Skin Rashes

Common Rashes

Seborrheic dermatitis: Seborrheic dermatitis is the single most common rash affecting adults. It produces a red, scaling eruption that characteristically affects the scalp, forehead, brows, cheeks, and external ears.

Atopic dermatitis: Atopic dermatitis, known as eczema, is a common disorder of childhood which produces red, itchy, weeping rashes on the inner aspects of the elbows and in back of the knees as well as the cheeks, neck, wrists, and ankles. It is commonly found in patients who also have asthma and hay fever.

Contact dermatitis: This is a rash that is brought on either by contact with a specific chemical to which the patient is uniquely allergic or with a substance that directly irritates the skin. Some chemicals are both irritants and allergens. This rash is also occasionally weepy and oozy and affects the parts of the skin which have come in direct contact with the offending substance. Common examples of contact dermatitis caused by allergy are poison ivy or poison oak and reactions to costume jewelry containing nickel.

Diaper rash: This is a common type of contact dermatitis that occurs in most infants who wear diapers when feces and urine are in contact with skin for too long.

Stasis dermatitis: This is a weepy, oozy dermatitis that occurs on the lower legs of individual who have chronic swelling because of poor circulation in veins.

Psoriasis: This bumpy scaling eruption never weeps or oozes and tends to occur on the scalp, elbows, and knees. It leads to silvery flakes of skin that scale and fall off.

Nummular eczema: This is a weepy, oozy dermatitis that tends to occur a coin-shaped plaques in the winter time and is associated with very dry skin.

How is skin rashes diagnosed?

The term rash has no precise meaning but it is used to refer to a wide variety of skin disorders. A rash is any inflammatory condition of the skin. There are various terms to describe skin rashes. The first requirement is to identify a primary and then other characteristics of the rash are noted including density, color, size, consistency, tenderness, shape, and perhaps temperature.

Finally, the distribution of the rash on the body can be very useful in diagnosis since many skin diseases have a pre-dilection to appear in certain body areas. Although certain findings may be a very dramatic component of the skin disorder, they may be of limited value in producing an accurate diagnosis. These include findings such as ulcers, scaling, and scabbing. Using this framework, it is often possible to develop a small listing of the possible diseases to be considered. Below is a short discussion of some common categories of skin rashes:

• Noninfectious, common rashes localized to a particular anatomical areas
• Rashes produced by fungal or bacterial infection
• Widely distributed rashes affecting large portions of the skin

Although most rashes are seldom signs of immediate impending doom, self-diagnosis is not usually a good idea. Rashes that quickly resolve are generally not dangerous. Proper evaluation of a skin rash requires a visit to a doctor or other health-care professional

Scaly Skin produced by fungal or bacterial infection

Fungal infections

Fungal infections are fairly common but don't appear nearly as often as rashes in the eczema category. Perhaps the most common diagnostic mistake made by both patients and non-dermatology physicians is to almost automatically call scaly rashes "a fungus." For instance, someone with several scaly spots on the arms, legs, or torso is much more likely to have a form of eczema or dermatitis than actual ringworm.

Likewise, yeasts are botanically related to fungi and can cause skin rashes. These tend to affect folds of skin. They look fiery red and have pustules around the edges. As is the case with ringworm, many rashes that are no more than eczema or irritation get labeled "yeast infections."

Fungus and yeast infections have little to do with hygiene. Despite their reputation, fungal rashes are not commonly caught from dogs or other animals, nor are they easily transmitted in gyms, showers, pools, or locker rooms. In most cases, they are not highly contagious between people either.

Treatment is usually straightforward. Many effective antifungal creams can be bought at the drugstore without a prescription, including 1% clotrimazole and 1% terbinafine. In extensive cases, or when toe nails are involved, oral terbinafine may be useful.

If a fungus has been repeatedly treated without success, it is worthwhile considering the possibility that it was never really a fungus to begin with but rather a form of eczema that should be treated entirely differently. A fungal infection can be independently confirmed by performing a variety of simple tests.

Bacterial infections:

The most common bacterial infection of the skin is impetigo. Impetigo is caused by staph or strep germs and is much more common in children than adults. Eruptions caused by bacteria are often pustular or may be plaque-like and quite painful (cellulitis). Again, poor hygiene plays little or no role. Non-prescription antibacterial creams like bacitracin or Neosporin are not very effective. Oral antibiotics or prescription-strength creams like mupirocin or Bactroban are usually needed.

Rashes affecting large portions of the skin

The outbreaks of this sort are usually either viral or allergic.
Viral rash:

While viral infections of the skin itself, like herpes or shingles (a term related to chickenpox), are mostly localized to one part of the body, viral rashes are more often symmetrical and everywhere. Patients with such rashes may or may not have other viral symptoms like coughing, sneezing, or stomach upset (nausea). Viral rashes usually last a few days to a week and go way on their own. Treatment is directed at relief of itch, if there is any.

Other rashes:

Urticaria are itchy, red bumps that come and go rapidly over six to eight hours on various parts of the body. Most urticaria run their course and disappear as mysteriously as they came. Heat rash is a skin irritation caused by excessive sweating during hot, humid weather. It can occur at any age but is most common in young children. Heat rash looks like a red cluster of pimples or small blisters. It is more likely to occur on the back, the neck and upper chest, in the groin, under the breasts, and in elbow creases.

Treatment for a rash?

Most rashes are not dangerous to people in the vicinity unless they are part of an infectious disease such as chickenpox. Many rashes last a while and get better on their own. It is therefore not unreasonable to treat symptoms like itchy or dry skin for a few days to see whether the condition gets milder and goes away.
Non-prescription remedies include

• anti-itch creams containing camphor, menthol, pramoxine (Itch-X, Sarna Sensitive), or diphenhydramine (Benadryl);
• antihistamines like diphenhydramine, chlorpheniramine (Chlor-Trimeton), or loratadine (Claritin, Claritin RediTabs, Alavert); and cetirizine (Zyrtec);
• moisturizing lotions.

If these measures do not help, or if the rash persists or becomes more widespread, then consult your dermatologist.

Rashes Review

• Rash is not a specific diagnosis. It is instead a general term that means an outbreak of skin inflammation and discoloration that change the way the skin looks and feels.
• Common rashes include eczema, poison ivy, and heat rash.
• Infections that cause rashes include fungal, bacterial, or viral infection.
• Over-the-counter products to combat infection or itch may be helpful with the proper diagnosis.
• Rashes lasting more than a few days that are unexplained should be evaluated by a doctor.

Shingles (Herpes Zoster)

Shingles starts with burning, tingling, or very sensitive skin. A rash of raised dots develops into painful blisters that last about two weeks. Shingles often occurs on the trunk and buttocks, but can appear anywhere. Most people recover, but pain, numbness, and itching linger for many -- and may last for months, years, or the rest of their lives. Treatment with antiviral drugs, steroids, antidepressants, and topical agents can help.

Hives (Urticaria)

A common allergic reaction that looks like welts, hives are often itchy, and sometimes stinging or burning. Hives vary in size and may join together to form larger areas. They may appear anywhere and last minutes or days. Medications, foods, food additives, temperature extremes, and infections like strep throat are some causes of hives. Antihistamines can provide relief.

Psoriasis

A non-contagious rash of thick red plaques covered with white or silvery scales, psoriasis usually affects the scalp, elbows, knees, and lower back. The rash can heal and recur throughout life. The cause of psoriasis is unknown, but the immune system triggers new skin cells to develop too quickly. Treatments include medications applied to the skin, light therapy, and medications taken by mouth, injection or infusion.

Eczema

Eczema describes several non-contagious conditions where skin is inflamed, red, dry, and itchy. Stress, irritants (like soaps), allergens, and climate can trigger flare-ups though they're not eczema's exact cause, which is unknown. In adults, eczema often occurs on the elbows and hands, and in "bending" areas, such as inside the elbows. Treatments include topical or oral medications and shots.

Rosacea

Often beginning as a tendency to flush easily, rosacea causes redness on the nose, chin, cheeks, forehead, even the eyes. The redness may intensify over time, taking on a ruddy appearance with visible blood vessels. In some cases, thickened skin, bumps and pus-filled pimples can develop. Rosacea treatment includes medications as well as surgical procedures such as laser therapy, dermabrasion, and electrocautery to reshape affected areas.

Cold Sores (Fever Blisters)

Small, painful, fluid-filled blisters on the mouth or nose, cold sores are caused by the herpes simplex virus. Lasting about 10 days, cold sores are very contagious. Triggers can include fever, too much sun, stress, or hormonal changes such as menstruation. Antiviral pills or creams can be used as treatment, but call your doctor if sores contain pus, there is spreading redness, you have a fever, or if your eyes become irritated.

Rash From Plants

Contact with the oily coating from poison ivy, oak, and sumac causes a rash in many people. It begins with redness and swelling at the contact site, then becomes intensely itchy with the development of blisters usually 12 to 72 hours after exposure. The typical rash is arranged as a red line on an exposed area, caused by the plant dragging across the skin. The rash usually lasts up to two weeks.

Soothe Itchy Plant Rashes

Prescription or over-the-counter medication may soothe the itching of mild rashes. Cool compresses and oatmeal baths may help with symptoms. For a severe rash, oral corticosteroid may be given. If the skin becomes infected, antibiotics may be necessary. Avoiding direct contact with the plants can prevent the rash, so learn to recognize poisonous plants. In general, poison oak grows west of the Rockies; poison ivy to the east.

Razor Bumps

Razor bumps are tiny, irritated bumps that develop after shaving. People with curly hair are most affected by them. The sharp edge of closely shaven hair can curl back and grow into the skin, causing irritation and pimples, and even scarring. To minimize razor bumps, take a hot shower before shaving, shave in the direction of hair growth, and don't stretch the skin while shaving. Rinse with cold water, then apply moisturizer.

Skin Tags

A skin tag is a small flap of flesh-colored or slightly darker tissue that hangs off the skin by a connecting stalk. They're usually found on the neck, chest, back, armpits, under the breasts, or in the groin area. Skin tags appear most often in women and elderly people. They are not dangerous and usually don't cause pain unless they become irritated by clothing or nearby skin rubbing against them. A doctor can remove a skin tag by cutting, freezing, or burning it off.

Acne

At the heart of acne lies a clogged pore from oil and dead skin cells that can become inflamed. When open, it is called a blackhead or open comedo; closed, a whitehead or closed comedo. Often seen on the face, chest, and back, acne can be triggered by hormones and bacteria. To help control it, keep oily areas clean and don't squeeze pimples (it may cause infection and scars).

Athlete's Foot

A fungal skin infection that can cause peeling, redness, itching, burning, and sometimes blisters and sores, athlete's foot is contagious, passed by direct contact, sharing shoes worn by an infected person, or by walking barefoot in areas such as locker rooms or near pools. It's usually treated with topical antifungal lotions or oral medications for more severe cases. Keeping feet and the inside of shoes clean and dry is important in treatment.

Moles

Usually brown or black, moles can be anywhere on the body, alone or in groups, and generally appear before age 20. Some moles (not all) change slowly over the years, becoming raised, developing hair, and/or changing color. While most are non-cancerous, some moles have a higher risk of becoming cancerous. Have a dermatologist evaluate moles that change, have irregular borders, unusual or uneven color, bleed, or itch.

Liver Spots

These pesky brown or gray spots are not really caused by aging, though they do become more common as people age. They're the result of sun exposure, which is why they tend to appear on areas that get a lot of sun, such as the face, hands, and arms. Bleaching creams, acid peels, and light-based treatments may lessen their appearance. To rule out serious skin conditions such as melanoma, see a dermatologist for proper identification.

Pityriasis Rosea

A harmless rash, pityriasis rosea usually begins with a single, scaly pink patch with a raised border. Days to weeks later, a scaly rash appears on the arms, legs, back, chest, and abdomen, and sometimes the neck. The rash, whose cause is unknown, isn't believed to be contagious and can be itchy. It often goes away in 6-8 weeks without treatment. Pityriasis rosea is most often seen between the ages of 10 and 35.