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Making the call on rashes |
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Itchy rashes, while annoying, often respond to home cures. But if that rash hurts more than it itches, see your doctor. Shrug off those scaly spots and inflammation as a minor rash, and you're probably right. Luckily, most skin eruptions are simple irritations - a superficial dermatitis or eczema - that can be soothed with over-the-counter (OTC) remedies. But if the redness, swelling or itching doesn't improve in two to three days, or you're feverish, in pain, achy or tired, check with your family doctor. Your innocent rash could involve a more serious disorder. Allergies/irritants If an itchy rash develops after something has touched your skin, doctors call it allergic contact dermatitis. Poison ivy, oak and sumac are good examples. Other allergens include the nickel in jewelry; perfumes and cosmetics; latex used in rubber gloves and other products; and even the chemicals in the materials used to make shoes. Irritants, such as strong soaps or other solvents, can also damage the skin, causing a rash. Overactive immune system Allergy sufferers often get an itchy rash called atopic dermatitis, one of the most common forms of eczema. Atopic dermatitis isn't caused by allergy to a particular substance. Instead, it's an abnormal response of the body's immune system. The system gets stuck in the "on" position, producing what's referred to as the "itch that rashes." Only when you scratch an itch does the rash appear. Common areas for atopic dermatitis are in the skin folds in front of the elbow and behind the knee. Psoriasis, another immune-mediated condition, is triggered when faulty signals speed up skin cell growth, producing white, scaly, itchy patches, often on slightly raised red- to purple-colored plaques. Microbes Your skin is your body's biggest protective barrier. But it's still vulnerable to microorganisms living on or invading it. Bacteria. Staphylococcus and streptococcus are the most common sources of bacterial infections. You may be familiar with impetigo, a highly contagious, sometimes painful infection of blisters or open sores that develop a yellow crust. A deeper skin infection is cellulitis, a potentially serious infection that can spread from any wound, break in the skin or even an insect bite. The affected area is usually red, warm and slightly raised, and it hurts. Fungi. Fungal skin infections enjoy warm, wet, dark places. Ringworm, a common example, is a ringshaped infection caused by several different fungi, depending on its location: athlete's foot between the toes, jock itch in the groin and scalp ringworm on the head. Most times, the more active outer area of the rash is raised, red and a little scaly; sometimes there can even be blisters. Viruses. The same varicella-zoster virus that gave you chickenpox as a child may erupt after years as herpes zoster or shingles, an infection of the nerve endings. It includes a painful, localized rash of small, crusting blisters, which can sometimes produce discomfort for months or years after healing. |
Antibiotics to ACE inhibitors Both OTC and prescription drugs can trigger allergic skin reactions - usually after a first use. Rashes vary from the itchy, red welts of hives to the scarlet scaling of exfoliative dermatitis, an inflammatory skin disorder linked to penicillin or sulfa-containing antibiotics. Symptoms disappear when you stop the medication, but drug allergies are lifelong - and can be life-threatening. So report any reactions to your doctor. Here's what to do Keep it clean. Avoid cleaning products with fragrance since they may provoke further allergic responses. Gently washing a rash with soap and water - and letting it dry thoroughly - can relieve itching and make an ointment more effective. Treat with topicals/pills. Your family doctor may recommend a combination of medications. Here's a sampling. Corticosteroids. Many rashes get better on their own once you remove the source. But OTC hydrocortisone creams and ointments are effective in relieving inflammation and itching. You may need prescription-strength, however. Non-responsive atopic dermatitis could also be treated with tacrolimus (Protopic), an immunosuppressant prescription ointment that reins in the immune response. Antibiotics. If your rash is red, warm and raised, and started near a cut, bug bite or other break in the skin, you're probably dealing with cellulitis. You will need to see your doctor right away to get a prescription antibiotic. Impetigo requires oral penicillin, or penicillin-like drugs alone or in combination with a prescription-strength topical antibiotic cream, such as mupirocin (Bactroban). Antifungals. If you're experiencing a fungal infection, such as ringworm, athlete's foot or jock itch, you'll need an OTC or prescription antifungal cream, such as terbinafine, clotrimazole or ketoconazole (Lamisil, Cruex or Lotrimin). Antivirals. If your rash is painful, chances are you have a more serious condition such as shingles. While no drug eliminates this virus, an antiviral such as acyclovir (Zovirax) may shorten the course and reduce the chance of lasting pain in the area. Don't scratch. Scratching can open up skin, allowing a secondary infection. Instead, take a cool bath or shower to "quiet" the irritation. If the itching is severe, your doctor may suggest you take an oral antihistamine, such as diphenhydramine (Benadryl), to break the cycle. See your doctor if your rash persists, or if you have any questions or concerns. Peter Wehrwein is a health writer in Newton, Mass.
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