A Family Doctor's Tale - RASHES

DOC I HAVE A RASH

A rash is a very common symptom seen in a family doctor clinic.
A rash can be itchy and uncomfortable.
They can be painful in cases of shingles rashes, chickenpox and infected rashes.
They can very small, raised, patchy in urticaria, spread over the body or blister like in appearance(chickenpox or herpes)


In Babies atopic eczema is a common skin condition which presents as a chronic, relapsing, and very itchy rash at some point during childhood.
Atopic eczema clears and often disappears with age.
It is usually genetic as the condition runs in families


In Children the causes are :
Allergy
Infections


In adults the causes are:
Allergy
Infections
Autoimmune -abnormal response of the body’s immune system


Rashes can be genetic or due to environmental triggers:

a.rough or coarse materials coming into contact with the skin causes itchiness.

b.feeling too hot and/or sweating will cause an outbreak

c.certain soaps, detergents, disinfectants,


One of my Singaporean patient who has just relocated back after 3 years in UK had hives or patchy itchy rashes after moving to a service apartment after staying at a hotel for 2 days.
The apartment provides free soap different from the hotel.
She was given an injection of antihistamine and some steroid which clears her hives.
But after a bath the hives came back and I had to give her another injection to clear the rashes. We suspected the soap was the problem and change it to her normally used soap.
After that the rashes disappeared. It was due to a sosp which she was allergic to.

d.contact with juices from fresh fruits and meats,

e.food allergens in childhood such as cow's milk, hen's egg,peanuts, nuts, shellfish, duck flesh

f.dust mites,

g.animal saliva and danders may trigger itching.

h.Upper respiratory infections (caused by viruses) may also be triggers.

i.Stress can also sometimes aggravate an existing flare-up.
j.Pollens from flowers


I had another patient who was given about 100 different types of flowers just the day before her wedding. Normally she was not allergic to most flowers but in this case one of the hundred flowers probably cause very itchy hives all over her body.
I had to give her an anhistamine injection and 8 tablets of steroid tablets before the hives disappear 3 hours later. Happily she was able to go through her wedding the next day.

Rashes can occur on just about any part of the body

In infants, Atopic eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.


In children and adults, rashes typically occurs on the face, neck, and the insides of the elbows, knees, and ankles.


In some people, rashes may form bubbles which can ooze when broken.


In others, the condition may appear more scaly, dry, and red.


Chronic scratching usually make the skin worse taking on a leathery texture because the skin thickens (lichenification).


Typical features of rashes are:

1.dry,

2.red,

3.extremely itchy patches on the skin.

4.Oozing of the rash

5.Thickening of the skin


All rashes can be diagnosed from:
1.History and appearance of the rash

2.Screening test for food allergy

3.Blood test for specific antibodies to food substance



Treatment of rashes is:


1 application of lotions or creams to keep the skin as moist as possible after bathing2.Cold compresses applied directly to itchy skin can also help relieve itching.

3.application of nonprescription corticosteroid creams and ointments to reduce inflammation if the condition persists, worsens, or does not improve satisfactorily.

Hydrocortisone cream and ointment are preferred to prevent side effects such as skin thinning.

4.For severe flare-ups, I may prescribe oral corticosteroids (this treatment is not recommended for long-term use).

5.topical or oral antibiotics may be needed for the skin infection which may affect the dry inflammed skin.

6.sedative antihistamines are sometimes used to reduce the itch

7.Tar treatments can have positive effects; however, tar can be messy.

8.Phototherapy requires special equipment (lights).

9.cyclosporine A, an anticancer drug, modifies autoimmune response; however, this is used only in extreme cases because of its association with serious side effects on the blood cells.
10.prevent scratching.
   
Do not SCRATCH because damage to the skin barrier may lead to dryness and inflammation of the skin


Rashes can usually be avoided with some simple precautions.

The following suggestions may help to reduce the severity and frequency of flare-ups:

Moisturize frequently

Avoid sudden changes in temperature or humidity

Avoid sweating or overheating

Dress the child in breathable cotton clothes

Reduce stress

Avoid scratchy materials (e.g., wool or other irritants)

Avoid harsh soaps, detergents, and solvents

Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)

Be aware of any foods that may cause an outbreak and avoid those foods