What the Rash is That?!

Scabies Rash

Rashes really freak people out and make up a decent percentage of all urgent care telemedicine complaints.  There are several studies finding that rash diagnosis by telemedicine is just about as good as an in-person evaluation.  Another recent study published in the Journal of the American Medical Association (JAMA) Dermatology shows that medical providers evaluating a rash either by smartphone photos or in-person would agree on the diagnosis about 83% of the time.  The study’s conclusion is that photos are a reliable source on which to base a rash diagnosis.  83% is quite good considering that even if you have two doctor’s in the same room looking at the same rash you are not going to have agreement.  

The following slideshow goes over 16 commonly seen skin rash diagnoses based upon a review of prior case history of Care on Location. 

Hope you aren’t eating while viewing the slideshow as some of the rashes may decrease your appetite.  Here goes:

Cold Sores [1/16]

Blistering painful sores and itching usually on the lips that can be brought on by stress, illness, sun exposure and menstrual periods.  Caused by a type of herpes virus (but not the one you might be thinking of) called Herpes Simplex Virus Type 1 (HSV 1), initial exposure is usually from someone else that has the virus.  Those infected do not need to have an active sore in order to spread it.  Some common sources of spread include eating from the same utensils, sharing of lip balm, or kissing.  Treatment is not always necessary as they usually go away on their own.  However, you can start your own treatment with over-the-counter anti-viral cold sore ointment.  You may need prescription antivirals if the over-the-counter method does not work.  There is no cure for the virus and you will carry it in your body for the rest of your life any you may or may not get further outbreaks. 

Cold Sore - Herpes labialis
Cold Sore

Skin Fungal Infections [2/16]

There are various forms of fungal skin infections.  These infections have several names based partly on where the infection is on the body.  Some examples include “jock itch”, “athlete’s foot”, “ringworm”, and “toe fungus”.  Yummm!  They can be spread person to person, animal to person, object(like hair brushes) to person, and occasionally soil to person.  These rashes are usually itchy, flaking areas of skin, occasionally in a circular shape.  Sometimes blisters or pus-filled sores appear on the edge of the rash.  Luckily, these infections are rarely serious for most people.  The treatment can begin with over the counter anti-fungal medications but a stronger skin prescription medication or pill may be needed to get rid of the infection.

Ringworm, Tinea Corporis
Ringworm, Tinea Corporis

Chickenpox [3/16]

Usually an infection of childhood that rarely occurs more than once.  Before the rash starts, there may be some other symptoms like fever, headache, and loss of appetite.  Then the classic rash begins with red or pink bumps all over the body followed by blisters full of clear fluid that often break open. Then the bumps and blisters scab over as they begin to heal.  This rash could be very itchy particularly as it starts to heal which usually takes a week or two.  The virus is considered contagious until all the blisters have crusted over.  During the infection it can be spread through coughing, sneezing, and contact with the fluid in the blisters.  This rash caused by Varicella Zoster Virus which is the same one that causes shingles.  In certain individuals like infants, older adults, people with weak immune systems and pregnant women, complications can become serious.  Chickenpox symptoms of itching skin can be treated with lukewarm baths, calamine lotion, and it helps to have light, soft clothing on.  Doctor’s may prescribe anti-viral drugs which while it does not cure chickenpox, it does make the symptoms less severe.  Luckily, we do not see chickenpox as much as decades ago because of the use of a chickenpox vaccine which is effective in preventing the disease in 98% of people who receive it.

chickenpox, varicella
Chickenpox , Varicella

Hand-Foot and Mouth Disease [4/16]

Another skin rash that is most common in children.  The rash usually does not just appear but is usually preceded by a fever and sore throat.  Then a day or two later by painful red blisters in the mouth and possibly a red rash on the palms of the hands and soles of the feet.  Caused by a virus which is usually a strain of coxsackievirus, it has no specific cure.  The infection may take a week or so to completely go away, but it generally will on its own.  In the meantime, using skin ointments to soothe blisters and rashes, taking acetaminophen or ibuprofen, and medicated sprays or lozenges for the mouth sores can help get some of the symptoms under control.  Cool, soft foods and drinks can often be tolerated better than hot, spicy, acidic, or crunchy things.  This infection is also generally a one time deal and rarely happens again during the course of someones life.  Getting it looked at may be worthwhile if there is any concern of it being something more serious like a drug reaction or a tick bite related illness.

Sores and Blisters on Palm of Hand from Hand, Foot, and Mouth Disease, coxsackievirus

Slapped Cheek or Fifth Disease [5/16] 

You don’t engage in child abuse, but in this situation it looks like you have been slapping your child in the face.  Before the rash there may be headache, low-grade fever, sore throat, fatigue, and nausea.  Then a few days later a red rash that first appears on the cheeks and often then spreads to the arms, legs, and chest/back.  The rash is more common in children than adults and may appear as a hot red race which does look like someone had slapped them, hence the common name.  Parvovirus B19 is the underlying cause of the symptoms.  There is no cure or other medication that will shorten the course.  Occasionally, particularly in adults, the infection can cause joint inflammation and be quite painful.  In this situation, ice, acetaminophen, and ibuprofen may be needed to help calm down the joint pain.

Pityriasis rosea [6/16] 

Looking fairly similar to Ringworm initially, this usually starts off with a single, large pink oval-shaped patch that clears in the center and gets scaly on the edges.  This patch is known as the “herald patch” as it heralds or signals the onset of a bunch of smaller pink patches all over the upper body that will start about one to two weeks later.  The rash is occasionally itchy and it normally clears up on its own over the course of 2-3 months.  This is believed be to due to a virus because there are sometimes some mild cold-like symptoms of headache, sore throat, and just not feeling well before the rash appears.  Generally, treatment is not needed but sometimes some anti-histamines or prescription steroid creams are used for the itching.  In severe cases, the use of prescription acyclovir has been shown to speed up the process of healing.

Pityriasis Rosea
Pityriasis Rosea

Intertrigo [7/16] 

Inflammation of the skin folds, particularly the armpits, groin area, under breasts, and in-between those skin folds.  It often starts off are small red bumps in these areas, then red raised patches that can start to get moist and weep fluid which can get very raw with some skin breakdown and crusting on top.  Sometimes this is simply caused by the moisture and some friction leading to skin breakdown.  But other times it can be due to a fungal or bacterial infection.  So treatment for mild cases can simply be to keep the skin dry and exposed to the air.  For more significant cases an antibiotic or anti-fungal cream may be needed.

Axillary intertrigo
Armpit intertrigo

Cellulitis [8/16]

Bacterial skin infections of the skin is cellulitis.  The skin is becomes red and swollen and may feel warm and tender to touch.  Occasionally the skin starts to look tight and glossy. Cellulitis is usually limited to the surface of the skin but can spread deeper causing a pus collection called an abscess and can also lead to major problems including bloodstream infections that could be life-threatening.  The bacteria can get into the skin from breaks in the surface such as from cuts, scratches, eczema, or puncture wounds.  This infection requires early diagnosis as it will need to be treated with antibiotics to prevent it from becoming more serious.

Skin infection of leg, cellulitis

Impetigo [9/16]

A common, highly contagious bacterial skin infection that mainly affects infants and children.  It is very common on the face, usually starting off as red bumps clustered together and then they develop blisters, oozing, and forming a yellowish crust.  Luckily this infection, caused by a Staph or Strep bacteria, is usually easily treatable just with antibiotic ointment which can be obtained over-the-counter at the local food or drug store.  Occasionally some treatment is needed for pain and itching plus an antibiotic prescription might be needed in some circumstances.

Impetigo

Contact Dermatitis [10/16]

Sometimes something that comes into contact with our skin just doesn’t agree with us.  There are two general categories of contact dermatitis, allergic and irritant.  Allergic contact dermatitis occurs when the body develops an allergic reaction to something that  touched the skin.  Examples here include nickel in necklaces or latex gloves.  The skin becomes red, itchy, sensitive and can appear dry, flaky with blisters or darkening.  Hives may develop as part of the allergic reaction.  With irritant contact dermatitis, the skin comes into contact with something that is directly toxic to the skin.  Examples here include poison ivy, bleach, detergents, and pepper spray.  The skin may appear similar to allergic contact dermatitis but is more prone to blistering, cracking, and open sores.  Contact dermatitis is treated by removing the irritating cause when it can be identified and cleaning the skin with mild soap and water.  Keep an eye open for signs of a secondary bacterial infection developing from any breaks in the skin surface.

Contact Dermatitis from Poison Oak, Ivy, or Sumac

Drug Rash [11/16]

Many people list allergies to medications.  The reality is that true allergic reactions are relatively rare. But for those drugs that cause true allergic reactions, antibiotics are to blame most of the time.  The most common sign of an allergic reaction to a drug is the development of a rash.    The rash can range from mild redness and itching to large areas of red bumps or red patches.  As the skin reacts more in certain areas hives develop.  In severe situations, angioedema occurs where the skin swells.  If this occurs around the neck, lips, tongue, or throat, things can go bad pretty quickly.  It is best to catch the symptoms early and begin treatment quickly.  At home, start with taking antihistamines like diphenhydramine.  Also, the stomach acid-reducing medicines Pepcid and Zantac have some anti-histamine properties and can also be used to help treat the symptoms.  Beyond that, prescribed steroids help tell the immune system to calm down.  For anything beyond an isolated mild to moderate skin reaction, it is best to go to the nearest Emergency Room as IV medications will possibly be needed.  

Drug reaction, exanthum
Drug reaction

Bites and Stings [12/16]

Every now and then bites and stings can lead to skin infections and allergic reactions but most just need some treatment of the annoying symptoms and they will go away on their own.  There are numerous bites and stings that can cause skin issues including mosquito bites, biting flies and fleas, ticks, spiders, ants, bed bugs, lice and scabies mites.  Determining exactly what caused the bite or sting by looking at the rash is not always possible but there are certain patterns that provide a clue.  This is particularly true to certain spiders and ticks.  Scabies and bedbugs also often have a pattern that helps identify them to then allow for a determination of best treatment. Identification of a scabies rash may result in a prescription to try and kill that mites that cause the reaction. Certain ticks can spread disease and identification of the tick and where it was encountered can help inform whether or not an antibiotic is needed.  The classic Lyme Disease rash is a bull’s eye rash at the site of the initial bite, although seeing this rash is relatively rare.  For spiders, the three in the US that deserve special attention are the Brown Recluse, the Black Widow, and the Hobo Spider.  For any spider bite that does anything more than leave a small bite mark, it is worth having it looked at.  A known Black Widow bite should probably be looked at immediately. 

Brown Recluse Spider Bite
Brown Recluse Spider Bite

Methicillin Resistant Staph Aureus (MRSA) [13/16]

A bacterial skin infection that can either be hospital-acquired or community-acquired.  Hospital acquired MRSA is more likely to lead to more serious complications such as pneumonia, deep skin infections, and bloodstream infections.  This bacteria can be tougher to treat because it is resistant to the most commonly used antibiotics.  They usually start off a swollen, painful red bumps that might resemble a spider bite.  The could be warm to touch and develop into pus collections that need to be drained.  Those most at risk for this include people that live in crowded conditions like school dorms, military barracks, or prisons and those with more skin-to-skin contact such as wrestlers.  Treatment is with select antibiotics to which these bacteria are still considered sensitive to.

Methicillin Resistant Staph Aureus (MRSA)
Methicillin Resistant Staph Aureus (MRSA)

Hives [14/16]

Also known as Urticaria.  Hives are the manifestation of an allergic reaction where the skin becomes red, and itchy with often raised patches with well-defined borders.  As a component of allergic reactions, this can progress into a full-blown anaphylactic reaction including swelling of tongue and throat, which can lead to death if not managed quickly.  Mild hives can be treated with antihistamines and the stomach acid-reducers like Pepcid or Zantac that also have antihistamine functions.  For those with a history of allergic reactions, they may already have an epinephrine injectable pen prescribed to them.  This may be used at home for more than mild reactions that may be progressing to a more dangerous reaction.  Further treatment requires an in-person evaluation for potential IV medications.

Hives or Urticaria on the stomach
Hives or Urticaria on the stomach

Scarlatiniform Rash (Scarlatina) [15/16]

This rash is associated with Strep throat.  A bright red rash that may feel like fine sandpaper on the skin and may look like a sunburn. After the rash expands, the skin then begins to peel. Treatment for the rash may not be needed but treatment for the strep throat will be.  This rash itself is generally not dangerous but those with Scarlitina my be more likely to get rheumatic fever which can have serious consequences.

Scarlet Fever, Scarlatiniform Rash in Child
Scarlet Fever, Scarlatiniform Rash in Child

Shingles [16/16]

Pain, burning and sometimes itching that starts on only one side of the body and progresses to a red rash followed by fluid-filled blisters that break and then crust over.  This is caused by Varicella Zoster Virus also called Herpes Zoster which is the same virus that causes Chickenpox.  The rash normally follows a single-sided limited area starting at the spine and working its way towards the front of the body.  Rare but serious complications include the rash affecting the eye or the eardrum resulting in vision or hearing loss.  Also, a bacterial infection of the skin could develop from the open skin where the blisters have broken.  Treatment includes anti-viral medications, anti-inflammatories, anti-histamines for itching, numbing anesthetic skin applications, capsaicin for nerve pain and occasionally anticonvulsants or antidepressants that are used to treat longer term pain.

Shingles on chest, also known as Herpes Zoster
Shingles on chest, also known as Herpes Zoster

The above slideshow rashes are just a few of the variety of skin conditions that can be evaluated and treated through a thorough telemedicine evaluation.  Being able to provide a good history about the rash helps significantly in getting a correct diagnosis and treatment recommendation.  Based on experience and research so far, don’t hesitate to start your rash diagnosis search through a telemedicine evaluation.  Those dermatology appointments are often costly and the next appointment could be months away whereas a telemedicine evaluation is inexpensive and usually requires little to no wait.