Rash mirrored both sides body

Contents

Rash

There are many different causes for rashes. Here’s a list of 21 with pictures.

Warning: graphic images ahead.

Flea bites

  • usually located in clusters on the lower legs and feet
  • itchy, red bump surrounded by a red halo
  • symptoms begin immediately after being bitten

Read full article on flea bites.

Fifth disease

  • headache, fatigue, low fever, sore throat, runny nose, diarrhea, and nausea
  • children are more likely than adults to experience a rash
  • round, bright red rash on the cheeks
  • lacy-patterned rash on the arms, legs, and upper body that might be more visible after a hot shower or bath

Read full article on fifth disease.

Rosacea

Share on PinterestBy M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara , via Wikimedia Commons

  • chronic skin disease that goes through cycles of fading and relapse
  • relapses may be triggered by spicy foods, alcoholic beverages, sunlight, stress, and the intestinal bacteria Helicobacter pylori
  • the four subtypes of rosacea encompass a wide variety of symptoms
  • common symptoms include facial flushing, raised, red bumps, facial redness, skin dryness, and skin sensitivity

Read full article on rosacea.

Impetigo

  • common in babies and children
  • often located in the area around the mouth, chin, and nose
  • irritating rash and fluid-filled blisters that pop easily and form a honey-colored crust

Read full article on impetigo.

Ringworm

Share on PinterestJames Heilman/Wikimedia Commons

  • circular-shaped scaly rashes with raised border
  • skin in the middle of the ring appears clear and healthy, and the edges of the ring may spread outward
  • itchy

Read full article on ringworm.

Contact dermatitis

  • appears hours to days after contact with an allergen
  • has visible borders and appears where your skin touched the irritating substance
  • skin is itchy, red, scaly, or raw
  • blisters that weep, ooze, or become crusty

Read full article on contact dermatitis.

Allergic eczema

  • may resemble a burn
  • often found on hands and forearms
  • skin is itchy, red, scaly, or raw
  • blisters that weep, ooze, or become crusty

Read full article on allergic eczema.

Hand, foot, and mouth disease

Share on PinterestImage by: KlatschmohnAcker (Own work) , via Wikimedia Commons

  • usually affects children under age 5
  • painful, red blisters in the mouth and on the tongue and gums
  • flat or raised red spots located on the palms of the hand and soles of the feet
  • spots may also appear on the buttocks or genital area

Read full article on hand, foot, and mouth disease.

Diaper rash

  • located on areas that have contact with a diaper
  • skin looks red, wet, and irritated
  • warm to the touch

Read full article on diaper rash.

  • yellow or white scaly patches that flake off
  • affected areas may be red, itchy, greasy, or oily
  • hair loss may occur in the area with the rash

Read full article on eczema.

Share on PinterestMediaJet/Wikimedia Commons

  • scaly, silvery, sharply defined skin patches
  • commonly located on the scalp, elbows, knees, and lower back
  • may be itchy or asymptomatic

Read full article on psoriasis.

Chickenpox

  • clusters of itchy, red, fluid-filled blisters in various stages of healing all over the body
  • rash is accompanied by fever, body aches, sore throat, and loss of appetite
  • remains contagious until all blisters have crusted over

Read full article on chickenpox.

Systemic lupus erythematosus (SLE)

Share on PinterestImage by: Doktorinternet (Own work) , via Wikimedia Commons

  • an autoimmune disease that displays a wide variety of symptoms that affect many different body systems and organs
  • a wide array of skin and mucous membrane symptoms that range from rashes to ulcers
  • classic butterfly-shaped face rash that crosses from cheek to cheek over the nose
  • rashes may appear or get worse with sun exposure

Read full article on systemic lupus erythematosus (SLE).

  • very painful rash that may burn, tingle, or itch, even if there are no blisters present
  • clusters of fluid-filled blisters that break easily and weep fluid
  • rash emerges in a linear stripe pattern that appears most commonly on the torso, but may occur on other parts of the body, including the face
  • may be accompanied by low fever, chills, headache, or fatigue

Read full article on shingles.

Cellulitis

This condition is considered a medical emergency. Urgent care may be required.

  • caused by bacteria or fungi entering through a crack or cut in the skin
  • red, painful, swollen skin with or without oozing that spreads quickly
  • hot and tender to the touch
  • fever, chills, and red streaking from the rash might be a sign of serious infection requiring medical attention

Read full article on cellulitis.

This condition is considered a medical emergency. Urgent care may be required.

  • mild, itchy, red rash may occur days to weeks after taking a drug
  • severe drug allergies can be life-threatening and symptoms include hives, racing heart, swelling, itching, and difficulty breathing
  • other symptoms include fever, stomach upset, and tiny purple or red dots on the skin

Read full article on drug allergies.

Scabies

Share on PinterestNo machine-readable author provided. Cixia assumed (based on copyright claims). , via Wikimedia Commons

  • symptoms may take four to six weeks to appear
  • extremely itchy rash may be pimply, made up of tiny blisters, or scaly
  • raised, white, or flesh-toned lines

Read full article on scabies.

Measles

Share on PinterestBy Photo Credit: Content Providers(s): CDC/Dr. Heinz F. Eichenwald , via Wikimedia Commons

  • symptoms include fever, sore throat, red, watery eyes, loss of appetite, cough, and runny nose
  • red rash spreads from the face down the body three to five days after first symptoms appear
  • tiny red spots with blue-white centers appear inside the mouth

Read full article on measles.

Tick bite

Share on PinterestImage by: James Gathany Content Providers(s): CDC/ James Gathany , via Wikimedia Commons

  • pain or swelling at the bite area
  • rash, burning sensation, blisters, or difficulty breathing
  • the tick often remains attached to the skin for a long time
  • bites rarely appear in groups

Read full article on tick bites.

Seborrheic eczema

  • yellow or white scaly patches that flake off
  • affected areas may be red, itchy, greasy, or oily
  • hair loss may occur in the rash area

Read full article on seborrheic eczema.

Scarlet fever

Share on PinterestImage by: badobadop.co.uk (Own work) , via Wikimedia Commons

  • occurs at the same time as or right after a strep throat infection
  • red skin rash all over the body (but not the hands and feet)
  • rash is made up of tiny bumps that make it feel like “sandpaper”
  • bright red tongue

Read full article on scarlet fever.

Kawasaki disease

This condition is considered a medical emergency. Urgent care may be required.

  • usually affects children under age 5
  • red, swollen tongue (strawberry tongue), high fever, swollen, red palms and soles of the feet, swollen lymph nodes, bloodshot eyes
  • may cause severe heart problems so consult a doctor if there’s concern
  • however, usually gets better on its own

Read full article on Kawasaki disease.

Celiac Disease and Dermatitis Herpetiformis

Dermatitis herpetiformis is a skin condition that is seen in about 20 percent of people with celiac disease. “Dermatitis herpetiformis is a dermatologic manifestation of celiac disease. The name of this is descriptive and implies a ‘herpes-like’ inflammation of the skin. This means that the skin is inflamed, usually itchy, and has fluid-filled vesicles that erupt,” explains Rick Desi, MD, a gastroenterologist for the Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore.

What Causes Dermatitis Herpetiformis?

Despite its name, dermatitis herpetiformis is not caused by a herpes virus. It is caused by an abnormal immune response to gluten, a protein found in wheat, barley, and rye. Celiac disease leads to swelling and irritation in the lining of the intestine, whereas inflammation of the skin after exposure to gluten results in dermatitis herpetiformis.

If you have a gluten sensitivity, your body mistakenly treats gluten like a dangerous invader and forms antibodies against this protein. These antibodies, substances that usually fight bacteria and viruses, attach to the gluten and travel throughout your blood. When clumps of antibodies and gluten enter blood vessels in your skin, they cause an inflammatory reaction, leading to dermatitis herpetiformis.

What Are the Symptoms of Dermatitis Herpetiformis?

Dermatitis herpetiformis is more common in men and usually begins between the ages of 15 and 40. Like celiac disease, it is more common in people of northern European descent. Symptoms include:

  • Clusters of itchy, red bumps or small blisters on the scalp, elbows, knees, back, and buttocks. “The typical location is the front of the body, especially the trunk and lower extremities,” notes Dr. Desi.
  • Severe burning and itching.
  • A symmetrical rash on both sides of the body. The iodine in salt and sun exposure may trigger the rash in some cases.

How Is Dermatitis Herpetiformis Diagnosed?

Dermatitis herpetiformis is often misdiagnosed. “Most practitioners will not recognize this rash as being dermatitis herpetiformis. It is usually not obvious and usually diagnosed after some time when the rash does not improve, or when a biopsy is performed,” says Desi. In most cases, the diagnosis is made when a dermatologist examines a small piece of skin near the rash under the microscope. The accumulation of special antibodies indicates the diagnosis of dermatitis herpetiformis.

Dermatitis Herpetiformis: Can It Be Treated or Prevented?

Just like celiac disease, dermatitis herpetiformis is a chronic condition. The good news is that eating a gluten-free diet can prevent or reverse the symptoms of celiac disease and dermatitis herpetiformis. It may take a few years for the antibody deposits in your skin to go away, however.

“Patients can be treated conservatively while on a gluten-free diet, as the response and relief is not immediate. These measures topical anti-itch creams, although medications, such as Dapsone, can be used with benefit,” says Desi.

Dapsone is an old but very effective drug. It has been used to treat leprosy since the 1940s. In the 1950s it was discovered that Dapsone rapidly relieves the itching and inflammation of dermatitis herpetiformis. The problem with Dapsone is that it can cause anemia and other blood cell problems. So if you are on Dapsone you will need to use it for as short a time as possible and be closely monitored by your doctor.

Dermatitis herpetiformis and celiac disease are caused by the same abnormal response to gluten, but the symptoms are different. Most people with dermatitis herpetiformis do not have the digestive symptoms associated with celiac disease. If you have celiac disease, there is about a one in four chance that you will develop dermatitis herpetiformis. A lifelong gluten-free diet is the best treatment for both diseases.

The itchy red bumps came out of nowhere and it’s unclear whether the mystery rash is something that needs a doctor or if it can be soothed away with over-the-counter salves.

While it might be hard to pinpoint what is causing skin redness or itching, but contact dermatitis can be a common allergic reaction to skin care products. As it turns out, plenty of rashes respond well to over-the-counter remedies.

But some are a sign of something more serious, experts say.

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One important rule of thumb is to seek help if the rash came with other symptoms.

“The majority of rashes are not life threatening,” said Dr. Daniela Kroshinsky, an associate professor of dermatology at Harvard Medical School and director of inpatient dermatology and pediatric dermatology at Massachusetts General Hospital.

“But, if you’re feeling generally unwell and having a rash, that would be a reason to seek medical attention. Your primary care physician or dermatologist should be able to help you triage whether it’s something that should be seen and whether it needs to be seen urgently.”

A rash can be a warning sign of a serious medical problem, such as an autoimmune disease or a Lyme infection, explained Dr. Laura Ferris, an associate professor of dermatology at the University of Pittsburgh Medical Center. Or it could simply be the result of a harmless, though vexing, insect bite or a brush past some poison ivy.

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Signs that your rash needs to be looked at by a medical professional:

1. If you have a fever or pain accompanying the rash.

You should get it checked out, Kroshinsky said. It could be a sign that you have an infection or are experiencing an allergic reaction.

2. If you have a sudden spreading of bruise-like lesions.

It might be a symptom of vasculitis and you need to get that looked at because your clotting cells might not be working right, Kroshinsky explained.

3. If your rash continues unabated.

You might have an infection, Kroshinsky said. “Some rashes start out completely benign, but then a secondary infection develops because the integrity of the skin, which is a barrier against potential pathogens, has been disrupted,” she explained. “Signs of an infection include warmth and pain, yellow or green cloudy discharge and a bad odor.”

4. Any rash that is widespread.

It can be a sign a major allergic reaction. “For example, if this happens within two weeks of starting a new medication, the concern would be a reaction to the medication,” Ferris said.

5. Rashes that start to blister should send you straight to the doctor’s office, unless you have good reason to suspect you’ve come in contact with poison ivy, both experts noted.

6. Purple spots that appear on your hands and feet could be a sign of a bacterial infection of the heart, Kroshinsky said. “You can look at the skin as a window to the inside of the body,” she explained.

6. If you develop a circular-shaped rash and you’re in an area where Lyme disease is endemic, you should get it checked out, Ferris said.

If you’re not ready to see your doctor, Kroshinsky suggested taking a photo of your rash.

“It can be helpful when you come in to see us since the rash could have changed by then,” she explained. “This will tell us what it looked like before you started treating it with bacitracin or hydrocortisone. It will help us get a sense of the evolution of the rash.”

Also, Kroshinsky counseled, keep in mind that the preparations you use to treat your skin condition might make things worse.

“One thing to keep in mind is that if you’re using a preparation with topical antibiotics, a significant number of people are allergic to bacitracin and neomycin,” she explained. “If the area you are treating becomes itchy or blistery you might want to stop using them and see a doctor.”

And if you feel unsure about the rash, don’t hesitate to seek medical advice from a dermatologist, Ferris said.

“We’re trained to distinguish between concerning and non-concerning rashes and getting you on the appropriate treatment,” she added.

Common skin rashes and what to do about them

What’s that rash? Here’s what to look for to diagnose a common skin complaint. from www..com

21 March 2018

H. Peter Soyer, The University of Queensland and Katie Lee, The University of Queensland

This article is part of our series about skin: why we have it, what it does, and what can go wrong. Read other articles in the series here.

Everyone has had the unpleasant experience of a rash on the skin – pink, red or purple, flat or bumpy, itchy, scaly, pus-filled, or just plain unsightly. This variety isn’t surprising, because the skin is a complicated organ.

Infections, allergic reactions, immune system problems and even bad reactions to medication can all manifest as a rash.

Here are a few of the most common types.

Drug allergy

Almost every prescription medication available can cause a rash as a side effect, and more than 80% of those are “exanthematous drug eruptions”, meaning a widespread rash accompanied by other symptoms such as headache, fever and feeling generally unwell.

This rash usually appears within two weeks of starting a new medication, as a widespread, symmetrical rash with pink-to-red spots that are flat or elevated and firm, and that might join together in patches.

Read more: Common lumps and bumps on and under the skin: what are they?

This type of rash is a hypersensitivity reaction, in which the attacking soldiers of the immune system (called “T-cells”) detect the drug and try to clear it from the body by releasing inflammatory proteins.

Exanthematous drug eruption. DermNet New Zealand.

Very rarely, a drug can cause a severe and life-threatening rash called “toxic epidermal necrolysis” where the skin begins to peel off in sheets. It’s more common in Han Chinese people with a specific genetic variant, and requires intensive care or burn unit treatment.

Most drug eruptions go away within a week once the patient stops taking the problem medication, or within several weeks in protracted cases. In the meantime, or if the drug is essential, steroid creams (which reduce inflammation) and emollient (softening) moisturisers can bring some relief.

Allergic contact dermatitis

Allergic contact dermatitis is caused by direct skin contact with a substance to which the person is allergic. The immune system’s T-cells overreact to the allergen and release proteins that call more immune cells to the area, making it red and swollen.

Read more: Why does Australia have so much skin cancer? (Hint: it’s not because of an ozone hole)

It’s often itchy and can be blistered or dry but bumpy. The reaction is often delayed by 48-72 hours, so it can be difficult to determine exactly what caused the reaction. It should also die down by itself over a few days, as long as the allergen is no longer on the skin.

Contact allergies can develop suddenly after years of exposure to an allergen. Jewellery containing nickel, fragrances in lotions, household cleaners, preservatives in hair products, and latex in gloves or condoms are common sources. A dermatologist can carry out a patch test to determine whether a substance is the allergen, by applying it to a small patch of skin.

Severe contact dermatitis from a drug patch. Dr. Khatmando

Active dermatitis is treated with emollient moisturisers and steroid creams, or with oral steroids or drugs to suppress the immune system if very severe. Further episodes can be prevented by becoming aware of the sources of the allergen, reading labels carefully, and using gloves to handle allergen-containing products.

Eczema

Atopic dermatitis or atopic eczema (often just called eczema) is very common in children from three months old onwards, but appears in adults too, often with hay fever and asthma.

Atopic dermatitis features patches of intensely itchy red skin, sometimes with blisters and weeping patches. Children often have open sores and scabs, because it’s so itchy that it’s hard to refrain from scratching.

Over time the skin becomes thickened and rough from frequent scratching and rubbing. Childhood atopic dermatitis tends to improve as the child grows up, but may continue. Far less commonly, atopic dermatitis can also appear first in adulthood.

Atopic dermatitis is very common in children, but often improves as they get older. DermNet New Zealand

Atopic dermatitis is a disease of the immune system, in which structural defects in the skin barrier make it easier for irritants to penetrate into the skin. This throws the delicate balance of the microbial community on our skin out of whack, causing the immune system to go into overdrive. Triggers include stress, sweating, coarse fibres in clothing, inhalation of allergens such as pollen, irritants such as soap or perfumes, and eating food we’re allergic to.

Steroid creams can help treat a bad flare of atopic dermatitis, but shouldn’t be used constantly. In very severe cases, immunosuppressant drugs are prescribed. Ongoing control of atopic dermatitis often includes using emollient moisturisers to combat dry skin, keeping cool, avoiding hot water or irritants, and reducing allergens such as dust mites in the home.

For severe cases that don’t respond to these methods, the drug dupilumab has just been approved for use in Australia. This drug blocks a specific cell receptor to prevent immune cells from detecting two overactive inflammatory proteins.

Atopic dermatitis can have a big impact on quality of life, due to insomnia from the constant itchiness, and restrictions on clothing, body products, pets or activities. Its presence on prominent parts of the body like the face and hands can also reduce self-esteem. Evening sedatives to improve sleep and psychotherapy can help reduce the impact on everyday life.

Psoriasis

Psoriasis is another chronic immune disorder. It can start at any age and can be lifelong, and is usually present as red plaques (raised or thickened skin) with well-defined edges and silvery-white scales, ranging from a few millimetres to several centimetres across. The overactive inflammation can also damage the joints and lead to psoriatic arthritis.

Read more: The skin is a very important (and our largest) organ: what does it do?

Often the plaques feel itchy or sore, and because psoriasis is long-lasting and can appear prominently on highly visible parts of the body, it often comes with severe psychological effects.

Psoriasis lesions are raised, red and often have white scales. DermNet New Zealand

Psoriasis is caused by too many new skin cells being produced and moving up to the surface of the skin too quickly. It’s not known exactly why, but there’s usually an overabundance of inflammatory messenger proteins in the skin.

It can be triggered or aggravated by a streptococcal infection such as tonsillitis, smoking, hormonal changes such as menopause, and some medications. Genetics play an important role in susceptibility to psoriasis and also in what treatments are effective.

Chronic plaque psoriasis, the most common form, can be very resistant to treatment. Small areas can be treated with creams containing steroids, coal tar, or vitamin D. If a lot of the body is covered by plaques, oral immunosuppressant drugs are used, or phototherapy, which uses targeted UV light to destroy over-active immune cells. Moderate sun exposure sometimes improves psoriasis, but sunburn can worsen it – a tricky balance in Australia’s high-UV environment.

These treatments can usually improve the plaques, but it can be very difficult to clear it completely. There are several new drugs coming onto the market for severe psoriasis that hasn’t responded to other treatment.

Tinea

Tinea, or ringworm, is not caused by worms at all but a fungal infection. Tinea is usually named according to the body site it’s on, but the same few kinds of fungus can cause tinea in many parts of the body and it can be spread from one part of the body to another, such as by scratching or using a contaminated towel.

Tinea pedis, on the foot, is an important type because spores can live for weeks in communal showers and changing rooms, making it a common source of infection that can then spread to the trunk, arms and legs (tinea corporis) or groin (tinea cruris, or jock itch). Cats, dogs and other animals are a common source of ringworm fungus, but many types can be spread between people too.

The fungus continues to spread further out while the inner area heals, forming a distinctive ring shape. Grook Da Oger

Typically, tinea spreads in a circular or oval patch, often healing in the middle so that it appears to be a red scaly ring of infection. Sometimes it can also become a fungal abscess that looks like a boil, feels boggy, and has pustules.

On the feet it can look like ringworm circles, patchy fine dry scales on the sole, blisters on the instep or a moist, red peeling area between the toes (athlete’s foot).

In the groin, it can have a scaly, red raised border and be extremely itchy.

Tinea is diagnosed by microscopic examination and laboratory culture of skin scrapings. It’s usually treated with antifungal creams, or oral antifungal drugs if it persists. It can become chronic in the warm, moist folds of the body.

Shingles

Shingles is a famously painful, blistering rash caused by the reactivation of chicken pox virus, varicella-zoster virus, usually years or decades after the original infection.

The virus lies dormant in nerves near the spine and migrates down the sensory nerve to the skin when it is reactivated, but it’s not known why the virus is reactivated. Some possible triggers are radiotherapy, spinal surgery, other infections, or cancers.

Shingles forms a painful, blistered red rash along the line of a sensory nerve. Fisle

Shingles starts with pain in the skin that is often described as burning or stabbing, followed in one to three days by a rash of raised red bumps that become blisters and then crust over. The rash is usually confined to a narrow arc of skin, along the sensory nerve that was harbouring the virus.

Patients often have a fever, headache and swollen lymph nodes. Recovery takes two to four weeks but the pain can persist after the rash has healed, called post-herpetic neuralgia.

If it’s caught within three days of onset, antiviral medication can reduce the severity of symptoms and length of the infection. Otherwise, treatment consists of powders or solutions to dry out the rash, as well as pain relief and rest.

Australians aged over 70 are eligible for a free zoster vaccine, which reduces the risk of shingles by half.

H. Peter Soyer, Professor of Dermatology, The University of Queensland and Katie Lee, Research assistant, The University of Queensland

This article was originally published on The Conversation. Read the original article.

How to Identify and Treat a Drug Rash

Most drug rashes are symmetric. This means they appear the same on both parts of your body.

Drug rashes also don’t tend to cause any other symptoms besides their appearance, though some are accompanied by itching or tenderness.

You can usually separate a drug rash from other rashes since they tend to coincide with starting a new drug. But in some cases, it can take a drug up to two weeks to cause a rash.

The rash usually disappears once you stop taking the drug.

Here’s a look at some of the more common drug rashes.

Exanthematous rashes

This is the most common type of drug rash, making up about 90 percent of cases. It’s marked by small lesions on reddened skin. These lesions can be either raised or flat. Sometimes, you might also notice blisters and pus-filled lesions.

Common causes of exanthematous drug rashes include:

  • penicillins
  • sulfa drugs
  • cephalosporins
  • anti-seizure drugs
  • allopurinol

Urticarial rashes

Urticaria is another word for hives. Hives are the second most common type of drug rash. They’re small, pale red bumps that can form larger patches. Hives are usually also very itchy.

Common causes of urticarial drug rashes include:

  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • ACE inhibitors
  • antibiotics, especially penicillin
  • general anesthetics

Photosensitivity reactions

Some drugs can make your skin extra sensitive to ultraviolet light. This can result in an itchy sunburn if you go outside without proper protection.

Drugs that tend to cause photosensitivity include:

  • certain antibiotics, including tetracycline
  • sulfa drugs
  • antifungals
  • antihistamines
  • retinoids, such as isotretinoin
  • statins
  • diuretics
  • some NSAIDs

Erythroderma

This type causes nearly all of the skin to become itchy and red. The skin may also grow scaly and feel hot to the touch. Fever might also occur.

Many drugs can cause erythroderma, including:

  • sulfa drugs
  • penicillins
  • anti-seizure drugs
  • chloroquine
  • allopurinol
  • isoniazid

An underlying health condition can also cause erythroderma.

Warning

Erythroderma can become serious and life-threatening. Seek immediate medical attention if you think this is the type of rash you have.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)

SJS and TEN are considered the same condition, but there’s a slight difference between the two:

  • SJS involves less than 10 percent of the body.
  • TEN involves more than 30 percent of the body.

SJS and TEN are marked by large, painful blisters. They can also cause large areas of the top layer of your skin to come off, leaving raw, open sores.

Common drug-related causes include:

  • sulfa drugs
  • anti-seizure drugs
  • some NSAIDs
  • allopurinol
  • nevirapine

Warning

SJS and TEN are serious reactions that can be life-threatening. They both require immediate medical attention.

Anticoagulant-induced skin necrosis

Some blood thinners, such as warfarin, can cause anticoagulant-induced skin necrosis. This causes the skin to become red and painful.

Eventually, the tissues beneath the skin die. It usually only happens at the start of taking a very high dose of a blood thinner.

Warning

Anticoagulant-induced skin necrosis is a serious reaction that requires immediate medical attention.

Drug reaction with eosinophilia and systemic symptoms (DRESS)

DRESS is a rare type of drug rash that can be life-threatening. It can take two to six weeks for symptoms to appear after starting a new drug.

A DRESS rash looks red and often begins on the face and upper body. Accompanying symptoms are severe and can involve the internal organs. They include:

  • fever
  • swollen lymph nodes
  • facial swelling
  • burning pain and itchy skin
  • flu-like symptoms
  • organ damage

Drugs that can cause DRESS include:

  • anticonvulsants
  • allopurinol
  • abacavir
  • minocycline
  • sulfasalazine
  • proton pump inhibitors

Warning

DRESS is a very serious reaction that requires immediate medical attention.

What is dermatitis herpetiformis?

Dermatitis herpetiformis (DH) is a skin condition causing a very itchy rash. It is due to intolerance to gluten, which is a natural substance (a protein) found in certain foods. Gluten is in wheat, rye and barley. Gluten intolerance also causes a gut condition called coeliac disease, which is closely linked to DH.

What causes dermatitis herpetiformis?

The cause of DH is gluten intolerance. In this condition, your body reacts to gluten in food. Gluten intolerance is also sometimes called gluten sensitivity.

People with gluten intolerance have a kind of allergy to gluten, but it is not the same as a typical food allergy. With gluten intolerance, the gluten somehow triggers your body’s immune system to react against the body’s own organs. This is instead of doing what the immune system normally does, which is to be a defence against infections, etc. This may lead to various symptoms in different parts of your body. With DH, it is your skin which is affected.

It is not known exactly what causes the gluten intolerance in the first place.

Gluten intolerance also usually causes inflammation in the gut (in the small intestine). When this happens it is called coeliac disease. Most people with DH have some degree of coeliac disease. However, they may not have had any noticeable symptoms and their coeliac disease may not have been diagnosed. See the separate leaflet called Coeliac Disease for more details.

The rest of this leaflet deals with DH.

Who develops dermatitis herpetiformis?

  • Around 1 in 10,000 people have DH. About 1 in 8 people with coeliac disease will have DH.
  • DH is more common in men than in women and usually starts between ages 30-50 years, although it can occur at any age.

What are the symptoms of dermatitis herpetiformis?

There is an extremely itchy rash. It can affect any part of your skin, but is usually on your elbows, knees, buttocks and scalp. The rash is usually on both sides of your body at the same time (symmetrical). The rash has blisters and/or raised spots (papules) – but the blisters usually get scratched off to leave scabs. There may be burning or stinging on the area before the blisters start.

The rash can vary from week to week but does not usually clear up without treatment.

Dermatitis herpetiformis rash

You may also have symptoms of coeliac disease, such as tummy (abdominal) symptoms or unexplained tiredness. However, some people with coeliac disease have little in the way of symptoms, and DH may be the first sign of coeliac disease.

How is dermatitis herpetiformis diagnosed?

There are various skin conditions that cause itchy rashes with blisters, so a test is needed to diagnose DH for certain. The test is a a skin biopsy. This involves taking a small sample of skin under local anaesthetic. The sample is examined under the microscope in a laboratory, using a special test to look for antibodies called IgA. This test can reliably diagnose DH.

If DH is suspected, you will usually be offered tests for coeliac disease as well. Blood tests can help to show if coeliac disease is likely. If the blood tests are positive, you may be offered a test on the gut (a biopsy to sample the lining of your bowel), which can confirm if you have coeliac disease.

How is dermatitis herpetiformis treated?

There are two treatments for DH:

  • Diet
  • Medication

Diet

In the long term, a diet free of gluten will gradually reduce the DH symptoms and may cure DH completely. (This diet also treats coeliac disease.) However, it can take months or years for the diet to improve DH. Therefore, medication is often needed to bring the skin symptoms under control. See the separate leaflet called Coeliac Disease Diet Sheet for more information about the gluten-free diet. In the UK more information is also available from Coeliac UK – see under ‘Further Reading and References’, below.

Medication

Medication helps control the rash quickly. The usual medication for DH is dapsone. Dapsone often stops the itching within two days. Dapsone may have side-effects, including anaemia. Therefore, regular check-ups and blood tests are needed while you are taking it.

Dapsone is used to treat certain skin conditions, including DH. Exactly how it works is not known. However, it seems to have anti-inflammatory and antibacterial actions. In DH, it is probably the anti-inflammatory action that is helpful.

If you cannot take dapsone or you have side-effects from it, other alternative medicines are available – for example, sulfasalazine or sulfapyridine.

Are there any possible complications?

DH itself does not usually cause complications. However, the gluten intolerance and coeliac disease, if untreated, may make you ill and have possible complications. Most of these problems can be prevented or treated by following a gluten-free diet, which treats both DH and coeliac disease.

What is the prognosis?

Untreated, DH tends to go up and down in severity, but usually continues.

With treatment, the outlook (prognosis) is very good, as DH clears up with medication and a gluten-free diet. Dapsone usually improves the rash quickly. The gluten-free diet takes longer to help – it may take a year or more to get the full benefit. About 8 in 10 people with DH have good results from the diet so they can either stop taking dapsone, or can reduce the dose.

Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is a severe, chronic skin rash associated with celiac disease.

The symptoms of dermatitis herpetiformis are extremely itchy and blistering skin. Sometimes referred to as gluten rash or celiac rash, DH is a chronic condition that is considered to be the skin form of celiac disease. Not all people with celiac disease develop DH. The rash usually occurs on the elbows, knees, and buttocks and it is typically symmetrical, meaning it appears on both sides of the body. When this gluten-related rash goes away, which it often does spontaneously, it may leave brown or pale marks on the skin where pigmentation is lost.

Skin contact with gluten-containing foods and products has not been shown to cause outbreaks. While this skin condition is officially called dermatitis herpetiformis, some people describe it as a celiac rash or a gluten rash.

Who Gets Dermatitis Herpetiformis?

  • About 15-25% of individuals with celiac disease experience DH
  • Dermatitis herpetiformis affects more men than women
  • Dermatitis herpetiformis generally starts in adulthood. It’s not common to see DH in children, but it can occur

Only about 20 percent of people with DH have intestinal symptoms of celiac disease, however, biopsies show that 80 percent have some degree of damage to the small intestine, especially if a high gluten diet is maintained.

Dermatitis Herpetiformis Symptoms

Symptoms of dermatitis herpetiformis include extremely itchy skin and blisters or lesions.

DH can appear anywhere on the body. However, it most frequently presents in the following areas:

  • Buttocks
  • Elbows
  • Knees
  • Lower back
  • Scalp

Dental defects can also be a symptom of DH. Only about 20 percent of people with DH will experience intestinal symptoms.

Diagnosing Dermatitis Herpetiformis

Doctors diagnose DH by examining the cells under the top layer of skin, known as the dermal papillae, for neutrophils and granular IgA deposits in the skin.

These types of skin samples are collected by performing a biopsy. DH can often be misdiagnosed and frequently confused with skin conditions such as allergies, bug or mosquito bites, contact dermatitis, diabetic pruritus, eczema, herpes, hives and psoriasis. While 70-80% of DH patients have higher than normal blood IgA- tTG antibody levels, a typical celiac disease blood test is not considered sufficient or reliable enough to properly diagnose patients.

Dermatitis Herpetiformis Treatment

Dermatitis herpetiformis treatment consists of a lifelong gluten-free diet, just like celiac disease. The skin’s response to the gluten-free diet is much slower compared to the healing of the intestines with celiac disease. It may take about six months to achieve some improvement in the skin condition and up to two years or more to get total control through the gluten-free diet alone.

Rash symptoms can be controlled with an antibacterial medication. In general, itching and new lesions will begin to subside within 48-72 hours of starting this drug. However, this medication does not treat the intestinal condition, meaning that people with DH should also maintain a strict lifelong gluten-free diet.

Dermatitis Herpetiformis and Celiac Disease

DH is a skin manifestation of celiac disease and is part of the abnormal immune response to gluten. For those with celiac disease and DH, eating gluten triggers an autoimmune response which causes DH blisters to form. This rash is connected to celiac disease, not non-celiac gluten sensitivity (‘gluten sensitivity’).

Dermatitis Herpetiformis Remission

DH has been known, in some cases, to go into remission, whether or not patients are adhering to a gluten-free diet. Research indicates that DH remission is both spontaneous and only experienced in a very small percentage of patients (about 12%). However, patients diagnosed with DH should NOT abandon a gluten-free diet at any time, regardless of apparent remission.

Learn More About Dermatitis Herpetiformis

  • National Institutes of Health
  • Answers from a Dietitian: Dermatitis Herpetiformis

Do you or a family member suspect dermatitis herpetiformis? You may have celiac disease. Find out now. Take our Celiac Disease Symptoms Checklist.

What is your skin trying to tell you? 9 ways it could reveal serious health problems

Checking for changes in moles has become second nature, with all the worries and ­warnings over skin cancer .

But little changes in your skin, whether a rash, puckering or new bump, can also be an early sign of other diseases lurking in your body.

And being able to spot the signs sooner rather than later could make a massive difference.

Dr Joanna Gach, consultant dermatologist at Spire Parkway Hospital in Solihull, explains: “The skin is your body’s largest organ so it stands to reason that if things aren’t quite right on the inside, there will be telltale signs on the outside.”

Your skin is your body’s biggest organ and it can reveal a lot (Image: Getty) What is your skin trying to tell you? (Image: Getty)

While the majority of skin changes can be eczema or skin infections, which are easily diagnosed and treated, some can be signs of something a lot moresinister.

If they don’t disappear after a few days or they get worse, it’s always best to see a GP .

Dr Gach says: “Hopefully it will be something ­harmless that can be treated with medication.

“But often the more dangerous conditions don’t present with any pain so it’s important to take these things seriously.”

So which lumps, bumps, rashes, puckering and marks should you be worried about? And what could they be?

Here, Dr Gach talks you through those other changes we should all be watching out for…

Skin change: Yellowing of the skin

It could be… jaundice

Yellowing of the skin could indicate jaundice (Image: Science Photo Library)

Jaundice is something we tend to associate with young babies but it can happen to anyone.

It occurs when the liver isn’t clearing the toxins from the body as it should and allows a substance called bilirubin to build up.

This will cause the skin to take on a very yellow ­appearance, which can also be seen in the whites of theeyes.

If you notice this, then see your GP who will arrange urine tests and liver function and
blood tests.

Skin change: Puckering on the breast

It could be… breast cancer

A puckering of the skin could reveal breast cancer (Image: Alamy)

Although we know to look out for lumps in our breasts, many women are unaware that other changes to the skin in
this area can also be indicators of cancer.

I would advise women to look for any puckering, or dimpling, of the skin on the breasts.

Red, raised marks or skin with an orange peel appearance can also be warning signs of breast cancer so anyone who’s had these symptoms for more than three weeks, and who doesn’t have a history of skin conditions like eczema or psoriasis, should see their GP to get checked.

Skin change: Velvety looking rash on the back of the neck

It could be… Cancer or diabetes

A velvety rash on the back of your neck could be cancer or diabetes (Image: Alamy)

As obesity is now a common problem we are seeing this skin complaint, known as acanthosis ­nigricans, more and more.

We even see it in ­children. Sufferers will have dark, thickened patches of skin on the back of the neck, armpits or groin area.

They feel dry and rough, similar to velvet.

Acanthosis nigracans mainly affects those people who are overweight and although not a condition in itself, it can be a sign of a more serious problem, such as diabetes or cancer.

Skin change: A rash on the tops of the feet and lower legs

It could be… Hepatitis C

A rash on the top of the feet could be a sign of hepatitis C (Image: )

Hepatitis C affects ­approximately 215,000 people in the UK and is a virus spread through contaminated blood.

It causes flu-like ­symptoms, stomach pains and one of the signs can be a rash on the lower legs and feet.

I must stress that this is very rare, so don’t panic if you notice a rash this area.

The rash associated with hepatitis C is painful, purple in colour and can lead to ulcers around the ankles.

Hepatitis C can be ­life-threatening if left untreated so see your GP for a blood test if you are worried.

Skin change: Scaly bumps on knuckles

It could be… cancer

Scaly bumps on your knuckles could be an indication of cancer (Image: Alamy)

Raised scaly red bumps on the knuckles can be a sign of dermatomyositis, an inflammatory muscle disease caused by the body’s immune system turning on itself.

It can be linked with other autoimmune diseases, such as diabetes or thyroid disease, but in 20% of cases it is an indicator of an internal cancer, such as ovarian cancer.

Another sign is a violet-colored rash on the upper eyelids.

Look out for other indicators, for example unintentional weight loss, a cough, night sweats and generally feeling weak and unwell.

If you experience these symptoms, see your doctor.

Skin change: Hardening of the skin

It could be… Scleroderma

Hardening of the skin could be an indication of Scleroderma (Image: Alamy)

Scleroderma is a ­condition caused by the immune system attacking the tissue under the skin and around the internal organs.

There are two types, one that causes the skin to harden and a second, potentially life ­threatening type, which also affects the internal organs.

This is a very rare condition and causes the skin to harden, especially over the hands, arms, feet and face.

The skin loses its elasticity and becomes so hard that you can’t pinch it. If you have noticed these symptoms, see your GP.

Skin change: Waxy or yellow bumps

It could be… Diabetes

Waxy or yellow lumps could be a sign of diabetes (Image: Alamy)

Diabetes affects every part of the body so skin problems can be the first sign that someone has the condition.

High cholesterol and insulin resistance can lead diabetics to develop firm, yellow, waxy bumps on their skin.

These will be itchy little bumps that form in ­clusters.

Sometimes they can appear before diabetes is diagnosed but it’s important to look out for the more common symptoms of the disease, such as excessive thirst and needing the toilet more often than usual.

Skin change: Very dry, itchy skin

It could be… An underactive thyroid

Very dry and itchy skin could be a sign of an underactive thyroid (Image: Getty)

The thyroid gland controls the body’s hormones and when this isn’t functioning properly it can cause havoc with your skin and hair.

An underactive thyroid will lead to dry, itchy skin that has lost its elasticity and feels almost doughy.

Other symptoms include tiredness, hair loss, thinning of the eyebrows, weight gain, muscle aches and depression.

Thyroid ­conditions can be treated by your doctor with hormone ­replacement tablets so mention it if you have any concerns.

Skin change: Darkening creases

It could be… Addison’s disease

Darkening creases could be a sign og Addisons disease (Image: Alamy)

As a dermatologist, I don’t see Addison’s disease very often – it’s a rare disorder of the adrenal glands.

At first, sufferers mostly experience flu-like ­symptoms such as exhaustion and muscle weakness.

But over time, these become more severe and other ­symptoms include ­dizziness and cramps.

The disease can also cause people to develop areas of darkened skin, especially in the hand creases, or cause darkening on the inside lips orgums.

Although these symptoms aren’t always ­associated with Addison’s disease, if you do have them, see your GP for advice.

I smothered my itchy skin in body lotion – but it was trying to tell me something…

Emma Stephenson, 40, is a full-time mother of two from Exeter.

She discovered the itchy skin she suffered
as a teenager was a tell-tale sign she shouldn’t have ignored…

Emma Stephenson knows he importance of getting skin conditions checked

My mum would tease me as a teenager because I’d always smother myself in body lotion.

But if I didn’t, my skin would feel itchy, dry and uncomfortable.

Then in 2011, after having my first child Lara, I felt exhausted – but I put it down to being a new mum.

I’d wake up wishing I could sleep forever and became really forgetful, struggling to remember words.

When Lara was six months old I had a funny turn, where my heart was pounding, I felt sick and my legs were shaking violently.

But a doctor blamed low blood sugar due to breastfeeding.

Eventually, I started feeling dizzy, so when Lara was 10 months old my GP tested my thyroid and discovered it was seriously underactive.

It took six months to regulate my hormones with medication but now I feel like a different person.

I later learned my itchy skin was a symptom of hypothyroidism. I just wish I’d pushed harder to find out what was causing it.

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