it is worth making an appointment with a dermatologist in order to accurately establish the reasons and choose the right treatment.

Causes of the rash

First thoughts on the appearance of a rash and itching – what to do? How to wipe, anoint or what kind of medicine to drink to get rid of discomfort as soon as possible.Medications are taken depending on the reason for the appearance of the rash on the skin.

All of them can be divided into 3 groups:

• Allergic;
• Non-communicable diseases;
• Rash associated with infectious diseases.

The rashes themselves differ in shape, color, localization and additional symptoms, depending on what caused them. If this is your first time dealing with a rash, it is worth contacting a paid dermatologist to understand the exact cause.

With an external examination of the skin and by location, you can determine what caused the rash and what to do in a particular situation.

If you have doubts about the causes, and itching is uncomfortable, make an appointment with a dermatologist who will help you cope with the problem.

The nature of the rash, depending on the cause

An allergic rash is accompanied by additional symptoms, including:

• Swelling of the face or eyelids;
• Runny or stuffy nose;
• In some cases, the temperature rises.

If you know for sure that you have eaten a product that you are allergic to or used a cream, the rash will soon disappear on its own after eliminating contact with the allergen. It is not always known what the allergic reaction is to.

In this case, it is worth consulting a dermatologist, who will send you for tests to identify the allergen.

An infectious rash is always accompanied by fever, intoxication of the body, headaches.It does not itch, but pain occurs when the affected area is touched.

Only a doctor can tell you what to do when an infection-related rash develops. Different infections require individual treatment. Make an appointment with a paid dermatologist in Rostov to get rid of the infection as soon as possible and prevent the spread of the disease.

Skin rash: what to do?

The appearance of rashes on the body is a reason to seek the advice of a dermatologist Rostov.Since it can be caused by a variety of reasons, only a doctor can prescribe the necessary tests and prescribe treatment.

Only experienced specialists work in MC “Heratsi” to help you take care of your health. The schedule and prices of a dermatologist’s appointment can be found on our website or by calling the information desk. Don’t put off taking care of your health.

In MC “Heratsi” you can contact a specialist who will consult, check and give a treatment plan for any of the reasons that cause discomfort.

We can undergo the necessary treatment, including injections, both intravenous and intramuscular in the treatment room.

Itching in the vagina – reasons, what to do and how to treat

Causes of vaginal itching

Itching in the vagina is not a disease, but only a symptom indicating a particular disorder in a woman’s body. There are many reasons for its development, therefore, before starting treatment, the doctor will prescribe a comprehensive examination for the patient, which will help to identify the etiology of the disease, and choose the most effective treatment.Vaginal itching may be present in the following cases:

Bacterial infections: candidiasis, vaginosis.
1. Sexually transmitted infections: trichomoniasis, chlamydia, genital herpes.
2. Inflammatory processes in the pelvic organs: cervicitis, adnexitis, endometritis, cervical erosion.
3. Allergies to linen, hygiene products, birth control pills, food.
4. Poor genital hygiene.
5. Hormonal imbalance.
6. External factors: wearing low-quality or tight underwear, stress, nervous strain.

In addition to the main causes, itching in the vagina is often present in women who have diabetes mellitus or have problems with the functioning of the endocrine system. Such a symptom is not an indicator for making a diagnosis or prescribing therapy, so the doctor pays attention to other manifestations, as well as the results of studies that a woman will appoint for an initial consultation after a gynecological examination and an anamnesis.

Associated symptoms

Itching in the vagina is not the only symptom that may bother a woman. Clinical signs directly depend on the etiology of the disease, stage of development, characteristics of the female body. As practice shows, vaginal itching is accompanied by other unpleasant symptoms:

• Increased vaginal dryness, burning;

90 091 skin rash;

• discharge of a different nature: from cheesy whites to brown and bloody;
• unpleasant odor;
• pain, discomfort in the lower abdomen or in the lumbar region;
• increased body temperature;
• sudden mood swings;
• weakness, increased fatigue.

If you ignore the itching, with constant scratching, the risk of a secondary infection increases, which will only worsen the prognosis for a quick recovery. Many diseases of the female genital area have similar symptoms, so when it appears, you do not need to hesitate to visit a gynecologist. The sooner the cause is identified and treatment is carried out, the faster a woman can get rid of unpleasant symptoms.

What treatment the doctor can prescribe

A gynecologist or venereologist is engaged in the treatment of itching in the vagina, but consultation of related specialists, in particular a dermatologist, allergist, neurologist, may be required.Therapy is prescribed only after a comprehensive examination, directly depends on the root cause, may include taking the following medications:

1. Antibacterial and antimicrobial. Appointed if the source of the disease is the bacterial flora. Taking antibiotics will help destroy the pathogenic pathogen, exclude its reproduction and spread. The choice of the medicine is made by the doctor: it can be both pills and injections, and topical preparations in the form of vaginal suppositories.
2. Antifungal. Shown in diseases that are caused by fungal pathogens, more often the genus Candida.
3. Antihistamines. Eliminate itching, suppress allergic reactions, relieve tissue swelling.
4. Hormonal. Appointed by an endocrinologist strictly according to indications.
5. Sedatives.
6. Vitamins.

Medicines are prescribed by the doctor individually for each woman, based on the diagnosis, the stage of the disease, and the characteristics of the organism.The duration of therapy can take from a couple of days to several weeks. The doctor also gives valuable advice on nutrition and lifestyle. As an auxiliary therapy, various herbal baths can be prescribed, which relieve itching, inflammation and irritation.

If the cause of itching is fungal or bacterial flora, sexually transmitted diseases, treatment is prescribed not only to the woman, but also to her sexual partner.

Prevention

Itching in the vagina as a sign of the disease occurs very often, it causes not only physical, but also mental discomfort.To reduce the risks of its development, women need to follow some rules:

• regular hygiene;

90 091 preventive examinations by a gynecologist 2 times a year;

• avoid unprotected intercourse;
• take contraceptives as directed by a doctor;
• healthy and proper nutrition;
• wearing quality underwear;
• to use hypoallergenic care products for intimate areas.

The main rule that women should adhere to when itching in the vagina is considered to be refusal of self-medication, going to the doctor. It is important to understand that such a symptom can be a sign of a banal skin irritation or a symptom of a serious illness. Therefore, the sooner a woman turns to a specialist, the faster she will get rid of discomfort and possible illness.

90,000 Skin rash in children: we analyze the causes

Features of children’s skin

The skin, like most other organs and systems, gradually develops until puberty.In a child, it is functionally and structurally more sensitive to external influences and allergic reactions. At the same time, the sweat and sebaceous glands do not yet work properly, which is associated with insufficient development of the innervation of the skin.

At the same time, the skin from the very birth takes an active part in metabolism and respiration due to the many superficially located vessels. Because of this, skin diseases often greatly affect the general condition of the child.

Types of rash in children

Skin rash caused by this or that disease usually has its own characteristics. The most common types of rash include:

• Papules. These are small volumetric formations (up to 10 mm), which rise above the skin. The main colors are red and pink. Occur with lichen planus, baby roseola, atopic dermatitis, etc.
• Vesicles. They are bubbles up to 5 mm in diameter, filled with a turbid liquid.After opening, erosion is often left behind. May be a sign of chickenpox and other herpes infections.
• Petechia. A purple-colored skin rash that does not go away with pressure. Its elements do not exceed 3 mm in diameter, do not rise above the skin and are not felt to the touch. As a rule, they indicate meningococcal infection, vascular lesions (vasculitis), platelet deficiency.
• Erosion. This is a skin defect that does not penetrate deeper than the epidermis.It has the appearance of a rounded, somewhat in-depth formation of red color with a weeping surface.
• Cork. A secondary element formed when secretions from vesicles, erosions or blood dries. Solid, dark red, brown in color.
• Macula or spot. This is an area of ​​discoloration that is flush with the adjacent areas of the skin. It can be both an independent element in rubella, measles, roseola, and a residual phenomenon after papules, vesicles or erosions.
• Blisters or urticaria. A rounded element of a rash of pale pink, red or purple-white color, the size of which varies from 1-2 mm to tens of centimeters. Does not leave behind secondary elements. Occur with allergic reactions, urticaria.
• Lichenification. These are areas of excessive thickening of the skin with increased skin pattern. It is often a secondary element.

Diseases that cause skin rashes in children

A rash on the baby’s skin may indicate various diseases, most often infections and allergic reactions.

Baby roseola

Children’s roseola or sudden exanthema is a childhood infectious disease that occurs when infected with human herpes viruses type 6 or 7. It is most often observed between the ages of 6 months and 2 years.

Sudden exanthema is accompanied by an increase in body temperature to 39-40 ° C, which persists for 3-5 days, after which a bright red maculopapular rash appears on the child’s skin. It occurs on the surface of the chest and abdomen, spreading throughout the body (Fig.1). The elements of the rash, as a rule, are not felt with the fingers, but sometimes they can be raised. They disappear when the skin is stretched or the glass of a glass is pressed on them.

In baby roseola, there may be white rings around some elements of the rash. Often, the rash is limited only to the body and, before it reaches the face and limbs, disappears. The rash does not cause discomfort or itching, but children at this time usually become sharply moody and “obnoxious”; the rash lasts from several hours to several days and then disappears without leaving any pigmentation or scaling.An excerpt from the book by Sergei Butriya “Child’s health: a modern approach. how to learn to cope with illness and your own panic. ”

Children’s roseola is treated symptomatically, mainly with antipyretics and drinking plenty of fluids. In case of immunodeficiency conditions (HIV infection, congenital disorders of the immune system), antiherpetic drugs are additionally prescribed.

No matter how hard the baby roseola may flow, it is completely safe.Complications are extremely rare and are usually limited to febrile seizures. An excerpt from the book by Sergei Butriya “Child’s health: a modern approach. how to learn to cope with illness and your own panic. ”

Figure 1. Rash with baby roseola. Source: Wikipedia

Enteroviral exanthema: Turkish chickenpox and enteroviral pharyngitis

Pemphigus viral, also known as Turkish chickenpox, is caused by enterovirus 71 (EV-71). Enteroviral pharyngitis is caused by Coxsackie viruses A16, B2, B5.They are found mainly among children under the age of 10, infection often occurs during holidays in southern countries.

The primary signs of pathologies are pain in the mouth and throat, which is why the child refuses to eat and does not even swallow saliva, but spits it out. Further, the body temperature rises to 39 ° C. Fever persists for about 4 days and is accompanied by nausea and vomiting, loss of appetite, and excessive irritability. With enteroviral pharyngitis, small white ulcers usually appear only on the palatine arches (Fig.2), but Turkish chickenpox is a rash all over the mouth, including the tongue, around the mouth, on the palms and feet. The skin rash can resemble chickenpox – red spots or blisters.

Figure 2. Rash in the mouth with herpangina (enteroviral pharyngitis). Source: James Heilman, MD / Wikipedia

Symptomatic treatment:

• Oral hygiene and rinsing with antiseptic solutions.
• Drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) that help suppress pain and at the same time lower body temperature.
• Plentiful warm drinks to prevent dehydration, cold drinks and ice cream can be given (they are more easily tolerated by sick children).
• Diet with the exception of mechanically hard, sour and salty foods.
• Enterovirus exanthema is self-passing, the disease usually subsides after 3-7 days. Nevertheless, the condition of the child during the illness must be monitored in order to consult a doctor in time in case of complications. The most common are dehydration and secondary bacterial infections.In the latter case, abscesses, yellow crusts appear on the skin, the skin swells. It is extremely rare that an enterovirus infection leads to serous meningitis.

Chickenpox

Chickenpox or chickenpox is an infectious disease caused by the human herpes virus type 3 (Varicella Zoster). People of any age are ill with it, but mostly they are children 5-9 years old.

The main symptom is skin rashes with a certain order of development. The first to appear are small pink spots, quickly transforming into papules, and then into vesicles (Fig.3) with redness around. After a couple of days, they open or dry out, forming crusts of a dark red, brown color on their surface. A characteristic feature is severe itching.

Figure 3. Development of skin rash with chickenpox. Source: SlideToDoc

In total, the period of the rash lasts from 2 to 9 days. The general condition is practically not affected, but fever may occur.

There are no medications that can completely eliminate the virus, therefore, treatment tactics are aimed at eliminating symptoms and normalizing the child’s condition:

• Bed rest with fever.
• Treatment of rash elements with manganese solution, methylene blue or brilliant green (brilliant green).
• Antihistamines for itching.
• Antipyretic drugs.
• Regular warm shower without a washcloth or brush.

Complications of chickenpox occur against the background of suppression of the body’s immune system. These include: pneumonia (pneumonia), lesions of the nervous system (neuralgia, meningitis, encephalitis, damage to the facial nerve), eyes (keratitis, conjunctivitis, uveitis), etc.

Important ! For the prevention of chickenpox, especially in adults, against the background of a weakened immune system and a high risk of complications, vaccination is recommended. It can also be carried out as an emergency prophylaxis within 2 days from the moment of contact with a sick person.

Measles

Measles is a viral infectious disease. It is often found in unvaccinated children between 2 and 5 years of age and older.

Measles debuts with a sharp rise in temperature to 39-40 ° C, dry cough, runny nose, headache, hoarseness.Characteristic features are swelling and redness of the eyelids, pharynx, and red spots on the palate. On the 2-3rd day of development, a measles-specific symptom appears – Filatov-Belsky-Koplik spots. These are white spots with a red border, observed on the inner surface of the cheeks near the molars. On the 4-5th day from the appearance of the first signs of the disease, these spots disappear, and they are replaced by a skin rash.

Primary localization of papular measles rash – the outer surface of the elbow, knees, fingers. Then it spreads throughout the body (Fig.4). The elements of the rash are surrounded by red spots and tend to merge with each other. After 4 days from the moment of their appearance, the child’s condition is normalized, and the elements of the rash become darker and flaky. Residual effects and pigmentation disappear after 7-10 days.

Figure 4. Skin rash with measles. Source: CDC

No specific treatment for measles has been developed, helping a child means combating individual symptoms:

• NSAIDs for lowering body temperature.
• Expectorants for the relief of cough.
• Antiseptics for mouth rinsing.
• Topical treatment of elements of the rash with astringents or tea to relieve itching and soreness.

Measles is very dangerous. Potential complications of measles:

• Laryngeal stenosis – croup.
• Primary measles or secondary bacterial pneumonia.
• Inflammation of the respiratory tract – bronchitis, tracheitis, laryngitis, pharyngitis.
• Otitis media.
• Hepatitis.
• Encephalitis and subacute sclerosing panencephalitis.

Scarlet fever

Scarlet fever is a bacterial infection caused by group A beta-hemolytic streptococcus.In most cases, the disease occurs in children from 3 to 7 years old.

The first manifestation of scarlet fever is intoxication syndrome – an increase in body temperature to 38-39 ° C, headache, general weakness and loss of appetite.On the 2-4th day from the moment of the appearance of the first signs of the disease, one of the characteristic symptoms arises – “crimson tongue” (Fig. 5). It is manifested by pronounced graininess and bright red color of the surface. Angina also occurs – inflammation of the tonsils.

Figure 5. “Raspberry tongue” with scarlet fever. Source: ResearchGate

From the first days of the development of scarlet fever, a characteristic red small-point rash appears, which does not disappear when pressed with a glass, but becomes yellowish when applied.It is located on the flexor surfaces: the inner parts of the elbows, under the knees, in the groin fossa, on the cheeks and sides of the body. It lasts up to 1 week, after which it disappears without leaving behind pigmentation. A specific sign is the pallor of the nasolabial triangle.

Another characteristic feature of scarlet fever is the flaking of the skin that occurs after the rash has disappeared. In this case, the skin “leaves” in whole layers in the area of ​​the palms and feet, while in other areas – in small fragments.

The treatment is based on antibiotics from the penicillin group. Vitamin C and B vitamins, symptomatic drugs are used as auxiliary agents. A plentiful warm drink and bed rest are recommended. In severe cases, glucocorticosteroids and intravenous drip of glucose solutions and plasma substitutes are used.

The most common complications of scarlet fever: otitis media, sinusitis and frontal sinusitis (inflammation of the maxillary and frontal paranasal sinuses, respectively), cervical lymphadenitis (inflammation of the lymph nodes of the cervical region).

Rubella

The causative agent of rubella is the Rubella virus. The majority of patients are children aged 3 to 9 years.

Rubella begins with moderate intoxication syndrome: fever up to 38-38.5 ° C, headache and increased fatigue, signs of pharyngitis and conjunctivitis, marked enlargement of the lymph nodes of the cervical and occipital region.

After 1.5-2 days from the onset of the disease, a skin rash occurs in the form of spots, which spreads downward for several hours – appearing on the face, gradually passes to the trunk and limbs.Outwardly, the rash initially resembles measles, then scarlet fever. At the same time, itching and peeling are absent, and the spots, unlike measles, do not merge with each other. Most of the spots are located on the buttocks and lower back, the outer surface of the elbows and knees. After 3-5 days, the rash disappears without a trace.

There is no specific treatment for rubella, and the main actions are aimed at eliminating individual symptoms of the disease. Complications are very rare, as a rule – against the background of impaired functioning of the immune system.In such cases, the development of pneumonia, arthritis, otitis media is possible.

Important ! Rubella is especially dangerous for pregnant women, as it causes disturbances in the fetus, therefore, when planning a pregnancy, all unvaccinated people should be vaccinated against this infection.

Urticaria

Urticaria or urticaria is a type of dermatitis caused by allergies. The disease is very common in both children and adults. In total, about 20% of the adult population and 2-7% of children suffer from it.

Medications (most often antibiotics), various foods, vaccines and physical effects: cold, sunlight, mechanical pressure can provoke the development of urticaria.

The leading symptom of the pathology is a skin rash in the form of dense red or pink blisters or nodules 2-10 mm in diameter with clear edges that become pale when pressed (Fig. 6). A characteristic feature is the sudden appearance and equally rapid disappearance of the elements of the rash without a trace, as well as severe itching.

Figure 6. Hives rash. Source: James Heilman, MD / Wikipedia

Treatment, depending on the form of the disease, is represented by antihistamines, histamine receptor blockers or glucocorticosteroids.

Complications occur in the absence of treatment and include angioedema Quincke, anaphylactic shock, heart and kidney damage in the form of myocarditis or glomerulonephritis, respectively.

Lichen planus

Lichen planus is a chronic dermatitis of unknown origin.Most of the patients are people between the ages of 30 and 60. However, about 5% of the total number of patients are children.

The typical form of the disease is accompanied by the appearance of gray-white papules up to 2 mm in diameter on the mucous membrane of the mouth, namely: the inner surface of the cheeks behind the molars, on the lateral parts of the tongue and on the palate. Sometimes rashes can coalesce to form patterns.

In some patients, a rash also appears on the skin of the flexor surfaces of the limbs of the arms and legs, the inner thighs.It has the appearance of small papules of various shapes and pinkish-purple color with a shiny surface and a depression in the center.

Treatment includes a diet with restriction of salt, smoked and fried foods, rough food that irritates the mucous membranes. As medical support, glucocorticosteroids are prescribed.

Pink lichen

Pink lichen or Gibert’s versicolor is a variant of skin lesions, the cause of which is not precisely established. Exacerbations occur against the background of suppression of immunity – colds, hypothermia, chronic stress, etc.Most of the cases of this pathology are observed in persons aged 20 to 40 years, as well as in adolescents.

The disease begins with the formation of a primary scaly lesion of pinkish or yellowish color from 1 to 10 cm in diameter with a clear rim. After 1-2 weeks, secondary plaques and papules of a smaller size – up to 2 cm (Fig. 7) appear on the body and limbs. Gradually, the elements of the rash fade, and the outer edge becomes more rough. Itching, fever and other manifestations of intoxication syndrome may accompany the rash.

The disease tends to heal on its own within 4-5 weeks. Treatment is mainly local in the form of ointments based on glucocorticosteroids, and antihistamines and NSAIDs are prescribed to combat itching and fever.

Figure 7. Skin rash with pink lichen. Source: James Heilman, MD / Wikipedia

Atopic dermatitis

Atopic dermatitis or eczema is a genetically determined inflammatory skin lesion that is autoimmune in nature.Most often, children under 14 years old who live in large, industrial cities are sick.

Atopic dermatitis develops with an 80% probability if both parents have a history of this pathology, and with a 50% probability, if only one of them.

The first symptoms appear before the age of 2 years against the background of exposure to allergens, which can be food, pollen, dust and mold, cosmetics.

Typical symptoms are skin eruptions that vary according to the stage of the disease.With an exacerbation, red spots, papules and small vesicles appear, accompanied by severe itching. In infants, the typical site is the face, scalp and neck. At an older age, the flexion surfaces of the limbs and the neck are affected. In the stage of remission, they are replaced by foci of increased dryness of the skin, peeling and lichenification. During the year, on average, 2-4 exacerbations are observed.

For treatment, ointments and creams based on glucocorticosteroids, calcineurin inhibitors, and zinc are used.In severe cases, hormonal drugs are used in the form of tablets or intravenous injections. Antihistamines are also used to combat itching.

Infectious mononucleosis

Infectious mononucleosis is the result of infection with human herpesvirus type 4 (Epstein-Barr virus). It is believed that already up to 5 years of age, about 50% of children are infected with this virus, and its prevalence among adults reaches 95% of the population. Most often, clinical signs of pathology occur at the age of 14-18 years.

Typical symptoms of infectious mononucleosis include:

• General weakness and malaise.
• Sore throat and pain when swallowing
• Headache.
• Slight increase in body temperature.
• Sensation of aching muscles and joints.
• Swelling and tenderness of the lymph nodes in the mandible and neck.

Skin rashes are noted in less than ¼ of patients.Most often they occur on the 5-10th day of the course of the disease against the background of mistakenly prescribed antibiotics ampicillin or amoxicillin. The rash is represented by spots and papules and is located in the face, trunk, thighs and shoulders. It is accompanied by swelling of the skin and itching, sometimes peeling. The rash disappears within 5-7 days.

Since mononucleosis is of viral origin, antibiotic therapy is not used against it. Treatment of the disease involves the elimination of individual symptoms.In severe cases and with concomitant immunodeficiency, antiherpetic drugs are prescribed: ganciclovir, valacyclovir.

Prevention of rash formation

In cases with infectious diseases, the only way to avoid the appearance of a rash is to prevent infection, namely, to limit contact with sick people and observe banal rules of personal hygiene.

In case of allergic pathologies, it is important to exclude contact with triggers, and if this is not possible, to take antihistamines or corticosteroid drugs previously agreed with the attending physician in advance.

A number of recommendations to help people with sensitive skin avoid skin rashes of other origins:

• Avoid direct skin contact with aggressive, irritating substances such as household chemicals.
• Limit skin exposure to sunlight, cold.
• Give preference to clothing and underwear made from natural fabrics.
• Avoid using tight, uncomfortable clothing and mechanically rough items such as washcloths.
• Use ointments or other skin care products recommended by a dermatologist or beautician.

Conclusion

Skin rash is an important symptom of many diseases. She can tell you what kind of disease to deal with. This, in turn, makes it possible to provide the correct assistance before going to the doctor, avoiding mistakes or even dealing with the problem on your own.

References

1. Federal clinical guidelines.Dermatovenereology 2015. Skin diseases. Sexually transmitted infections. – 5th ed. revised and add. – M: Business Express, 2016 .– 768 p.
2. V.M. Kozin, Yu.V. Kozina, N.N. Yankovskaya “Dermatological diseases and sexually transmitted infections: Study guide” – Vitebsk: VSMU, 2016. – 409 p.
3. P.D. Take a walk. “Skin and Venereal Diseases: Textbook” – Grodno: Grodno State Medical University, 2003. – 182 p.
4. Yu.V. Odinets, MK Biryukova “Atopic dermatitis, allergic rhinitis, urticaria in children: method. decree. for stud. and doctors-interns “- Kharkiv: KhNMU, 2015. – 52 p.
5. S. A. Butriy “Child health: a modern approach. How to learn to cope with illness and your own panic “-” Eksmo “, 2018.

Child’s rash

Many parents have noticed suspicious body rashes in their children. This symptom indicates the presence of any disease of the body or simply its morbid state.In any case, a rash on a child’s body can be very dangerous. Therefore, if you notice a rash on the skin, you should immediately make an appointment with the child’s pediatrician.

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Causes of rashes

A rash in children can appear for various reasons.The safest case is when the rash appears due to poor hygiene. In addition, rashes are caused by allergies, blood diseases, cardiovascular diseases, as well as infections and germs. In the case of an infection, the rash becomes not the only symptom: fever, runny nose, sore throat, severe cough, chills, etc. are added to it. Infections are often accompanied by stomach upset and vomiting. The rash in such cases does not appear immediately, but appears after a few days.

Rash most often occurs as a symptom of diseases that are commonly referred to as “children”.We are talking about chickenpox, rubella, measles, scarlet fever and some other infections that people get sick, mainly in childhood. Moreover, depending on the disease, the nature of the rash changes, due to which doctors can diagnose only one type of rash. Most dangerous is the rash, which is related to the symptoms of meningitis.

Diseases causing rashes on the skin of children

Let’s analyze the types of rashes in a child in more detail, depending on the diseases.

• Chickenpox.Perhaps the most famous disease that is accompanied by a rash. With chickenpox, reddish spots appear on the entire surface of the body, which grow and become bubbles filled with a clear liquid. The growth of bubbles is accompanied by itching, but over time they dry out and fall off, sometimes leaving characteristic “pockmarks”. Chickenpox often causes a rise in temperature, and doctors recommend treating the blisters of the rash with brilliant green.
• Measles. Initially, a rash in the form of large red spots appears on the face, but literally within 2-3 days it spreads “from top to bottom” along the body to the very legs.In addition, the child begins to have a sore throat, a runny nose and cough, and the temperature rises. The largest spots merge into large inflamed areas.
• Meningococcal infection. The most dangerous infection, as it causes meningitis. It is very important to recognize the disease in time, as it develops very quickly. The rash appears as large, bruising spots. If you see a doctor as soon as possible, the probability of a cure is very high.

• Rubella.The rash is accompanied by fever and inflammation of the lymph nodes. A rash on the body of a child in the form of small red spots appears mainly on the buttocks and in places where the limbs are bent. After a few days, the rash disappears without leaving any consequences.
• Scarlet fever. With scarlet fever, a rash in the form of small pimples appears on the second day throughout the body, but their greatest concentration is noted in the groin, in the folds of the arms and legs and in the lower abdomen. After a few days, the rash disappears, and the skin in these places begins to peel off strongly.Also, during the peak of the disease, there is swelling, rash and redness of the entire skin.
• Enterovirus infection. Redness and rash appear on the third day after infection and last for about two to three days. Among other symptoms, doctors note vomiting, diarrhea, fever and general weakness of the body.
• Parasites. In this case, the rash is not caused by infections, but by scabies mites or other parasites living on the human body. The scabies mite “drills” holes in the skin, leaving points of entry and exit.The most “attractive” parts of the body for a tick are places with thin skin: groin, wrists, areas between fingers, etc. Since the tick can be transmitted from one person to another, urgent treatment is necessary after the detection of this pathology.
• Cardiovascular diseases. As a rule, these diseases are not typical for children, although they do occur. Vascular disease can be recognized by small hemorrhages under the skin. Larger areas will bruise.

Other causes of the appearance of rashes

Sometimes, even with all the rules of hygiene and the absence of diseases, a rash on the child’s body appears with enviable regularity.In this case, the matter is most likely in the body’s allergic reaction to various substances. If this is true, then allergies can be recognized by other symptoms that will inevitably appear with the rash: runny nose, cough, tears and itching. Also, a rash on the body of a child may appear from plant burns or insect bites. Even a simple mosquito bite often causes severe itchy rashes in children.

And, of course, very often a rash appears due to poor hygiene.Unlike adults, children have thinner and softer skin, so even a short-term lack of care can lead to a rash. Children, especially the smallest, should be washed and washed regularly. But it is not worth putting on a lot of clothes on him or leaving him in wet diapers – this can lead to diaper rash, irritation, and the appearance of a rash.

Help with a rash

If you find a rash on your child’s body, you should see a doctor as soon as possible.You can make an appointment in our clinic “Poem of Health”. In addition, you can call a doctor at home if your child is in serious condition. Moreover, sometimes it is compulsory to call a doctor at home, as many diseases with symptoms in the form of rashes are easily transmitted to these children. You need to be especially careful with rubella, as it seriously affects the health of pregnant women. And if you suspect meningitis, you need to call not just a doctor, but an ambulance team.

Do not try to get rid of the rash on your own until you see a doctor.First, it will make it difficult for a doctor to make a diagnosis. Secondly, it can lead to an even greater appearance of the rash in the child. It is best to wait for a doctor’s examination and listen to his recommendations for further treatment of the rash. Bacterial rashes are treated with antibiotics, scabies – with special anti-tick agents, allergies – with appropriate preparations with isolation from the source of allergies, etc. More complex treatment is needed for cardiovascular diseases, but, in the end, a rash on a child’s body is always treated successfully.

Prevention of rashes

To avoid the appearance of a rash on the body, measures must be taken to prevent it. First of all, we are talking about the basic rules of personal hygiene. At a very early age, parents should take care of this, later they should teach their child about it as early as possible. Good hygiene not only helps to get rid of rashes, sweating and dirt, but also prevents many infectious diseases.

In addition, infections can be prevented by vaccinations.Some of them are done once and for life, others need to be done periodically. Doctors have a vaccination schedule for different ages, so it’s best for parents to trust their pediatrician. As for the rash due to allergies, it is often associated with age-related changes. As a child grows up, his immune system strengthens, but at an early age, if you have problems, you should follow a diet and take medications as directed by doctors.

Fifth Disease – Southern Nevada Medical District

Fifth Disease

Fifth Disease is a viral infection that often affects red blood cells.It is caused by the human parvovirus (B19).

For many years, fifth illness has been regarded as an insignificant rash in children. Recent studies have shown that the virus can cause serious complications in some people.

Who gets the fifth disease?

Anyone can get infected, but the disease is more common in primary school children.

How does the virus spread?

The virus is spread by contact with airborne droplets from the nose and throat of infected people.

What are the symptoms and when do they appear?

20 to XNUMX days after infection, some children will experience low-grade fever and fatigue.

By the third week, a red rash usually appears on the cheeks, giving the face a “slap” appearance. The rash can then spread to the entire body, disappear, and then reappear. Sometimes the rash is fishy and can be itchy.

Some children may have vague signs of illness or no symptoms at all.

In adults, the rash may be atypical or absent, but muscle or joint pain may occur for days or months.

When and for how long can a person spread the disease?

People with fifth illness appear contagious for the week before the rash appears. By the time the rash becomes apparent, the person is probably no longer contagious.

How is the fifth disease diagnosed?

In most cases, the disease is diagnosed based on the onset of typical symptoms.A special blood test has recently become available to confirm the diagnosis, but this is not necessary in healthy children.

Does past exposure to the virus make a person immune?

Previously infected individuals are believed to acquire long-term or lifelong immunity. Research has shown that over 50 percent of adults are immune to parvovirus B19.

What is treatment?

There is currently no specific treatment.

What complications are associated with the fifth disease?

Although there is no evidence that parvovirus B19 infection is a significant cause of fetal defects, some studies have shown that infection can increase the risk of miscarriage or miscarriage in women in the first half of pregnancy.

In people with chronic red blood cell disorders such as sickle cell disease, infection can lead to severe anemia. The infection has also been associated with arthritis in adults.

What can be done to prevent the spread of the fifth disease?

Measures to effectively combat the fifth disease have not yet been developed. During school outbreaks, pregnant school workers and people with chronic red blood cell disorders should consult their doctor.

What should I do if I become infected with a child with fifth illness during pregnancy?

If you contract a disease or develop symptoms of fifth disease during pregnancy, you should consult your doctor.