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Common Acute Rashes in Urgent Care Setting

Atopic Dermatitis

  • Cause: Mutation in Flaggrin a protein important for the skin barrier
  • Location: usually face and flexural surface of elbow and knee
  • Type of rash: excoriation and thickening with spotty bleeding from scratching
  • Often accompany Allergic Rhinitis and asthma
  • Affected skin is prone to staph infection

Treatment: fragrance free, non soap cleanser and moisturizers + Topical steroids

Tacrolimus (non steroid) is recommended for face and not the steroid cream

Contact Dermatitis

It has 2 main types Allergic and Irritant:

  • Allergic happens when the immune system overreacts to a chemical previously exposed to causing skin inflammation
  • Irritant Dermatitis is direct skin damage from harsh chemicals, soap and detergents
  • Common triggers of allergic dermatitis:
    1. Urushiol in Poison Ivy, Oak and Sumac
    2. Nickel in jewelry, zipper, cell phones and belts
    3. Fragrances
    4. Topical ointments Bacitracin and Neomycin

Location: Site of exposure and may spread

Type of rash: Redness and patch swelling with occasional blistering

  • Skin allergy testing can be helpful in diagnosing the cause.

Treatment:

  • Remove and wash off the triggering cause
  • Avoidance in the future
  • Antihistamine
  • Oral steroids (will need 2-3 weeks of gradual taper for Poison Ivy)

Lichen Simplex Chronicus

  • The cause is repetitive scratching or rubbing of skin already irritated by atopic dermatitis , dry skin and some psychiatric    
  • Type of rash: thickened, red, hyper-pigmented and cracking skin

Treatment: moisturizers, ultra potent steroid cream and intramural lesion steroid injection

Intertrigo

It is inflammation in the skin fold (abdomen and groin) in obese patients caused by friction ,warmth and moisture

  • The rash is red macerated eruption and itchy
  • Often complicated by fungal candida infection

Treatment: keep the skin dry and use anti fungal powder

Hand Dermatitis

It is caused by a combination of factors:

  • Excessive hands washing
  • Atopic dermatitis
  • Contact dermatitis
  • Dyshydrotic (pompholyx)

-those who use gloves, excessive and frequent water and chemicals are at risk

-Rash: red thick itchy cracking skin and at times blisters

Treatment:

-Topical emollients and potent steroid cream

-Remove the trigger

-Cotton gloves

Xerotic Eczema

  • Dry weather and excessive bathing will cause the dry skin
  • Hypothyroidism and medications (diuretics)can cause it
  • It is usually seen in elderly patients lower extremities

Treatment: Emollient and potent topical steroid cream for 2-3 weeks

Xerotic Eczema

Nummular Eczema

  • It is a form of Eczema (skin allergy)
  • Usually affects extremities
  • Coin size thickened scaly eruption
  • Can be confused with Ringworm

Treatment:emollients and topical steroids

Stasis Dermatitis

  • It is caused by poor venous legs drainage and swelling
  • It usually affects the lower extremities
  • It causes itching and redness in a swollen leg
  • Hyperpigmentation and dilated veins are common findings
  • Can be confused with Cellulitis

Treatment: Treat the cause of leg swelling emollients and Steroid cream

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