Category: Blog

“Rash” is a general term for a wide variety of skin conditions. A rash refers to a change that affects the skin and usually appears as a red patch or small bumps or blisters on the skin. The majority of rashes are harmless and can be treated effectively with over-the-counter anti-itch creams, antihistamines and moisturizing lotions.

Rashes can be a symptom for other skin problems. The most prevalent of these are:

• Atopic Dermatitis, the most common form of eczema.
• Bacterial Infections, such as impetigo.
• Contact Dermatitis, a type of eczema caused by coming into contact with an allergen.
• Chronic skin problems, such as acne, psoriasis or seborrheic dermatitis.
• Fungal Infections, such as ringworm and yeast infection.
• Viral Infections, such as shingles.

A rash may be a sign of a more serious illness, such as Lyme Disease, Rocky Mountain Spotted Fever, liver disease, kidney disease or some types of cancers. If you experience a rash that does not go away on its own after a few weeks, make an appointment to see one of our dermatologists to have it properly diagnosed and treated.

Shingles is a painful rash that is caused by the varicella zoster virus. It usually appears as a band or strip of blisters on one side of the body that goes from the spine around the front to the breastbone. However, shingles can also appear on the neck, nose and forehead.

Shingles derives from the same virus that causes chicken pox. After having chicken pox, the virus lies dormant in nerve tissue underneath the skin. Years later, and with no known reason, it reactivates and causes shingles. Shingles is contagious and can easily pass through touching from one person to another. The virus develops into shingles for people who have had chicken pox and develops into chicken pox for those who have not had it. Shingles appears most frequently among older adults (age 60+) and in people with compromised immune systems. Generally, a person only gets shingles once; it rarely recurs.

Symptoms for shingles include:

• Pain, burning, numbness or tingling on one side of the body. The pain often precedes any other symptoms.
• A rash that appears a few days after the pain. It may be itchy.
• Blisters that break open and then crust over.
• Fever, achiness or headache.

Some people never get a rash or blisters with shingles, but simply experience the pain.

Shingles is diagnosed based on a medical history and physical examination of the telltale rash. If you suspect you may have shingles, it is important to contact your doctor as quickly as possible. Early treatment can reduce the pain and severity of the episode. Two types of medications are prescribed to treat shingles:

• Antiviral drugs to combat the virus, such as acyclovir, valacyclovir and famciclovir.
• Pain medicines, from oral pain pills and antidepressants to anticonvulsants and topical preparations that contain skin-numbing agents.

Shingles usually heals in about 2 to 3 weeks without any problem. However, there is a small percentage of patients (10% to 15%), predominantly over age 50, who experience pain that lasts beyond one month after the healing period. This is called postherpetic neuralgia. Catching shingles early and beginning treatment can reduce the likelihood and severity of postherpetic neuralgia. See your dermatologist for pain relief.

The U.S. Food and Drug Administration has approved a vaccine, called Zostavax, for the prevention of adult shingles. It is approved for adults age 60 or older who have had chicken pox. Essentially, the vaccine delivers a booster dose of chicken pox. The vaccine has proven to be very effective in reducing the incidence of shingles and postherpetic neuralgia.

Scabies is a harmless but very itchy and highly contagious skin condition caused by mites that burrow into the skin and lay eggs. Symptoms include a severe itch, often worse at nighttime, and thin burrow tracks made of tiny bumps or blisters on the skin. Humans are allergic to the mites, which is what causes the itching.

Typically, scabies appear in folds of the skin, such as the armpits, around the waist, inside the wrists, between the fingers, on the soles of feet, on the back of knees or on inner elbows. In children, they more commonly appear on the face, scalp, neck, palms and soles. Scabies is spread through direct contact with an infected person or by sharing clothing and linens. It is so contagious that frequently when one person in a family is diagnosed with scabies, all family members are treated for it. It takes about 21 days for eggs to mature and new mites to begin burrowing through the skin.

Generally a visual examination of the skin is all that is needed to diagnose scabies. However, your dermatologist may take a small scrape of the skin to examine under a microscope. The typical treatment is prescription medicated creams applied liberally all over the body. It takes a few days of treatment before the sensation of itchiness begins to go away.

To help prevent further spreading, be sure to clean all clothes and linen in hot water and dry with high heat. Dry clean items you cannot machine wash in this manner or place the item in a sealed plastic bag and put it away for two weeks. The mites will die without a food source for this length of time.

Folliculitis is an inflammation of one or more hair follicles. It appears as a rash or white-headed pimples or pustules near a hair follicle. It can occur anywhere on the body, but typically affects hairy areas, such as the neck or groin. Follicles can be damaged from repeated friction (such as rubbing of too tight clothes) or a blockage of the hair follicle (for instance, from shaving). In most cases, follicles become infected with the Staphylococcus bacteria.

There are two types of folliculitis:

Superficial Folliculitis affects the upper area of the hair follicle and may cause red, inflamed skin, small clusters of red bumps, blisters that break open and crust over and/or itchiness and tenderness. When the infection occurs in men’s beards, it is called Barber’s Itch.. When it is caused by a fungal infection, it is known as Tinea Barbae (ringworm).

Deep Folliculitis affects the entire follicle from its deepest parts under the skin to the surface of the skin. This less-common form of folliculitis is seen in people who are undergoing chronic acne antibiotic treatment, people with HIV or people with boils and carbuncles.

Generally, folliculitis is treated with antifungal medications.

Lyme disease is a bacterial illness and inflammatory disease that spreads through tick bites. Deer ticks house the spirochete bacterium (Borellia burgdorferi) in their stomachs. When one of these ticks bites the human skin, it may pass the bacteria into the body. These ticks tend to be attracted to creases in the body, so Lyme disease most often appears in armpits, the nape of the neck or the back of knees. It can cause abnormalities in the skin, heart, joints and nervous system.

Lyme disease was first identified in 1975 in Old Lyme, Connecticut. More than 150,000 cases have been reported to the Centers for Disease Control since 1982. Cases have been reported from every state, although it is more commonly seen in the Northeast, Upper Midwest and Pacific Coast. Lyme disease has also been reported in European and Asian countries.

There are three phases to the disease:

Early Localized Phase. During this initial phase, the skin around the bite develops an expanding ring of redness. The ring may have a bull’s eye appearance with a bright red outer ring surrounding clear skin in the center. Most people don’t remember being bitten by a tick. More than one in four patients never gets a rash. The skin redness may be accompanied by fatigue, chills, muscle and joint stiffness, swollen lymph nodes and/or headaches.

Early Disseminated Phase. Weeks to months after the rash disappears, the bacteria spread throughout the body, impacting the joints, heart and nervous system. Symptoms include migrating pain in the joints, neck ache, tingling or numbing of the extremities, enlarged lymph glands, sore throat, abnormal pulse, fever, changes in vision or fatigue.

Late Dissemination Phase. Late in the dissemination of the disease, patients may experience an inflammation of the heart, which can lead to heart failure. Nervous system issues develop, such as paralysis of facial muscles (Bell’s Palsy) and diseases of the peripheral nerves (peripheral neuropathy). It is also common for arthritis and inflammation of the joints to appear, which cause swelling, stiffness and pain.

Lyme disease is diagnosed through a combination of a visual examination and a blood test for Lyme bacteria antibodies. Most cases of Lyme disease are curable using antibiotics, but the longer the delay, the more difficult it is to treat. Your dermatologist may prescribe medications to help alleviate joint stiffening.

The best form of prevention is to avoid tick bites. Use insect repellent containing DEET. Wear long sleeves and pants when outdoors. Tuck the sleeves into gloves and pants into socks to keep your skin covered. After a hike, check the skin and look for any tick bites, especially on children. If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination.

Granuloma is a generic term that refers to a small nodule. It can be any type of nodule, from benign to malignant. Granulomas occur throughout the body. Two types of granuloma apply expressly to the skin:

Pyogenic Granuloma. Pyogenic granuloma looks like small, reddish bumps on the skin that tend to bleed. It is caused by an injury to the skin. It is most frequently found on the hands, arms and face. In some cases, the nodule will spontaneously disappear. More often, the lesions need to be removed by surgery. There may be some scarring as a result of these treatments.

Granuloma Annulare. This type of nodule can occur in any person, but is more common in children and young adults. It is characterized by a ring-shaped lesion that is round and firm; red, white or purple skin around a clear crater of normal skin. It can appear individually or in groups. Most often, it appears on tops of hands and feet, elbows and knees. Most people have no other symptoms, but some may experience itchiness at the site of the lesion. Granuloma annulare can resolve itself and may or may not disappear over time without treatment. However, if the incidence is widespread or aesthetically undesirable, a dermatologist may prescribe a steroid cream or inject steroids just below the skin’s surface to speed healing. Another successful treatment is PUVA, in which a medication called psoralen is given and then the area is exposed to ultraviolet light.

Also known as skin abscesses, boils form as a result of a cut or break in the skin, which leads to a bacterial infection. They are characterized as a red, tender area with a painful, pus-filled center that can open spontaneously or by surgical incision. Some boils are caused by an ingrown hair. Others are caused by plugged-up sweat glands, such as some types of cystic acne. Anyone can get a boil. They grow quickly and are usually painful until they drain. However, left alone a boil will naturally come to a head and burst open, allowing the pus to drain and the skin to heal. People with weakened immune systems are more susceptible to boils than the general population.

Boils tend to occur on parts of the body that have hair or sweat glands and are exposed to friction, typically on the face, neck, armpits or buttocks. There are a variety of different types of boils:

Furuncle or Carbuncle. These abscesses are caused by the Staphylococcus aureus bacterium. A furuncle is an individual boil; carbuncles are deep clusters of boils that most often form on the back of the neck, shoulders or thighs.

Pilonidal Cyst. An infected hair follicle around the buttocks area caused by long periods of sitting. Pilonidal cysts almost always require medical treatment.

Hidredenitis Suppurativa. These are multiple abscesses that form from blocked sweat glands in the armpits or groin areas.

Cystic Acne. These boils are situated more deeply into skin tissue than the more superficial forms of acne. It typically occurs among teenagers.

Boils respond well to home remedies. To promote healing, apply heat to the boil in the form of hot soaks or compresses. Keep the area clean, apply over-the-counter antibiotics and then cover with gauze. Do not puncture or squeeze the boil because it can lead to further infection. If the boil does not go away within two weeks, is accompanied by a fever or is painful, contact your dermatologist. The doctor will clean, lance and drain the boil and prescribe an antibiotic to alleviate the infection.

A skin inflammation that occurs in warm, moist folds of the body where two skin surfaces chafe against each other. It most commonly appears on the inner thighs, armpits, groin, the crease on the back of the neck, the bottom of breasts in women and below the belly in obese people. It can be caused by a bacterial, yeast or fungal infection. Symptoms include a reddish-brown rash that looks raw and may ooze or itch. In severe cases, the skin may crack or bleed.

Treatment for intertrigo focuses on keeping the affected area dry and exposed to air. Your dermatologist may prescribe steroidal creams, oral antibiotics or antifungal medications (depending on the cause of the infection) to relieve itching and promote healing. Applying warm, moist compresses to the area can also help relieve itching.

Candidiasis is the medical term for yeast infections in the body. There are three forms of candidiasis that relate specifically to the skin:

Oral Candidiasis (Oral Thrush). This infection is characterized by lacy, white patches on top of reddened areas that occur on the tongue, throat or elsewhere in the mouth. It is usually accompanied by a fever, colic or diarrhea. Oral thrush can be painful and lead to an uncomfortable burning sensation in the mouth. People who are diabetic, have suppressed immune systems, patients undergoing antibiotic or chemotherapy treatment and denture wearers are more susceptible to this infection. It is particularly important to catch it early in infants and children. Because of the discomfort caused by oral thrush, they may stop eating and/or drinking.

Diaper Rash. Candidiasis breeds in warm, moist environments and in the natural creases of the skin. Some diaper rashes are bacterial, but many are caused by yeast infections. To treat diaper rash, use over-the-counter powders and ointments and antifungal creams and lotions. Plan on frequent diaper changes to give the skin a chance to be exposed to air regularly. If diaper rash doesn’t abate in seven to 10 days, contact your dermatologist.

Candidal Intertrigo. This yeast infection occurs in moist overlapping skin folds, such as areas in the inner thighs, armpits, under the breasts, below the belly, behind the ears and in the webbed spaces between the fingers and toes. It is more common among people who are overweight. It is characterized by red, raw skin surrounded by scaling and, in some cases, lesions that itch, ooze or hurt. Candidal intertrigo is treated with medicated topical creams.

Cellulitis is a common bacterial skin infection that is caused by either Staphylococcus or Streptococcus bacteria. Both of these bacteria occur naturally on the skin. A break or cut in the skin causes the bacteria to enter the body, which leads to an active infection. Cellulitis most often occurs from:

• cracking or peeling skin between the toes,
• insect bites or stings, and
• a skin cut, break or trauma.

Cellulitis appears as a swollen red area of skin that is tender and hot to the touch. Symptoms include chills, fever, muscle ache, fatigue, pain or tenderness in an area with a skin rash or sore. The redness increases in size as the infection spreads. It typically comes on suddenly and spreads quickly. Cellulitis can arise anywhere on the body, but usually appears on the face or legs. Be sure to contact your dermatologist as soon as you observe these symptoms to start an effective treatment.

To prevent cellulitis, be sure to clean any cut or break in the skin promptly with soap and water and cover the wound with a bandage until it scabs over. Watch for redness, tenderness, drainage or pain as these are signs of infection.