Rash

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What Is Rash?
  • Pruritus is a a sensation (usually unpleasant) that elicits a desire to scratch
  • Pruritus is the most common skin symptom, with underlying systemic etiology in 10-25% of patients
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remotederm - Pruritus
Rash
rash itchy skin remotederm
Rash
Rash - remotederm
Rash
What Causes Rash?
  • Generalized pruritus can be due to
    • Hepatic, renal or thyroid dysfunction
    • Lymphoma, myeloproliferative disorders (e.g. polycythemia vera, hypereosinophilic syndrome) and Chronic Lymphocytic Leukemia (CLL)
    • HIV or parasitic infections
    • Neuropsychiatric disorders
Clinical Presentations Of Rash
  • Patients with pruritus presents with excoriations (sores) over the area which has been constantly rubbed or picked at
  • Lesions on the mid upper back suggest a primary skin disease, since this difficult-to-reach region is typically spared (“butterfly sign”) in patients with pruritus of systemic or psychogenic etiology, they present with excoriations and other secondary changes, but no primary lesions (no actual rash)
  • Patients with underlying urticaria (hives) & mastocytosis tend to present with pruritus after their skin has been pressed & rubbed
  • Scabies & other infestations are higher in differential diagnosis if multiple family members have been affected
  • Pruritus after emergence from a bath (due to cooling or drying of the skin) is an indication to investigate the possibility of polycythemia vera or idiopathic aquagenic pruritus.
  • Nocturnal (night time) generalized pruritus in association with chills, sweating and fever classically due to Hodgkin lymphoma may precede the disease by as much as 5 years
Complication Of Rash

Excoriations due to constant scratching of skin can lead to secondar bacterial skin infection

Treatment Options for Rash
  • Home remedies
    • Avoiding hot bath or hot shower
    • Avoiding scented products
    • Avoiding scented detergents
    • Using cotton cloths
  • Over the counter medications
    • Regular use of moisturizers
    • Regular use of cleansers instead of moisturizers
    • Antihistamines
      • Claritin (Loratadine)
      • Cetirizine
      • Fexofenadine
      • Benadryl
  • Prescription
    • Topical medications
      • Topical steroid cream or ointment
      • Topical calcineurin inhibitors cream or ointment: Protopic or Elidel
      • Menthol or pramoxine
      • Capsaicin 0.025–0.3% every 4-6 hours
      • Topical calcipotriene
    • Phototherapy
      • Narrow Band UVB phototherapy
    • Systemic therapy
      • Selective Serotonin Reuptake Inhibitor (SSRI)
      • Tricyclic antidepressants (TCA):
      • Doxepin has anti-histamine & anti-depressant properties
      • Gabapentin or pregabalin (Lyrica)
      • Thalidomide
      • Cyclosporine
Prevention Of Rash
  • Avoiding scented products
  • Avoiding the triggering agents
  • Age appropriate cancer prevention measures
  • Addressing any underlying hepatic (liver), renal (kidney), thyroid, infectious process to prevent development of generalized pruritus

Essential Reads

Itchy Skin

Pruritus is a a sensation that elicits a desire to scratch. Pruritus is the most common skin symptom, with underlying systemic etiology in 10-25% of patients

Rash

Pruritus is a a sensation that elicits a desire to scratch. Pruritus is the most common skin symptom, with underlying systemic etiology in 10-25% of patients.

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Pruritus is a a sensation (usually unpleasant) that elicits a desire to scratch. Pruritus is the most common skin symptom, with underlying systemic etiology in 10-25% of patients

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