Rash - Patients ask Dr. Ringpfeil answers
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The word rash is a general term that can refer to a variety of skin eruptions. The symptoms or lack thereof, the appearance of the rash, location and duration are useful in arriving at a diagnosis.
Is the rash itchy? Typically rashes associated with eczema (atopic dermatitis) and contact dermatitis are known for being very itchy. A classic example of a contact dermatitis is a rash from poison ivy. If you have ever had a rash from contact with poison ivy you know that itching is a predominant feature. Plants are not the only source of a contact dermatitis. You can get contact dermatitis from metals, particularly nickel, from cosmetics and even from some topical medications such as Neosporin Ointment or Bacitracin. Avoiding continued contact with the offending agent is key. Treatment usually involves use of a topical anti-inflammatory agent such as a steroid cream.
Eczema (atopic dermatitis) is associated with a history of dry, sensitive skin. Often there is a personal or family history of asthma or seasonal allergies. Cleansing your skin gently with a soap free cleanser and moisturizing liberally and regularly are key to preventing eczema flares. When flares of itchy red areas on the skin do occur treatment with a topical steroid appropriate to the location on the body is often needed.
Rashes for which itching is not a predominant feature include psoriasis, fungal infections and viral exanthems. Psoriasis presents with red patches with silvery scale typically on elbows and knees. While psoriasis on these locations usually does not itch, psoriasis on the scalp can be itchy. Psoriasis often has a hereditary component. Treatment is based on how much skin is involved and can include use of topical steroids and Vitamin D analogues, light treatments, oral or injectable medications.
Fungal skin infections commonly known as ringworm appear as a ring of scaly red skin. Sometimes little bumps can be present along the edge. Itching is often present but not intense. Sometimes a skin scraping has to be taken to confirm the diagnosis. The problem can usually be treated with a topical antifungal medication.
Viral exanthems are rashes caused by a systemic viral infection. They usually are not itchy. These rashes tend to resolve with time without the need of treatment.
Appearance is another important clue in identifying a rash. A poorly defined area of scaly red skin often suggests eczema (atopic dermatitis), well defined thickened scaly plaques suggest psoriasis, scaly ring-like lesions suggest a fungal infection, pus-filled bumps suggest a bacterial infection, small blisters can indicate a viral infection like fever blisters or shingles; insect bites or contact dermatitis. Of course this is just a sampling of the many ways a rash can present and less common causes also need to be considered.
The location on the body provides a valuable clue. Common sites for a fungal infection are the groin and the feet; psoriasis often affects the elbows, knees and scalp; eczema (atopic dermatitis) commonly involves the inside of the elbow and the area behind the knee in children; fever blisters occur on the lips; rashes brought on by the sun affect sun exposed areas of the skin; seborrheic dermatitis affects hair bearing areas, ears and face.
Duration of the rash is an identifying characteristic. New onset itchy rashes may indicate a contact dermatitis whereas rashes that have come and gone over a period of months or years would more likely denote atopic dermatitis, psoriasis or seborrheic dermatitis.
These general guidelines can provide some clues to the diagnosis but rashes need to be seen and sometimes felt to arrive at an accurate diagnosis. It is recommended that you make an appointment with a trained skin care provider for assessment of your rash since different rashes can have a similar