Rash

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Rash
A typical rash

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]]

Overview

A rash is a change in skin which affects its color, appearance, or texture. A rash may be localized to one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, dry, cracked or blistered, swell and may be painful. The causes, and therefore treatments for rashes, vary widely. Diagnosis must take into account such things as the appearance of the rash, other symptoms, what the patient may have been exposed to, occupation, and occurrence in family members.

The presence of a rash may aid associated signs and symptoms are diagnostic of certain diseases. For example, the rash in measles is an erythematous, maculopapular rash that begins a few days after the fever starts; it classically starts at the head and spreads downwards.

Causes

Causes by Organ System

Cardiovascular Kawasaki syndrome, Rheumatic fever, Vasculitis
Chemical / poisoning Mercury(II) chloride, Metal fume fever, Dicofol, Lead poisoning, Lewisite, Satratoxin-H, Scombroid food poisoning
Dermatologic Acne, Acrodermatitis chronica atrophicans, Actinic keratosis, Boil, Bruise, Cholinergic urticaria, Dermatitis herpetiformis, Dermatomyositis, Duke's disease, Eczema, Eczema vaccinatum, Erythema toxicum, Fifth disease, Gestational pemphigoid, Granuloma annulare, Grover's disease, Hives, Impetigo, Intertrigo, Irritant contact dermatitis, Jock itch, Juvenile dermatomyositis, Keratoderma blennorrhagica, Keratosis pilaris, Lichen planus, Miliaria, Molluscum contagiosum, Photodermatitis, Pityriasis lichenoides et varioliformis acuta, Pityriasis rosea, Porphyria, Psoriasis, Rosacea, Seborrheic dermatitis, Southern tick-associated rash illness, Toxic epidermal necrolysis, Warts, Atopic dermatitis, Erythema multiforme, Folliculitis, Hot Tub Folliculitis, Hot tub rash, Tinea faciei, Tinea versicolor, Monkeypox, Mononucleosis, Rabbitpox
-bgcolor="LightSteelBlue" Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental Decompression sickness, Dysbarism, Sunburn, Sweat rash, Photoallergy, Actinic keratosis, Cholinergic urticaria, Photodermatitis
Gastroenterologic Crohn's disease
Genetic Darier's disease, Holocarboxylase synthetase deficiency, Tuberous sclerosis, Wiskott-Aldrich syndrome
Hematologic Angioimmunoblastic T-cell lymphoma, Cutaneous T cell lymphoma, Juvenile Myelomonocytic Leukemia (JMML), Kikuchi-Fujimoto disease, Langerhans cell histiocytosis
Iatrogenic Eczema vaccinatum
Infectious Disease TORCH infections

Bacteria: Cellulitis, Congenital syphilis, Ehrlichiosis, Erysipelas, Folliculitis, Group A streptococcal infection, Haverhill fever, Hot Tub Folliculitis, Hot tub rash, Human ehrlichiosis, Leptospirosis, Lyme disease, Meningococcal Infections, Meningococcemia, Neisseria meningitidis, Pseudomonas aeruginosa, Pseudomonas dermatitis, Rat-bite fever, Scarlet fever, Streptococcus pyogenes, Syphilis, Toxic Shock Syndrome, Typhoid fever, Typhus, Yersiniosis, Acrodermatitis chronica atrophicans, Boil, Impetigo

Virus: Adenovirus infection, Arbovirus, Asceptic Meningitis, Babanki virus, Barmah Forest virus, Chickenpox, Chikungunya, Colorado tick fever, Coxsackie A virus, Dengue fever, Ebola, Hand, foot and mouth disease, Herpes zoster, HIV, Human Herpesvirus Six, Infectious mononucleosis, Measles, Monkeypox, Mononucleosis, O'nyong'nyong virus, Parvovirus, Rabbitpox, Rickettsialpox, Rocky Mountain spotted fever, Ross River virus, Rubella, Scrumpox, Shingles, Sindbis virus, Smallpox, Vaccinia, Varicella-zoster virus, West Nile virus, Zika fever, Fifth disease, Molluscum contagiosum

Fungi: Blastocystosis, Candidiasis, Ringworm, Tinea faciei, Tinea versicolor, Jock itch

Parasite: Dientamoebiasis, Hookworm, Scabies, Schistosoma mansoni, Toxocariasis

Musculoskeletal / Ortho Fat Embolism Syndrome, Juvenile idiopathic arthritis, Reactive arthritis, Still's disease
Neurologic Neisseria meningitidis
Nutritional / Metabolic Biotin deficiency
Obstetric/Gynecologic Pregnancy
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity Alemtuzumab, Atovaquone , Clofarabine Injection , Erlotinib , Gefitinib , Pemetrexed injection , Zafirlukast , Benztropine Mesylate Oral , Sorafenib , Spironolactone
Psychiatric Anxiety
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Allergy, Atopic dermatitis, Contact dermatitis, Cradle cap, Eosinophilic folliculitis, Erythema multiforme, Food allergy, Hypersensitivity vasculitis, Lupus erythematous, Milk allergy, PhotoallergySalicylate sensitivity, Soy allergy, Uncaria tomentosa, Urticaria, Urushiol-induced contact dermatitis, Graft-versus-host disease, Sarcoidosis, Serum sickness, Hives, Irritant contact dermatitis, Seborrheic dermatitis, Toxic epidermal necrolysis, Vasculitis, Cholinergic urticaria
Sexual No underlying causes
Trauma Road rash
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Body lice, Diaper rash, Road rash

Causes in Alphabetical Order


Evaluating a Rash

The causes of a rash are extremely broad, which may make the evaluation of a rash extremely difficult. An accurate evaluation by a doctor may only be made in the context of a thorough history (What medication is the patient taking? What is the patient's occupation? Where has the patient been?) and complete physical examination.

Points to note in the examination include:

Typically, according to Anthony Iannazzo, it is never a good habit for one to scratch their rash; as doing so may invigorate the rash and cause it to spread. Gently rubbing the rash may provide temporary relief, but it is more than likely better to avoid contact with the affected areas altogether.

Quick Overview of Symptoms of Skin Rashes/Diseases

Skin Disease Symptoms Usual Area of Body
Acne Covered in small pus-filled sacs, blackheads, pimples or sore red bumps Face, Chest or Back
Rosacea Flushed appearance or Redness Around cheeks, chin, forehead or nose
Boil Painful red bump or a cluster of painful red bumps Anywhere
Cellulitis Red, tender and swollen areas of skin Around a cut, scrape or skin breach
Insect bite Red and/or itchy bumps on your skin Anywhere and can be sprinked randomly
Allergic Reaction Irregular, raised or flat red sores that appeared after taking medicine/drugs Anywhere
Hives Bumps formed suddenly Anywhere but usually first noticed on face
Seborrheic dermatitis Bumps and swelling Near glands
Cradle Cap Dry, scaly skin Cover the head of a child
Irritant contact dermatitis Red, itchy, scaly or oily rash Eyebrows, nose, edge of the scalp, point of contact with jewellery, perfume or clothing.
Allergic Contact Dermatitis caused by poison ivy, oak or sumac Red, itchy, scaly or oily rash Eyebrows, nose, edge of the scalp, point of contact with jewellery, perfume or clothing.
Allergic purpura Small red dots on your skin, or larger, bruise-like spots that appeared after taking medicine Anywhere
Pityriasis Rosea Started with a single scaly, red and slightly itchy spot, and within a few days, did large numbers of smaller patches of the rash, some red and/or others tan Chest and Abdomen
Dermatitis herpetiformis Intensely itchy rash with red bumps and blisters Elbows, knees, back or buttocks
Erythema nodosum Large red bumps that seem to bruise and are tender to touch Anywhere
Psoriasis White, Scaly rash over red, irritated skin Elbows and knees
Erythema multiforme Red, blotchy rash, with "target like" hives or sores. Anywhere
Measles Red Rash that is raised with a fever or sore throat. Usually starts first on the forefead and face and spreads downward.
Chickenpox Multiple blisters with a fever, cough, aches, tiredness and sore throat. Usually starts first on the face, cheast and back and spreads downward.
Shingles Red Blisters that are very painful and may crust Anywhere
Fifth Disease Started as a fever and then developed a bright red rash Cheeks
Warts Soft bumps forming that don't itch and have no other symptoms Anywhere
Ringworm Bald spot on your scalp or a ring of itchy red skin Anywhere
Syphilis Rash that is red but not itchy Palms of hands or soles of feet
Jock Itch, Yeast Infection or Diaper rash Red itchy rash Groin
Tinea versicolor Light coloured patches Anywhere
Impetigo Crusted, tan-colored sores Near nose or lip
Scabies Bite-like sores that itch and spread intensely Usually start on hands or feet and spread everywhere
Rocky Mountain Spotted Fever A fine rash with a fever and headache Usually start on arms and legs including the hands and feet
Lupus Erythematosus A butterfly rash with achy joints Forehead and cheeks
Jaundice or sign of Hepatitis Yellowish Skin, whites of eyes and mouth
Bruise Blue or black area after being hit Anywhere
Actinic keratoses Scaly, pink, gray or tan patches or bumps Face, scalp or on the backs or your hands
Keloid or Hypertrophic scar Scar that has grown larger than expected Anywhere
Lipoma Soft or rubbery growth Anywhere
Milia Lots of white spots on the face of a baby
Molluscum or Contagiosum Small, firm, round bumps with pits in the center that may sit on tiny stalks Anywhere
Sebaceous cyst Bump with a white dome under your skin Scalp, nape of your neck or upper back
Skin Tag Soft, fleshy growth, lump or bump Face, neck, armpits or groin
Xanthelasma Yellow area under your skin Under Eyelids
Melanoma Dark bump that may have started within a mole or blemish, or, is there a spot or mole that has changed in color, size, shape or is painful or itchy Anywhere
Basal Cell Carcinoma Fleshy, growing mass Areas exposed to the sun
Squamous Cell Carcinoma Unusual growth that is red, scaly or crusted Face, lip or chin
Kaposi's Sarcoma Dark or black raised spots on your skin that keep growing or have appeared recently Anywhere

Related Chapters

References

  1. Boyd MA, Menon P, Graves S, Gordon DL (2007). "A febrile illness with generalized papular rash involving the palms and soles". Clin Infect Dis. 44: 755&ndash, 756.

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