Rashes

Definition

Rash is a popular term for a group of spots or an area of red, inflamed skin. A rash is usually a symptom of an underlying condition or disorder. Often only temporary, a rash is rarely a sign of a serious problem.

Description

A rash may occur on only one area of the skin, or it can cover almost all of the body. A rash may or may not itch. Depending on how it looks, a rash may be described as:

• blistering (raised oval or round collections of fluid within or beneath the outer layer of skin)
• macular (flat spots)
• nodular (small, firm, knotty rounded masses)
• papular (small, solid, slightly raised areas)
• pustular (pus-containing skin blisters )

Causes & symptoms

There are many theories as to why skin rashes occur. Sometimes the cause can be determined, and sometimes it cannot. Generally, a skin rash is an intermittent symptom, fading and reappearing. Rashes may accompany a range of disorders and conditions.

• Infectious illnesses. A rash is a symptom of many different infectious illnesses or conditions caused by bacteria, viruses, fungi, and other organisms. These include chickenpox , scarlet fever , Rocky Mountain spotted fever, ringworm, herpes, shingles, measles, scabies , and Lyme disease .
• Shared cosmetics and similar personal care items. It is not unusual for people to develop rashes from sharing face powder, mascara, and similar items with other family members or friends.
• Allergic reactions. One of the most common symptoms of an allergic reaction is an itchy rash. Contact dermatitis is a rash that appears after the skin is exposed to an allergen, such as metal, rubber, some cosmetics or lotions, or some types of plants (such as poison ivy, oak , or sumac). Drug reactions are another common allergic cause of rash. In this case, a rash is only one of a variety of possible symptoms, including fever, seizures, nausea and vomiting, diarrhea , heartbeat irregularities, and breathing problems. This rash usually appears soon after the first dose of the medicine is taken, although allergic reactions may be delayed for several days. Common culprits include such drugs as nevirapine, a medication used to treat HIV infection, and minocycline, a drug used to treat acne.
• Autoimmune disorders. Conditions in which the immune system attacks the body (like with systemic lupus erythematosus or purpura) often have a characteristic rash.
• Nutritional disorders. Scurvy, for example, is a disease caused by a deficiency of vitamin C and produces a rash as one of its symptoms.
• Cancer . A few types of cancer, such as chronic lymphocytic leukemia , can be the underlying cause of a rash.

Rashes in infants

Rashes are extremely common in infancy, are not usually serious, and can be treated at home most of the time.

Diaper rash is caused by prolonged skin contact with bacteria and the baby's waste products in a damp diaper. This rash has red, spotty sores and there may be an ammonia smell. In most cases, the rash will respond to drying efforts within three days. A diaper rash that does not improve in this time may be a yeast infection requiring prescription medication. A doctor should be consulted if the rash is solid, bright red, and is associated with a fever, or if the skin develops blisters, boils , or pus.

Infants can also get a rash on their cheeks and chin caused by contact with food, saliva, and stomach contents. This rash will come and go, but usually responds to a good cleaning after meals. About one-third of all infants develop acne , usually after the third week of life, in response to their mothers' hormones before birth. This rash will disappear in a few weeks to a few months. Heat rash is a mass of tiny pink bumps on the back of the neck and upper back caused by blocked sweat glands. The rash usually appears during hot, humid weather, although a baby with a fever can also develop the rash.

A baby should been seen by a doctor immediately if a rash:

• appears suddenly and is purple or blood colored
• looks like a burn
• appears while the infant seems to be sick

Diagnosis

A family doctor, naturopathic doctor, or dermatologist (skin disease specialist) can diagnose and treat rashes. Diagnosis can be made based on the patient's medical history, the appearance of the rash, the location of the rash, and any other accompanying symptoms. In some cases, the doctor may take a biopsy (skin sample) of the rash to assist in the diagnosis.

Treatment

Alternative treatments for rashes focus on relieving symptoms, clearing the rash, and rejuvenating the skin. There are many forms of alternative medicine that have remedies for rashes.

Herbals

Herbal remedies are very common in the treatment of different types of rashes. Shingles may be relieved by taking 30–50 drops of St. John's wort tincture in water three to six times a day. A variety of different herbals can be applied to different kinds of rashes.

• agrimony (Agrimonia eupatoria ) tea spray: hives and moist rashes
• aloe (Aloe vera ) gel: weeping rash, shingles, burns, sunburn
• amaranth (Amaranthus hypochondriacus ) tea wash: hives
• beech (Fagus grandifolia ) tea wash: diaper rash and poison ivy or oak rash
• black walnut (Juglans nigra ) leaf tea: rashes, rashes caused by parasites, scabies
• burdock (Articum lappa ) decoction: hives, eczema
• calendula (Calendula officinalis ) infusion: hives, burns, sunburn; calendula lotion: plant-contact dermatitis
• cattail (Typha latifolia ) paste: poison ivy rash
• chamomile tea wash: poison ivy, oak, or sumac rash
• chickweed (Stellaria media ) salve: severe rashes, hives
• comfrey (Symphytum officinale ) ointment, cream, or lotion: inflamed rash; cold tea compress from comfrey root: plant-contact dermatitis
• heartsease (Viola tricolor ) infusion: hives
• goldenseal (Hydrastis canadensis ) wash: poison ivy rash, rash caused by infection, diaper rash
• jewelweed (Impatiens pallida ) rub: poison ivy or oak rash and skin irritation caused by briars, brambles, or nettles
• nettle (Urtica dioca ) infusion: hives
• oak bark (Querus alba ) tea: rashes
• oatmeal bath: plant-contact dermatitis
• pennyroyal (Hedeoma pulegiodes ) tea wash: hives, shingles, measles, scabies, mumps , chickenpox, diaper rash, and poison ivy or oak rash
• pine (Pinus species) ashes: measles, chickenpox, and mumps rash
• plantain (Plantago major ) poultice: poison ivy rash
• poplar (Populus candicans ) tea wash: rashes
• sage (Salvia officinalis ) tea wash: poison ivy or oak rash, and moist, weepy rashes
• sassafras (Sassafras albidum ) root tea: rashes, shingles
• slippery elm (Ulmus fulva ) bark paste: rashes
• solomon's seal (Polygonatum multiflorum ) mashed root: poison ivy or oak rash
• St. John's wort (Hypericum perforatum ) oil: shingles, and dry, itchy rashes
• sumac (Rhus glabra ) tea wash: poison ivy rash
• thyme (Thymus vulgaris ) salve: rashes
• witch hazel (Hamamelis virginiana ) tincture: poison ivy or oak rash, diaper rash, and weeping rash
• yellow dock (Rumex crispus ) decoction: hives

It is a good idea, however, to be careful in using herbal remedies. Cases have been reported of patients developing body rashes from allergies to such herbs as feverfew .

Homeopathy

Homeopathic remedies are individually prescribed for each patient. Some possible homeopathic remedies include:

• calcium sulfide (Hepar sulphuris ) for rash with pus
• graphite (Graphites ) for dry, red, cracked, itchy rash in the skin folds
• honeybee (Apis ) for swelling and hives from bee stings
• nosode (Medorrhinum ) for sharply defined red, possibly shiny, rash suggesting yeast infection
• poison ivy (Rhus toxicodendron ) for plant contact dermatitis, itching hives, and restlessness
• stinging nettle (Urtica urens ) for stinging hives with little inflammation
• sulfur for dry, red, cracked, itchy rash anywhere, including around the anus.

Other treatments

Other rash remedies include:

• Aromatherapy. The essential oils thyme, lavender , jasmine, and German chamomile may relieve allergy-induced eczema.
• Ayurveda. Rashes and hives are treated by drinking fresh cilantro juice and applying the pulp onto the rash. Fresh coconut water, melon rind, or a paste of turmeric (one part) and sandalwood (two parts) in goat's milk can be applied to the affected area. Hot milk (1 cup) containing coriander (1 teaspoon), cumin (1/2 teaspoon), and raw sugar (1 teaspoon) can be ingested once or twice daily to heal rashes and hives and restore skin health.
• Chinese medicine. Hives are treated with herbal preparations, acupuncture , ear acupuncture, and cupping . Preparations applied to the skin to relieve the itching associated with hives include Jie Du Cha Ji (Resolve Toxin Smearing Liquid), Zhi Yang Po Fen (Relieve Itching Powder), and Zhi Yang Xi Ji (Relieve Itching Washing Preparation). Contact dermatitis and drug dermatitis are treated with herbal formulas comprised of herbs chosen specifically for the patient's symptoms.
• Diet. An increased intake of mackerel, salmon, and herring provides essential fatty acids that may decrease itching and inflammation.
• Hydrotherapy. Hives can be relieved by rubbing the affected area with an ice cube, taking a cool bath, or using a cold compress.
• Hypnosis. Emotional stress can trigger many different dermatoses including certain rashes. Hypnosis has been helpful in treating atopic dermatitis, herpes, itching, psoriasis , hives, and other dermatoses.
• Juice therapy. Red rashes are treated with fresh apple, dark grape, papaya, or pineapple juices drunk at room temperature between meals.
• Supplements. Rashes may be treated with skin-repairing vitamins A, C, B complex, and zinc . Vitamin E can reduce skin dryness (decreasing the itch).

Allopathic treatment

Treatment of rashes focuses on providing relief of the itching that often accompanies them. Soothing lotions, topical corticosteroids (such as hydrocortisone), or oral antihistamines (Benadryl) can provide some relief. Topical antibiotics may be administered if the patient, particularly a child, has caused an infection by scratching.

For diaper rash, the infant's skin should be exposed to the air as much as possible. Ointments are not needed unless the skin is dry and cracked. Experts also recommend switching to cloth diapers and cleaning affected skin with plain water.

Expected results

Most rashes that have an acute cause (such as an infection or an allergic reaction) will disappear as soon as the infection or irritant is removed from the system. Rashes that are caused by chronic conditions (such as autoimmune disorders) may remain indefinitely or may fade and then return periodically.

Prevention

Some rashes can be prevented, depending on the cause. A person known to be allergic to certain drugs or substances should avoid those things in order to prevent a rash. It is also a good idea to avoid sharing cosmetics and personal care items (including lip balms) with other family members or friends. Diaper rash can be prevented by using cloth diapers, keeping the diaper area very clean, breast-feeding, and changing diapers often. A person should launder clothing and rinse his or her skin first with rubbing alcohol and then with water after contact with a plant that can cause contact dermatitis.

Resources

BOOKS

"Rashes and Skin Problems." In The Alternate Advisor: The Complete Guide to Natural Therapies and Alternative Treatments. Richmond, VA: Time-Life Books, 1997.

Reichenberg-Ullman, Judyth, and Robert Ullman. Homeopathic Self-Care: The Quick and Easy Guide for the Whole Family. Rockland, CA: Prima Publishing, 1997.

Ying, Zhou Zhong, and Jin Hui De. Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.

PERIODICALS

Bennett, Paul J., and Mukta Panda. "RHE1: It is Not Nice to Fool with Mother Nature: The Case of the Herbal-Induced Rash." Southern Medical Journal 94 (December 2001): S29-S30.

Disdier, Patrick, Brigitte Granel, et al. "A Teenager with Rash and Fever." Lancet 358 (December 15, 2001): 2046.

"Mommy, Did You Borrow My Blush?" Consumer Reports 66 (October 2001): 9.

Shenefelt, Philip D. "Hypnosis in Dermatology." Archives of Dermatology 136 (March 2000): 393–399.

ORGANIZATIONS

American Academy of Dermatology. 930 N. Meacham Rd., P.O. Box 4014, Schaumburg, IL 60168. (708) 330-0230. <http://www.aad.org>.

Belinda Rowland

Rebecca J. Frey, PhD

Rashes

Definition

The popular term for a group of spots or red, inflamed skin that is usually a symptom of an underlying condition or disorder. Often temporary, a rash is only rarely a sign of a serious problem.

Description

A rash may occur on only one area of the skin, or it may cover almost all of the body. Also, a rash may or may not be itchy. Depending on how it looks, a rash may be described as having the following characteristics:

• blistering (raised oval or round collections of fluid within or beneath the outer layer of skin)
• macular (flat spots)
• nodular (small, firm, knotty rounded mass)
• papular (small solid slightly raised areas)
• pustular (pus-containing skin blister)

Demographics

Most persons experience rashes at many times in their lives. Rashes are not reportable events. As such, their prevalence is not precisely known. Rashes are common among infants, and most are harmless.

Causes and symptoms

There are many theories about the development of skin rashes, but experts are not completely sure what causes some of them. Generally a skin rash is an intermittent symptom, fading and reappearing. Rashes may accompany a range of disorders and conditions, such as the following:

• Infectious illness: A rash is a symptom of many different kinds of childhood infectious illnesses, including chickenpox and scarlet fever . It may be triggered by other infections, such as Rocky Mountain spotted fever or ringworm.
• Allergic reactions: One of the most common symptoms of an allergic reaction is an itchy rash. Contact dermatitis is a rash that appears after the skin is exposed to an allergen, such as metal, rubber, some cosmetics or lotions, or some types of plants (e.g. poison ivy ). Drug reactions are another common allergic cause of rash; in this case, a rash is only one of a variety of possible symptoms, including fever , seizures, nausea and vomiting , diarrhea , heartbeat irregularities, and breathing problems. This rash usually appears soon after the first dose of the course of medicine is taken.
• Autoimmune disorders: Conditions in which the immune system turns on the body itself, such as systemic lupus erythematosus or purpura, often have a characteristic rash.
• Nutritional disorders: For example, scurvy, a disease caused by a lack of vitamin C, has a rash as one of its symptoms.
• Cancer : A few types of cancer, such as chronic lymphocytic leukemia, can be the underlying cause of a rash.

Rashes in infancy

Rashes are extremely common in infancy. They are usually not serious at all and can be treated at home.

Diaper rash is caused by prolonged skin contact with bacteria and the baby's waste products in a damp diaper. This rash has red, spotty sores, and there may be an ammonia smell. In most cases the rash will respond within three days to drying efforts. A diaper rash that does not improve in this time may be a yeast infection requiring prescription medication. A doctor should be consulted if the rash is solid, bright red, causes fever, or the skin develops blisters, boils, or pus.

Infants also can get a rash on cheeks and chin caused by contact with food and stomach contents. This rash will come and go, but usually responds to a good cleaning after meals. About one-third of all infants develop acne usually after the third week of life in response to their mothers' hormones before birth. This rash can last a few weeks to a few months. Heat rash is a mass of tiny pink bumps on the back of the neck and upper back caused by blocked sweat glands. The rash usually appears during hot, humid weather, although a baby with a fever can also develop the rash.

A baby should be seen by a doctor immediately if the rash appears suddenly and looks purple or blood-colored, looks like a burn, or appears while the infant seems to be sick.

When to call the doctor

A doctor or other healthcare provider should be called when a rash that cannot accurately be identified appears or when an identified rash does not disappear in two to three days.

Diagnosis

A physician can make a diagnosis based on the medical history and the appearance of the rash, where it appears, and any other accompanying symptoms.

Treatment

Treatment of rashes focuses on resolving the underlying disorder and providing relief of the itching that often accompanies them. Soothing lotions or oral anti-histamines can provide some relief, and topical antibiotics may be administered if the person, particularly a child, has caused a secondary infection by scratching. The rash triggered by allergies should disappear as soon as the allergen is removed; drug rashes will fade when the person stops taking the drug causing the allergy. For the treatment of diaper rash, the infant's skin should be exposed to the air as much as possible; ointments are not needed unless the skin is dry and cracked. Experts also recommend switching to cloth diapers and cleaning affected skin with plain water.

Prognosis

Most rashes that have an acute cause, such as an infection or an allergic reaction, will disappear as soon as the infection or irritant is removed from the body's system. Rashes that are caused by chronic conditions, such as autoimmune disorders, may remain indefinitely or fade and return periodically.

Prevention

Some rashes can be prevented, depending on the triggering factor. A person known to be allergic to certain drugs or substances should avoid those things in order to prevent a rash. Diaper rash can be prevented by using cloth diapers, keeping the diaper area very clean, changing diapers often, and by breastfeeding.

Nutritional concerns

Foods that are known to trigger rashes in persons should be avoided.

Parental concerns

Parents should monitor the foods that their children eat so that they will be able to identify foods that cause rashes and avoid their consumption. In addition, children who are prone to skin allergies should avoid contact with strong, perfumed soaps; nickel-based jewelry; and irritating fabrics (such as wool).

KEY TERMS

Purpura —A group of disorders characterized by purplish or reddish brown areas of discoloration visible through the skin. These areas of discoloration are caused by bleeding from broken capillaries.

Scurvy —A nutritional disorder caused by vitamin C deficiency that is characterized by tiredness, muscle weakness, joint and muscle aches, a rash on the legs, bleeding gums, and skin bruising.

Resources

BOOKS

Bolognia, Jean L., and Irwin M. Braverman. "Skin Manifestations of Internal Disease." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 315–30.

Darmstadt, Gary L., and Robert Sidbury. "Eczematous Disorders." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 2188–90.

——. "Nutritional Dermatoses." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2003, pp. 2248–50.

Lim, Henry M. "Eczemas, Photodermatoses, Papulosquamous (Including Fungal) Diseases, and Figurate Erythemas." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 2458–65.

Swerlick, Robert A., and Thomas J. Lawley. "Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 309–14.

PERIODICALS

Ahmed, M., et al. "A peculiar rash and red eye." Postgraduate Medical Journal 80, no. 944 (2004): 370–1.

Blackwood, C. L. "Rash and fever in an ill-appearing child." American Family Physician 70, no. 2 (2004): 361–3.

Buccolo, L. S. "Severe rash after dermatitis." Journal of Family Practice 53, no. 8 (2004): 613–5.

Healy, C. P., and D. E. Thomas. "Leg rash." American Family Physician 69, no. 10 (2004): 2429–31.

Hedberg, C. L., et al. "An infant with generalized rash and abnormal hair." Annals of Allergy, Asthma, and Immunology 92, no. 2 (2004): 210–6.

Langran, M., and C. Laird. "Management of allergy, rashes, and itching." Emergency Medicine Journal 21, no. 6 (2004): 728–41.

ORGANIZATIONS

American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168–4014. Web site: <www.aad.org/>.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007–1098. Web site: <www.aap.org/>.

American College of Occupational and Environmental Medicine. 55 West Seegers Rd., Arlington Heights, IL 60005. Web site: <www.acoem.org/>.

American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106–1572. Web site: <www.acponline.org/>.

WEB SITES

"Drug Rashes." The Merck Manual. Available online at <www.merck.com/mmhe/sec18/ch203/ch203d.html> (accessed December 22, 2004).

"Rashes." MedlinePlus. Available online at <www.nlm.nih.gov/medlineplus/ency/article/003220.htm> (accessed December 22, 2004).

"Rashes and Skin Allergies." American Academy of Family Physicians Foundation. Available online at <http://quickcare.org/skin/rashes.html> (accessed December 22, 2004).

"Skin Rashes and Other Changes." American Academy of Family Physicians. Available online at <http://familydoctor.org/545.xml> (accessed December 22, 2004).

L. Fleming Fallon, Jr., MD, DrPH

Rashes

Definition

The popular term for a group of spots or red, inflamed skin that is usually a symptom of an underlying condition or disorder. Often temporary, a rash is only rarely a sign of a serious problem.

Description

A rash may occur on only one area of the skin, or it could cover almost all of the body. Also, a rash may or may not be itchy. Depending on how it looks, a rash may be described as:

• blistering (raised oval or round collections of fluid within or beneath the outer layer of skin)
• macular (flat spots)
• nodular (small, firm, knotty rounded mass)
• papular (small solid slightly raised areas)
• pustular (pus-containing skin blister).

Causes and symptoms

There are many theories as to the development of skin rashes, but experts are not completely clear what causes some of them. Generally a skin rash is an intermittent symptom, fading and reappearing. Rashes may accompany a range of disorders and conditions, such as:

• Infectious illness. A rash is symptom of many different kinds of childhood infectious illnesses, including chickenpox and scarlet fever. It may be triggered by other infections, such as Rocky Mountain spotted fever or ringworm.
• Allergic reactions. One of the most common symptoms of an allergic reaction is an itchy rash. Contact dermatitis is a rash that appears after the skin is exposed to an allergen, such as metal, rubber, some cosmetics or lotions, or some types of plants (e.g. poison ivy). Drug reactions are another common allergic cause of rash; in this case, a rash is only one of a variety of possible symptoms, including fever, seizures, nausea and vomiting, diarrhea, heartbeat irregularities, and breathing problems. This rash usually appears soon after the first dose of the course of medicine is taken.
• Autoimmune disorders. Conditions in which the immune system turns on the body itself, such as systemic lupus erythematosus or purpura, often have a characteristic rash.
• nutritional disorders. For example, scurvy, a disease caused by a lack of Vitamin C, has a rash as one of its symptoms.
• cancer. A few types of cancer, such as chronic lymphocytic leukemia, can be the underlying cause of a rash.

Rashes in infancy

Rashes are extremely common in infancy, and are usually not serious at all and can be treated at home.

Diaper rash is caused by prolonged skin contact with bacteria and the baby's waste products in a damp diaper. This rash has red, spotty sores and there may be an ammonia smell. In most cases the rash will respond within three days to drying efforts. A diaper rash that does not improve in this time may be a yeast infection requiring prescription medication. A doctor should be consulted if the rash is solid, bright red, causes fever, or the skin develops blisters, boils, or pus.

Infants also can get a rash on cheeks and chin caused by contact with food and stomach contents. This rash will come and go, but usually responds to a good cleaning after meals. About a third of all infants develop "acne" usually after the third week of life in response to their mothers' hormones before birth. This rash will disappear between weeks and a few months. Heat rash is a mass of tiny pink bumps on the back of the neck and upper back caused by blocked sweat glands. The rash usually appears during hot, humid weather, although a baby with a fever can also develop the rash.

A baby should see a doctor immediately if the rash:

• appears suddenly and looks purple or blood-colored
• looks like a burn
• appears while the infant seems to be sick

Diagnosis

A physician can make a diagnosis based on the medical history and the appearance of the rash, where it appears, and any other accompanying symptoms.

Treatment

Treatment of rashes focuses on resolving the underlying disorder and providing relief of the itching that often accompanies them. Soothing lotions or oral anti-histamines can provide some relief, and topical antibiotics may be administered if the patient, particularly a child, has caused a secondary infection by scratching. The rash triggered by allergies should disappear as soon as the allergen is removed; drug rashes will fade when the patient stops taking the drug causing the allergy. For the treatment of diaper rash, the infant's skin should be exposed to the air as much as possible; ointments are not needed unless the skin is dry and cracked. Experts also recommend switching to cloth diapers and cleaning affected skin with plain water.

Prognosis

Most rashes that have an acute cause, such as an infection or an allergic reaction, will disappear as soon as the infection or irritant is removed from the body's system. Rashes that are caused by chronic conditions, such as autoimmune disorders, may remain indefinitely or fade and return periodically.

Prevention

Some rashes can be prevented, depending on the triggering factor. A person known to be allergic to certain drugs or substances should avoid those things in order to prevent a rash. Diaper rash can be prevented by using cloth diapers and keeping the diaper area very clean, breast feeding, and changing diapers often.

Resources

ORGANIZATIONS

American Academy of Dermatology. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. 〈http://www.aad.org〉.

KEY TERMS

Purpura— A group of disorders characterized by purple or red brown areas of discoloration visible through the skin.

Scurvy— A nutritional disorder that causes skin bruising and hemorrhages.