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:
- Urushiol in Poison Ivy, Oak and Sumac
- Nickel in jewelry, zipper, cell phones and belts
- Fragrances
- 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
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
