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

 

 

Author: Dr Ahmad Abdullah, MBBS, MSc Clinical Pathology

Ahmad is a father, a husband and a poet. He was born and raised in Lagos, Nigeria. He earned his medical degree from the University of Juba, currently in South Sudan. He is interested in medical research and currently practicing in Lagos, Nigeria.

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