Skin Rash
That rascal rash
Skin rashes take many forms and few of us escape a brush with one, from irritating diaper rash to a maddeningly itchy patch of poison oak or ivy. Some are contagious, others are not. Some are minor requiring little or no treatment, while others can be serious and even lifethreatening.
Combating skin rashes involves identifying its causes and working with a doctor to treat it once it has formed. Because there are so many types of rashes and treatments, it is important to consult a doctor for the right course of treatment. With a little luck, relief will soon be on the way.
Synonyms and Abbreviations
- Dermatitis
- Atopic dermatitis
- Eczema
- Disseminated neurodermatitis
- Atopic eczema
- Atopic neurodermatitis
- Constitutional dermatitis
- Besnier's prurigo
- Contact dermatitis
- Dermatitis venenate
- Diaper rash
- Exfoliative dermatitis (pityriasis rubra)
- Erythroderma
- Herpetiformis dermatitis
- Duhring's disease
- Seborrheic dermatitis
- Tinea capitis
- Tinea cruris
- Stasis dermatitis
- Gravitational eczema
- Varicose eczema
- Venous dermatitis
- Dermatitis medicamentosa
Detailed Description
Skin rashes are generally characterized by red, inflamed areas of skin, minor to severe itching, small open sores, dry, cracking skin, and small, raised areas called papules.
Rashes range in severity from minor episodes that can heal on their own to extremely serious and potentially life-threatening conditions. Breakouts of diaper rash and heat rash are usually not serious, though very uncomfortable. More serious episodes, such as an outbreak of chickenpox in an adult, can be very serious and lead to dangerous complications.
Rashes that fall into the "contact" and "allergic" categories can be avoided once the cause is determined. Knowing what poison ivy looks like and being sure not to touch it, or avoiding certain foods that trigger reactions, can help prevent many skin rashes.
Because there are so many types of rashes, seeking a doctor's advice is recommended. With visual examination and an understanding of the events prior to the appearance of the rash, a doctor can prescribe proper treatment for the specific rash.
Rashes typically fall into one of five categories:
- Contact: including poison oak, poison ivy, or poison sumac
- Allergic: exposure to such things as antibiotics or food to which you may be sensitive
- Infectious: such as chickenpox
- Inflammatory: from rheumatological diseases like lupus
- Idiopathic: of unknown origin
Some of the more common skin rashes:
- Chickenpox (varicella-zoster)
- Shingles (herpes zoster)
- Diaper rash
- Heat rash
- Poison oak, ivy, or sumac
- Secondary bacterial infections related to staphylococcus, streptococcus, or yeast on the skin
- Eczema or extremely dry skin
How Common Is Skin Rash?
A skin rash will affect almost everyone at some point in their life. All age groups are affected. Different types of rashes will be more prevalent in certain age groups. There is no difference in prevalence between the sexes.
What You Can Expect
The expected course of a skin rash will vary depending on the type of rash. If left untreated, some will eventually disappear while others may become or lead to secondary infections.
Established Causes
Contact with allergens or irritants is a known cause of skin rashes. Some types of rashes, like athlete's foot, ringworm, and jock itch, are caused by fungi. Others, like chickenpox, are caused by viruses.
Theoretical Causes
The causes of many other skin rashes are unknown. However, a genetic predisposition is suspected.
Risk Factors
Numerous risk factors exist because of the variety of skin rashes. The list below details many of these factors.
- Family history
- Contact with an allergen or irritant
- Occupation which constantly brings you in contact with irritants or allergens
- Stress
- Immunosuppressive drugs (drugs which suppress your body's natural defenses)
- Immunosuppressive conditions
- Climate
- Oily skin
- Infrequent cleaning of hair
- Presence of other skin disorders, such as acne
- Obesity
- Use of drying toners
- Travel
- Pregnancy
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
The following are general signs. You may have one, some, or all of the following:
- Itching at the affected area
- Redness
- Dryness of skin
- Cracks and/or fissures
- Flaking
- Pain
- Blisters
Conditions That May Be Mistaken for Skin Rash
It may be difficult for a physician to distinguish between the many types of skin rashes and their causes. The following are causes of skin rashes which a physician must wade through to achieve a diagnosis:
- Atopic dermatitis
- Contact dermatitis
- Psoriasis
- Tinea (ringworm)
- Scabies
- Chickenpox
- Syphilitis
- Herpes simplex
- Seborrheic dermatitis
- Histiocytosis S
- Wiskott-Aldrich syndrome
- Ichthyosis vulgaris
- Candidiasis
- Letterer-Sixe disease
- Acrodermatitis enteropathica
- Eczema
How Skin Rash Is Diagnosed
Skin rashes are usually self-diagnosed. Physicians also make most of their diagnoses on clinical symptoms. However, they may also use the tests listed below.
- Patch test: to check for allergic reactions
- Blood test: to check white blood cell count
- Sedimentation rate (check for specific antibodies): may give insight into the presence of an underlying condition such as lupus
- Culture: to determine if the causative factor is a microorganism
- Scrapings: to check for a fungus
- Biopsy (rarely)
Goals of Treatment
Most skin rashes can be effectively treated at home. Whether or not a skin rash can be cured depends on the type of skin rash and its cause. If it is being caused by something under your control-- such as contact with poison oak-- simply stay away from that substance.
The treatment is working if you experience a reduction in the rash's inflammation and itching.
If you can't control the rash, consult a family physician, dermatologist, pediatrician, internist, or allergist.
Drug Therapy
Drugs most commonly prescribed
Drugs of choice include the following:
- Hydrocortisone or other topical steroids
- Oral antihistamines, to relieve itching (such as Benadryl)
- Calamine
- Oatmeal creams or baths
- Chamomile compresses
- Anti-inflammatory agents (such as Advil, Tylenol)
Second choices
If alternatives are needed for more severe cases, systemic steroids like prednisone may be taken over short periods of time. For stubborn localized eczema, intralesional steroids may be administered.
Activity and Diet Recommendations
Remember that some rashes, such as chickenpox and poison oak, are contagious and can be spread through air or touch. Keep linens and clothing separate and keep the infected areas as clean as possible. Try to avoid direct contact with people who may be susceptible to infection.
Special Diets
Because some rashes can be caused by an allergic reaction to food, avoid those that might cause such a reaction.
Possible Complications
Avoid scratching, which may cause scarring or secondary bacterial infection.
Considerations for Women
Pregnancy
Always check with a doctor before applying any creams or ointments while pregnant or lactating, since the skin can absorb medications into the bloodstream. This includes over-the-counter medications.
Nursing mothers
Always check with a physician if taking medication while breastfeeding.
Considerations for Children and Adolescents
Children can be vaccinated against chickenpox as young as 12 to 18 months. It is recommended they be vaccinated before age 13.
Contrary to popular belief, diaper rash is not a sign of neglect. This common infant rash can be an allergic reaction or just simply an irritation of the skin. Cleansing with water and soft cloths instead of disposable wipes can help. It is also helpful, when appropriate, to allow open-air exposure to the affected area.
Considerations for Older People
Some older people are hypersensitive and responsive to medications. The skin is a porous organ and transmits medications through it into the bloodstream. Check with a doctor before using over-the-counter medications, to ensure the correct dosage.
Current Therapies Available
For chickenpox:
- Children and adults can be vaccinated against chickenpox
- Medications such as acyclovir may be used to reduce the severity and duration of chickenpox in otherwise healthy individuals
For diaper rash:
- Change diapers often
- Avoid allergic agents that have led to diaper rash in the past
- Clean areas with a soft cloth and water, then apply a "diaper-area ointment" that contains either zinc oxide or petroleum jelly, such as Desitin or Vaseline.
- Consult a pediatrician before using any type of cortisone cream
- Avoid fragranced products
For heat rash:
- Take a cool bath and allow skin to air or "drip dry"
- Applications of an alcohol-free, menthol-based lotion may help soothe the skin
- Topical over-the-counter cortisone is safe and effective
Herbs
Jewelweed is the herb of choice for poison plant rashes. Several studies demonstrate its effectiveness. In one, researchers exposed 115 volunteers to the irritant chemicals in poison plants, then wiped the exposed areas with bruised jewelweed leaves. Instead of a week or more of itchy rash, 108 of the group were rash-free in just three days. [1]
Homeopathy
For poison plant rashes, homeopaths often prescribe Rhus tox, a microdose of poison ivy. They might also recommend other medicines or calendula ointment.
Homeopathic medicine is based on the idea that some conditions can be cured by administering tiny amounts of drugs or substances that, in a healthy person, would produce symptoms like that of the disease -- thereby working with, not against, the body's natural defense systems.
Purchase commercially prepared homeopathic medicines, or visit a professional; do not attempt to mix your own, as many of the substances are dangerous in more than tiny amounts.
[1] Duke, J. The Green Pharmacy. Emmaus, PA: Rodale Press, 1997.
Preventing Skin Rashes
- Rashes may indicate a sensitivity to an irritant such as a new detergent, chemicals, nickel, or epoxy. See if you can correlate your rash to some substance and then see if avoiding that substance helps. Being aware of the substances in and around your home may help you avoid those that cause adverse reactions.
- Rashes may indicate a food intolerance. An elimination diet -- which involves eliminating suspect foods and then gradually re-introducing them to see if they cause a reaction -- may help.
- Rashes made up of fluid-filled blisters suggest a poison plant: poison ivy, oak, or sumac. Learn which of these plants grows in your area and avoid contact. Be aware that blisters could also be a herpes infection, shingles, or a staph infection such as impetigo.
Self-Care Measures
- If you have a skin rash, maintaining proper hygiene may help speed your recovery.
- Skin lotions -- for example, calamine -- are standard home remedies for rashes.
- Bathing can soothe the itching of rashes. Try adding Aveeno powder (finely ground oatmeal) to your bath. Use one or two cups per bath. Or try baking soda. Use one-half to one cup of it per bath.
- Homeopathy and some herbs may be helpful for skin rashes. Learn more in Skin Rashes: Alternative Care.
Websites & Organizations
American Academy of Allergy, Asthma & Immunology
611 East Wells St.
Milwaukee, WI 53202
Phone: 414-272-6071
American Academy of Dermatology
930 N. Meachum Road
P.O. Box 4014
Schaumburg, IL 60168-4014
American Skin Association
150 East 58th Street, 32nd Floor
New York, NY 10155-0002
Phone: 212-753-8260
Contact Dermatitis and Contact Urticaria
Dermatology Foundation
1653 Maple Ave
Evanston, IL. 60201
Phone: 312-328-2256
Healthline
Health World
The Society for Investigative Dermatology
Suite 340, 820 West Superior Avenue
Cleveland, OH 44113-1800
Phone: 216-579-9300
Fax: 216-579-9333
E-mail: SID@SIDNET.org
Society for Pediatric Dermatology
5422 North Bernard
Chicago, IL 60625
Phone: 773-583-9780
Fax: 773-583-9765
Women's Dermatologic Society
930 North Meacham Road
Schaumberg, IL 60173
Phone: 847-330-9830
Fax: 847-330-1090
Email: kward@aad.org
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