What is a rash?

A rash is defined as a change in the skin’s

appearance, which may involve alternations
in texture (eg rough or smooth) and/or colour.
The skin may also become itchy, warmer, dry,
cracked, blistered, lumpy or painful. Depending on
where the rash is located, other symptoms you are
experiencing, what you have been exposed to and any
family history, there are many causes for a rash.
It is therefore very important to be aware of where the
rash initially arises from, how it changes or spreads
and recognize symptoms and signs that suggest that
you should seek medical attention immediately. These
details and other important issues such as common
causes, associated medical conditions and basic
management of rashes will be discussed below.
Rashes can be divided into acute (short term) and chronic (longer term)
causes. Within the acute group, they can be blanching (disappearing when
pressed) or non-blanching. In the chronic group, it is useful to divide them into
itchy and non-itchy causes. There are also a number of medical conditions
which can be associated with rashes.

Common causes of rashes

There are many causes of rashes. It is useful to divide the common causes
into two groups: those that develop quickly (acute) vs those that have been
present for a longer period of time (chronic).

Acute skin rashes

Blanching rash (rash disappears when pressed)
Viral infections
Skin rashes seen depend on the virus involved.
In chicken pox, the varicella zoster virus produces groups of many vesicles,
each like a drop of water on a reddened base on the trunk, face, extremities
and inside of the mouth.
The measles virus produces a rash with flattened and raised areas, starting
on the face and progressing to involve the trunk and limbs. White spots like
salt grains on a red base inside the mouth (Koplik’s spots) are characteristic of
 measles.
Herpes zoster virus can cause crusting infection with fluid filled collections,
affecting areas such as the lips.
Bacterial infections (impetigo)
Bacteria from groups called Staphylococcal and Streptococcal species are
most commonly implicated in skin infections. You may develop a skin infection
due to a wound in the skin, which has broken the barrier to preventing
external organisms from entering the body.
With bacterial infections, commonly:

 skin is red,
 crusting skin
 scaling skin
 blistering skin and
 pus producing skin.
Acute skin allergy reactions
 Urticaria: Urticaria is an allergic reaction in the skin seen as a well
circumscribed area of swelling, which usually lasts hours or days. You may feel
extremely itchy, and these areas of swelling can be pink or skin coloured.
 Insect bite-caused rashes: Mosquitoes, spiders and other insects can bite any
part of the body. Bites are usually raised lumps that become red and extremely itchy.
Flea bites usually occur around the ankles, possibly progressing onto fluid filled
collections.
 Vasculitis: Skin changes due to vasculitis are largely determined by the size
and site of affected vessels. In a condition called hypersensitivity vasculitis, there are
usually many red / purple skin lesions, predominantly located on the legs.
 Atopic dermatitis / allergic contact dermatitis: Dermatitis is a pattern of
inflammation in the skin, which may follow contact with an external skin irritating
substance or which may develop without any apparent external cause. The
term eczema is commonly used to refer to the latter condition. We tend to see this skin
condition in people with allergies or asthma. The rash is generally red, itchy, and
scaly.
 Drugs: The range of skin lesions produced by drugs are countless, but in most
cases, presents with widespread bodily involvement.
Non-blanching rash (rash doesn’t disappear when
pressed)
Meningococcal disease
 Meningococcal disease classically presents as a red / purple skin rash in an ill
patient. The rash may progress to join together over certain parts of the body,
with extensive purple bruising. Sometimes, there may be a raised, palpable
rash that disappears when pressed (blanching). Usually the patient is very
unwell, out of proportion to the viral illness.

Chronic rashes
Pruritic (itchy)
 Atopic dermatitis
 Scabies: This is caused by the mite Sarcoptes scabiei and is acquired by close
physical contact with someone suffering from the disease. Scabies symptoms include
intense itching, burrows and the scabies rash. Burrows are found principally in the
hands and feet – between the fingers, toes and wrists. Each burrow is several
millimeters long, light brown in colour and often surrounded by skin redness. The
scabies rash looks like many tiny papules (elevations of the skin) grouped around the
axillary folds (ie armpit, neck), umbilicus and the thighs.
 Ringworm: Symptoms of ringworm (Tinea Corporis):
 Characteristic skin lesions are located all over the body
 Large, red and scaly.
Non pruritic (not itchy)
 Psoriasis: Classically, psoriasis tends to occur as red, scaly itchy patches of
skin with a silvery white scale over the joints and scalp areas.
 Seborrhoeic dermatitis: Seborrhoeic dermatitis is a skin rash that can appear
in patches on the scalp, face, chest, upper back and in the skin folds in the joint areas.
Scalp involvement can present as itchy, red, widespread scaling. Involvement of the
scalp is called dandruff in adults and cradle cap in infants.
 Warts: Common warts coming in many different sizes and shapes. Warts can
be single or multiple raised, cauliflower like lesions which occur most frequently on
the hands. Plantar warts (ie located on the feet) usually appear as small areas of
thickened skin.
 Molluscum contagiosum: Pink /flesh coloured papules with a smooth surface
and small central depressed / thickened area, scattered all over the body are found.
 Cancers: Superficial basal cell carcinomas of the skin can present as slowly
enlarging, red scaling skin areas. Bowen’s disease refers to squamous cell carcinomas
that are still confined to their primary location. These look like slowly enlarging, red
scaly patches with a well defined border on sun exposed and sun protected areas.
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Medical conditions
associated with a skin rash
Skin rashes can be an indication of disease
processes occurring in the body.

Erythema nodosum
Erythema nodosum is a skin condition where
red, tender/painful lumps form on the shins,
and less commonly the thighs and forearms. More commonly occurring in
young females, the condition can be caused by many factors, including;
bacterial infection, drugs (oral contraceptive pill, aspirin), or inflammatory
bowel disease

Erythema multiforme
This skin rash usually appears suddenly, after exposure to the causative
agent. Although the cause is unknown in about 50%, possible causes include:
herpes simplex virus, other viral infections, drugs (anti-epileptic drugs),
connective tissue diseases (systemic lupus erythematosus) and HIV infection.

Acanthosis nigricans
Acanthosis nigricans presents as darkened areas of thick skin, especially in
the skin folds around the flexural areas (armpits, neck, groin). These changes
are often seen in overweight patients who have a high level of insulin.

Dermatomyostitis
 Dermatomyositis is inflamed skin and muscle which may occur in childhood or
adult life. It usually presents with distinctive facial redness, a purple coloured
skin rash around the eyes, and swelling. The knuckles and arms and legs may
develop blue/red nodules or patches. If you are affected by dermatomyositis
you may feel some muscle discomfort and weakness.
Scleroderma
Scleroderma refers to a group of diseases in which there are changes in the
layers of the skin, producing thickened layers, and destruction of hair follicles
and sweat glands. The lungs, bowels, kidneys and heart may all be affected.
Skin may become tight and tethered, especially around the hands, mouth and
nose.
Lupus erythematosus
The two main forms of lupus erythematosus include:

 Discoid: In this condition, disease is limited to the skin, classically affecting

light exposed areas. The lesions are well defined, consisting of scaling skin and areas
of reddened skin. Changes are predominantly located on the cheeks, forehead and
nose.
 Systemic: In the systemic form of lupus, skin lesions are associated with multi
organ involvement, including the kidneys, heart, lungs, brain and joints. This form is
much more common in women and can lead a short, severe, course of disease or be a
more progressive process. Classically there is facial redness in a butterfly distribution
(involving the cheeks linked by a band of redness across the nose).
Sarcoidosis
The most common skin changes in sarcoidosis include:
 Orange-brown papules, nodules and patches;
 Tender red nodules on the legs (erythema nodosum);
 Dusky red lesions on the nose and fingers (lupus pernio).
Diabetes mellitus
Diabetes mellitus can be associated with many skin changes. These include:
symptoms of fungal and bacterial infections and disease affecting the arteries
in the body. Skin changes specific to diabetes include: necrobiosis lipoidica
(an area of redness typically located over the shins, yellow in colour and with
 a depressed center with or without ulcers. Diabetic dermopathy is seen as
red-brown flat topped papules.
Systemic malignant disease
Particular skin rashes may be a manifestation of underlying malignancies.
Rarely, tumours may spread to the skin where they can present as collections
of pus or palpable lumps which may continue to develop into ulceration of the
skin.

Dermatologists

History
When you visit the health practitioner, he or she may ask you some of the
following information about your skin rash:

 Rash characteristics:
 Time course of skin rash (how your rash started, how rash has
progressed, changes over time),
 Distribution of skin lesions
 Types of lesion (skin redness, skin scaling, thickening of skin, cracks in
skin)
 Changes in skin colour
 Associated symptoms (skin dryness, itching skin, scratching)
 Any previous episodes
 Past medical history:
 Asthma
 Hayfever
 Skin infections
 Family history:
 Allergic diseases (asthma, hayfever, rhinitis)
 Psoriasis
 Itchy lesions / scabies
 Drug / allergy history:
 Have you taken any new drugs recently?
 What medications are you currently on?
 Aggravating factors:
 Do any of the following make the rash worse?
 Sunlight exposure
 Diet
 Woolen clothes
 Foods
 Animals
 Have you been in contact with anyone else with a similar rash?
 Is this the first time you’ve had the skin rash? If not, how was it treated
last time?
 Social history:
 How is this skin rash affecting your life – school, work, sleep. Do you or
anyone else in your household smoke?
 Do you have any pets?
Skin examination
When the doctor/dermatologist examines you, he or she may find the
following signs by looking at the skin rash and also feeling the surface of the
skin where required.
Looking at the rash, the doctor can determine whether the lesion involves the
external layer of the skin (the dermis) or the deeper layers (the epidermis).
With rashes that extend deeper into the skin, there may be changes such as
scaling skin, crusting skin, weeping and / or formation of vesicles (small
collections of fluid). If there are changes in the deeper layers of the skin, the
superficial layers are usually also affected. There may be lumps, papules
(elevations of the skin) and / or nodules. By feeling the skin during
examination, the doctor can get a good idea of the texture / consistency of the
skin rash.
Looking at where the rash is distributed, the doctor can also get an idea of
what may be causing the skin rash. Therefore it is very important to tell your
 doctor about all the places on your body that are affected by rashes.
In some skin rash cases, the dermatologist may need to do a more thorough
examination of the body, looking at parts such as the nails, mouth and scalp.

Medical warning signs

You should seek medical help if:

 You find it difficult to breathe, your throat is tight, or your face becomes
swollen.
 Your skin rash symptoms and any associated symptoms become worse / persist.
 You have any signs of infection such as areas of intense redness, swelling, pain,
pus or discharge.
 You have recently started on new medications.
 Your child has a purple rash that looks like bruising, especially if accompanied
by symptoms such as altered conscious level, increased irritability, fever and altered
cry.
References
1. Buxton P. ABC of Dermatology. London: BMJ Publishing Group Pty Ltd; 2005.
2. Kumar P, Clark M. Clinical Medicine. United Kingdom: WB Saunders; 2002.
3. Lissauer T, Clayden G. Illustrated Textbook of Paediatrics. Spain; Mosby
International Limited, 2003.
4. Murtagh J. General Practice; Skin Conditions. Australia: McGraw-Hill Australia
Pty Ltd; 2003
5. Rotstein H. Principles and Practice of Dermatology. Australia: Reed International
Books Australia Pty Ltd; 1998
6. White G. Colour Atlas of Dermatology. Spain: Elsevier Limited; 2004.

Published by : https://healthengine.com.au/info/skin-rashes