ERUPTIONS! Dealing with Rashes

Although rashes can be very annoying, they are usually symptoms of conditions that range from simple conditions to life-threatening medical emergencies

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What is a Rash?

A rash is a change that occurs on the skin, altering either its color/appearance, and/or texture. Rashes have all sorts of local names that can be quite confusing and misleading and they are one of the commonest complaints in children as well as in some adults too. Their appearance may be any of these;

  • Macular — Flat, red spots
  • Papular — Small, raised, solid bumps
  • Macular and papular — A combination
  • Papulosquamous — A combination of papules and scaly areas
  • Vesicular — Small, raised, fluid-filled blisters

Although rashes can be very annoying, they are usually symptoms of conditions that range from simple conditions to life-threatening medical emergencies. The fact that a rash can be any color from red to purple in spite of the natural skin color makes them quite unique. They can itch, swell, crack, bleed, contain pus, become painful and even artistic in ways that suggest they may be following a pattern.

Rashes in Children

Childhood rashes, starting with diaper rashes can be difficult to differentiate by appearance alone and it is the job of the parent to document and the doctor to extract all possible information to reach a logical conclusion which is usually a differential diagnosis. The are considered;

  • The appearance
  • Location of the rash (where it started, the pattern of distribution)
  • The clinical course (Events that preceded the rash and factors that have changed)
  • Associated symptoms (itching, fever, pain)
  • Associated medical conditions (Diabetes, immunocompromising diseases, malnutrition, obesity)

Types of Rashes

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  • Roseola is a rash presenting after resolution of a high fever
  • Impetigo is a superficial bacterial infection that most commonly affects the face and extremities of children.
  • Erythema infectiosum is characterized by a viral prodrome followed by the “slapped cheek” facial rash.
  • Tinea is a common fungal skin infection in children that affects the scalp, body, groin, feet, hands, or nails.
  • Eczema: Atopic dermatitis is a chronic, relapsing inflammatory skin condition that may present with a variety of skin changes.

Commonest causes of Rashes

  • Allergies
  • Bacteria infections
  • Viral infections
  • Heat
  • fungal infections
  • other forms of hypersensitivity reactions

Conditions associated with rashes

Measles is a highly contagious infection caused by the measles virus. Initial signs and symptoms typically include fever, often greater than 40 °C, cough, runny nose, and red eyes (conjunctivitis).

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  • Two or three days after the start of symptoms, small white spots may form inside the mouth, known as Koplik’s spots.
  • A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms.
  • Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.
  • Complications occur in about 30% and may include diarrhea, blindness, inflammation of the brain, and pneumonia among others.
  • Rubella (German measles) and roseola are different diseases.

Chicken Pox is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in,

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  • characteristic skin rash that forms small, itchy blisters, which eventually scab over
  • It usually starts on the chest, back, and face then spreads to the rest of the body.
  •  Other symptoms may include fever, feeling tired, and headaches.
  • Symptoms usually last five to ten days. Complications may occasionally include pneumonia, inflammation of the brain, or bacterial infections of the skin among others.
  • The disease is often more severe in adults than children.
  • Symptoms begin ten to twenty-one days after exposure to the virus.

Scabies is one of the three most common skin disorders in children, along with ringworm and bacterial skin infections.The most common symptoms are

  • Severe itchiness and a pimple-like rash. Occasionally tiny burrows may be seen in the skin.
  • The symptoms of scabies are due to an allergic reaction to the mites.
  • Often only between ten and fifteen mites are involved in an infection.
  • Most often spread during a relatively long period of direct skin contact with an infected person such as that which may occur during sex.

Dermatitis, also known as eczema, is a group of diseases that results in inflammation of the skin.Dermatitis is a group of skin conditions that includes atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and stasis dermatitis.These diseases are characterized by

  • Itchiness, red skin, and a rash.
  • In cases of short duration there may be small blisters while
  • In long term cases the skin may become thickened.
  • The area of skin involved can vary from small to the entire body.

Ringworm, is a fungal infection of the skin.About 40 types of fungi can cause ringworm. Risk factors include using public showers, contact sports such as wrestling, excessive sweating, contact with animals, obesity, and poor immune function. Ringworm can spread from other animals or between people. Typically it results in

  • a red, itchy, scaly, circular rash.
  • Hair loss may occur in the area affected. S
  • ymptoms begin four to fourteen days after exposure.
  • Multiple areas can be affected at a given time.
  • Infections of the groin are more common in males
  • Infections of the scalp are most common in children 

Urticaria, or Hives, frequently occur following an infection or as a result of an allergic reaction such as to medication, insect bites, or food. Psychological stress, cold temperature, or vibration may also be a trigger.In half of cases the cause remains unknown.Risk factors include having conditions such as hay fever or asthma. The presentation may include

  • skin rash with red, raised, itchy bumps.
  • They may also burn or sting.
  • Often the patches of rash move around. Typically they last a few days and do not leave any long lasting skin changes.
  • The condition frequently recurs.
  • Prevention is by avoiding whatever it is that causes the condition.
  • Treatment is typically with antihistamines
  • Keeping the environmental temperature cool is also useful
  • Can be associated with anaphylaxis (which is life threatening)

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MANAGEMENT OF RASH

General

  • Cleaniness, wash your hands frequently, bathe regularly and avoid sharing clothing or personal grooming items with other people.
  • Check that you and your children are up-to-date in your routine immunizations.
  • Avoid the specific food, medicine, skin care products or cosmetics that you had a reaction to. Never take a medicine prescribed for someone else.
  • For diaper rash, change diapers as soon as they become wet or soiled. Make sure that your baby’s bottom is completely clean and dry before closing up the fresh diaper.
  • For sensitivity to chemicals in cleaning products, switch to laundry soaps and fabric softeners that are free of dyes and perfumes.
  • For irritation due to cosmetics, use hypoallergenic products that contain fewer skin-irritating preservatives and fragrances.

Specific

  • For people with skin allergies, they should always have anti-histamines on hand
  • Pityriasis rosea usually resolves spontaneously in two to 12 weeks without active treatment.
  • Although impetigo is often self-limited, antibiotics are commonly prescribed to prevent complications and spread of the infection
  • The use of emollients is recommended for children with atopic dermatitis. A very good one is shea butter and black seed oil!
  • Do not use oral antibiotics for atopic dermatitis unless there is clinical evidence of infection

Very specific

  • Consult a doctor, specifically, a dermatologist promptly if a rash:
    • Worsens
    • Lasts longer than one week
    • Shows signs of local infection (oozing, redness or swelling of the skin)
    • Occurs together with fever, chills, swollen glands or other symptoms of infection (sore throat, cough, headache, nasal congestion, etc.)
    • Occurs together with symptoms that suggest an autoimmune disorder, such as recurring fever, malaise, fatigue, unexplained weight loss or joint swelling

 

 

MORE SUGAR, LESS POWER! 

Generally, excessive intake of anything is wrong – even water. Sugar is not a bad guy par-say, in fact, we all need a certain amount of it daily, for proper functioning. But when you take too much of it, it becomes unhealthy. We should also note that all classes of food (carbohydrates, proteins, fat and oil…) are eventually broken down into tiny “sugar molecules”.
In healthy individuals, these molecules are well handled by the metabolic hormones – especially insulin. Problems start when you take more sugar (or eat more food) than your insulin can handle. The excess sugar molecules are then converted to “fat molecules” which are stored in the liver. There is also a limit to the amount of fat the liver can store. Any excess beyond that limit is pushed back into your system. They get lodged under your skin and around your internal organ; which begets obesity, diabetes etc.
The worst case scenario is when these fats lodge in the blood vessels, resulting in inflammation and disruption of blood flow, known as atherosclerosis. When this happens in the brain, it causes stroke; in the heart, it causes myocardial infarction (heart attack)…..
As we know that penile erection is all about blood rushing into the phallus, leading to engorgement and turgidity, imagine if anything should impede the flow of blood down there… Yes, you guessed right!
Looking at it from another angle, excessive sugary foods with low fiber content can result in constipation. Constipation will result in chronic straining of your pelvic muscles when you defaecate. This can lead to chronic backache. Weakness of pelvic muscles plus backache will reduce your ability to perform pelvic thrusting during the act of coitus…
The only solution (and prevention) is to eat right. Alcohol, energy drinks and herbal concoctions will only give you a temporary illusion of well-being. They may, in fact, worsen the situation. So, yeah, eat and drink, but do so with moderation. 

​SAVE A SOUL SERIES: PART 3 – MOVE SAFELY TO SAFETY

After giving first aid or attempting CPR, the next step you want to take naturally, is to move the victim to the hospital. In places where emergency/ambulance services are not readily available, the task of moving victims of accidents and other acute events to the hospital is left to laypeople who may not have any training or experience in doing so. Over-enthusiastic carrying or moving can cause more harm than good; such as paralysis and death in case of spinal cord injuries. 
Here are some useful tips…
*Always keep the head and neck as stable as possible. Especially in road traffic accidents, always assume that the victim has a head/spinal cord injury until proven otherwise. If he has an helmet on, do not remove. Support the neck by stabilizing in-between two towels or pillows. While moving into a vehicle, someone should always hold the head in alignment with the rest of the body. 

*Drag (or roll) rather than lift. 

This is safer for the victim and less stressful for the volunteers moving him. Quickly scan through the victim’s body and check for signs of injuries especially, bone fractures. If he is injured in the arms, drag him by his legs and vice versa. Again, secure the head and neck before dragging. If he is injured in both arms and legs, then drag him by his clothes. However, if he is a small-stature adult or a child, you can carry him in your arms like a baby (cradle method) or on your back (backpack method) 


*Lift in one block. 

If the victim is unconscious or totally paralyzed, move him in one block. To do this, you need at least 4 volunteers: someone to support and lift the head and neck, two people by his sides, to lift him at the trunk and buttocks, and one person to lift the legs. The lead person should count to 3 and everyone should lift at once. Leaving the neck or buttocks sagging can cause or worsen spinal cord injury. Gently transfer the victim onto a strecher or wooden plank to keep his body horizontal. 


*If you suspect a fracture in any limb, stabilize it with a splint, using a wooden or metallic board to keep the bones together and prevent further damage. If there is obvious bleeding, apply pressure on the wound using a clean cloth. 

*Appropriate vehicle. 

Ambulances are designed to keep accident and emergency victims in proper posture until they reach the hospital. In the absence of an ambulance, it is important to maintain this posture as much as possible. If the victim is conscious and can ambulate, he can be moved in any vehicle but he must be well secured with a seat belt and he should be flanked by two people on both sides. If he is unconscious or paralyzed, he must be moved in and out of the vehicle in one block as described above. The body should be kept horizontal with a slight tilting of the head to the side (unless there is neck injury) to prevent aspiration. 

*If the victim is bleeding, or has bled considerably, elevate (not bend) the lower part of the body to an angle of about 30 degrees. This will help to redirect blood flow to the brain and prevent brain death or permanent brain damage. If she is a pregnant woman, let her lie on her left side or tilt the pregnant uterus away from the center of the abdomen. This will relieve the pressure of the uterus on the major blood vessels, thereby enhancing blood flow to the mother’s vital organs. 

SAVE A SOUL SERIES: PART 2 – FIRST AID FOR CHOKING 

Choking occurs when a solid object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, it could be a piece of food and in children, it’s usually a small piece of food or toy. Because choking cuts off oxygen to the brain, first aid must be done as quickly as possible. 

Signs of choking include:

  • Clutching the neck and trying to retch
  • Difficulty breathing or noisy breathing
  • Inability to cough forcefully
  • Skin, lips and nails turning blue or dusky
  • Loss of consciousness

The Red Cross recommends a “five-and-five” approach to delivering first aid:

  • Give 5 back blows. First, deliver five back blows between the person’s shoulder blades with the heel of your hand.
  • Give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich maneuver).
  • Alternate between 5 blows and 5 thrusts until the blockage is dislodged.

According to the American Heart Association, it’s OK not to use back blows, if you haven’t learned the technique. Both approaches are acceptable. They recommend  the abdominal thrusts only (Heimlich maneuver) 

  • Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
  • Make a fist with one hand. Position it slightly above the person’s navel.
  • Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
  • Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn’t dislodged, repeat the five-and-five cycle.

If you’re the only rescuer, perform back blows and abdominal thrusts and then call for help or move the victim to the nearest health center. If another person is available, have that person call for help while you perform first aid.

If the person becomes unconscious, perform standard CPR with chest compressions and rescue breaths.

To perform abdominal thrusts (Heimlich maneuver) on yourself:

First, if you’re alone and choking, call for help immediately. Then, although you’ll be unable to effectively deliver back blows to yourself, you can still perform abdominal thrusts to dislodge the item.

  • Place a fist slightly above your navel.
  • Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
  • Shove your fist inward and upward



To clear the airway of a pregnant woman or obese person:

  • Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.
  • Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.
  • Repeat until the food or other blockage is dislodged or the person becomes unconscious.

To clear the airway of a choking infant younger than age 1:

  • Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
  • Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
  • Hold the infant faceup on your forearm with the head lower than the trunk if the above doesn’t work. Using two fingers placed at the center of the infant’s breastbone, give five quick chest compressions.
  • Repeat the back blows and chest thrusts if breathing doesn’t resume. Call for emergency medical help.
  • Begin infant CPR if one of these techniques opens the airway but the infant doesn’t resume breathing.


If the child is older than age 1, give abdominal thrusts only.

***To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course. 

BASIC CPR FOR EVERYONE 


*Tap the victim or call his name if known, to find out if he is conscious or not. 

*If he is unconscious, look at his chest and place your ear close to his heart to check if he is still breathing.


*If the above are negative, immediately shout for help

*Call the local emergency number, or immediately start arrangements to transfer the victim to the nearest health center. 

*Put the person on his back and kneel next to his neck and shoulders. 

*Place the heel of one hand over the center of the person’s chest, between the nipples. 

*Place your other hand on top of the first hand. 


*Keep your elbows straight and position your shoulders directly above your hands. 

*Use your upper body weight (not just your arms) as you push (compress) about 5cm deep. 

*Push hard at a rate of about 100 compressions a minute. 

*If you haven’t been trained in CPR, continue chest compressions until there are signs of movement or until a trained medical personnel takes over. 

*If you have been trained in CPR, go on to checking the airway and perform rescue breathing (kiss of life). 

*1 breath should be given for every 30 chest compressions. 


*In children, same procedure should be followed except that only one hand should be used for chest compression (only two fingers in babies) and 1 breath is given for every 15 chest compressions. This is to prevent rib fractures.

FIRST AID 101 

Hands up if you have a first aid kit at home! Well, I can’t see any hands but my guess is that most people either don’t have it at all, or they have it but they don’t stock it with all the essential contents. A first aid kit is a must for every home, school, mosque, church and office. It should contain everything you need to treat minor injuries and ailments. It can also be tailored towards your family needs. For example, if you have an asthmatic patient in your home, you can keep an extra inhaler in there. Emergencies don’t happen everyday but at least, common things occur commonly; things like cuts, bruises and sprains can be managed at home without any need for further expert care. 

 
So, what are the basic contents of a first aid kit?

 
*plasters of different sizes and shapes

*sterile gauze

*at least two sterile eye dressings

*cotton wool or cotton buds

*triangular bandages

*crêpe rolled bandages

*safety pins

*disposable gloves

*tweezers

*scissors

*alcohol-free cleansing wipes

*methylated spirit or alcohol wipes

*povidon iodine (betadine) 

*antibiotic ointment (eg. fucidin)

*sticky tape

*thermometer (preferably digital)

*skin rash cream, such as hydrocortisone or sudocream or spray to relieve insect bites and stings

*antiseptic cream 

*analgesic gels or balm (eg. Neurogesic, olfen gel) 

*painkillers such as paracetamol (or infant paracetamol for children), aspirin (not to be given to children under 16), or ibuprofen

*Oral rehydration salts (ORS) for management of diarrhea 

*cough syrup 

*antacids (chewable or suspensions) 

*antihistamine tablets (loratadin or piriton) 

*distilled water for cleaning wounds

*eye wash and eye bath

*activated charcoal and ipecac: to be used with extreme care (in case of acute drug overdose) 


***Always read the information leaflets that come with medicines before you use. 

***Always check the expiry date on your supplies and discard as appropriate.

***Always keep your first aid kit out of reach of children.

THOSE ANNOYING PIMPLES THAT WON’T GO AWAY… 

Severe acne shouldn’t be taken lightly as it may result in serious psycho-social problems, like depression and suicidal ideation

Everyone wants an acne-free face: cheeks as smooth as that of a baby! Unfortunately, those annoying bumps begin to appear at adolescence, and up to 12% of women and 5% of men aged 25 years, will continue to have various degrees of acne on the face (sometimes extending to the chest and back). Severe acne shouldn’t be taken lightly as it may result in serious psycho-social problems, like depression and suicidal ideation.

Genetics plays a major role in the development and severity of acne. However, several causative or risk factors have been identified.
*Cosmetic products – such as pomades

*Certain drugs – eg, steroids, lithium, antiepileptics

*Hormonal imbalance – as in pregnancy

*Hormonal disorders – eg. Polycystic ovary disease (PCOS)

*Excessive exposure to sunlight

*High-fat, high-carb diet – fries, sugary drinks etc
The process of formation of acne is as follows:
1. Excess sebum production.

Sebum is an oil-based fluid produced in the sebaceous glands within the skin. It’s promoted by androgens (testosterone); which explains the preponderance in adolescent boys and adult ladies with abnormally high testosterone level.
2. Colonization by bacteria.

Excessive accumulation of sebum enhances the growth of Propionibacterium acnes, which causes inflammation and pustules.
3. The release of inflammatory substances into the skin.

This causes redness, pain, swelling and warmth. It’s advisable to avoid “popping” the pimples at this stage as it may worsen the inflammation.
4. Excessive thickening of the skin (hyperkeratinization).

This manifests in different grades(grades I – IV) as:

*Comedones- whiteheads and blackheads.

*Papules- reddish bumps of varying sizes

*Pustules – bumps containing pus

*Combination of the 3 above with scarring and darkening
**Darkening is worse in dark-skinned individuals, especially when the pimples are popped prematurely.

TREATMENT
*It’s important to be sure that what you have is simple acne and not some other acne-like diseases or infections. Don’t feel shy to talk to a physician or skin specialist. AVOID SELF MEDICATION.

*Do not take drugs without knowing the correct dosage and possible side effects to expect. In pregnancy, oral and injectable drugs are best avoided.

*Topical agents are preferred. Oral and injections are reserved for moderate to severe cases. Topicals come as soaps, creams, lotions and gels.

*A combination of two or more classes should be used for optimum results.

*Medications include: retinoids (eg. Tretinoin), antibiotics (eg. Clindamycin), anti-inflammatory (eg benzoyl peroxide), spironolactone (in cases of high androgen levels)

*Psychotherapy might be helpful for chronic sufferers.

*Surgical intervention, such as laser surgery can be offered in selected cases.

*Herbal remedies and natural therapies can be used as adjuncts. Excellent examples are aloe vera, cucumber and lemon juices, honey and vinegar.

To prevent recurrence and worsening…

*Practice excellent personal hygiene. Wash the affected areas twice daily using simple soaps (avoid harsh soaps), lukewarm water (not hot) and dab with clean towel (avoid vigorous scrubbing)

*Traumatic procedures such as shaving, piercing and tattooing should be avoided as much as possible.

*Modify your lifestyle by eating a healthy diet, exercising daily and stress management.