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    Rash, Age 12 and Older

    Rash, Age 12 and Older

    Topic Overview

    Healthy skin provides a barrier between the inside of the body and the outside environment. A rash means some change has affected the skin.

    Rashes are generally caused by skin irritation, which can have many causes. A rash is generally a minor problem that may go away with home treatment. In some cases a rash does not go away or the skin may become so irritated that medical care is needed.

    In adults and older children, rashes are often caused by contact with a substance that irritates the skin ( contact dermatitis ). The rash usually starts within 48 hours after contact with the irritating substance. Contact dermatitis may cause mild redness of the skin or a rash of small red bumps. A more severe reaction may cause swelling, redness, and larger blisters. The location of the rash may give you a clue about the cause.

    Contact dermatitis does not always occur the first time you are in contact with the irritating substance ( allergen ). After you have had a reaction to the substance, a rash can occur in response to even very small amounts of the substance. Contact dermatitis is not serious, but it is often very itchy. Common causes of contact dermatitis include:

    • Poisonous plants, such as poison ivy, oak, or sumac .
    • Soaps, detergents, shampoos, perfumes, cosmetics, or lotions.
    • Jewelry or fabrics.
    • New tools, toys, appliances, or other objects.
    • Latex. Allergy to natural rubber latex affects people who are exposed to rubber products on a regular basis, especially health care workers, rubber industry workers, and people who have had multiple surgeries. Latex allergies can cause a severe reaction.

    Rashes may occur with viral infections, such as herpes zoster ; fungal infections, such as a yeast infection (Candida albicans); bacterial infections, such as impetigo; and sexually transmitted infections (STIs) . Rashes may also occur as a symptom of a more serious disease, such as liver disease, kidney disease, or some types of cancer.

    Rashes may also appear after exposure to an insect or a parasite, such as the scabies mite. You may develop a rash when you travel to a rural area or go hiking or camping in the woods.

    A rash may be a sign of a chronic skin problem, such as acne , eczema , psoriasis , or seborrheic dermatitis . Other causes of rash include dry, cold weather; extremely hot weather (heat rash); and emotional stress. Emotions such as frustration or embarrassment may lead to an itchy rash.

    Some medicines can cause a rash as a side effect. A very rare and serious type of generalized red rash called toxic epidermal necrolysis (TEN) may occur after using sulfa drugs. TEN can cause the skin to peel away, leaving large areas of tissue that weep or ooze fluid like a severe burn. TEN may occur after the use of some medicines. If this type of rash occurs, you need to see a doctor.

    The need for medical treatment often depends on what other symptoms are present. A rash that occurs with other symptoms, such as shortness of breath or fever, may mean another problem, such as a serious allergic reaction or infection.

    Check your symptoms to decide if and when you should see a doctor.

    Check Your Symptoms

    Do you have a rash?
    Yes
    Rash
    No
    Rash
    How old are you?
    Less than 12 years
    Less than 12 years
    12 years or older
    12 years or older
    Are you male or female?
    Male
    Male
    Female
    Female
    Do you have a tick bite?
    Yes
    Tick bite
    No
    Tick bite
    Have you been bitten or stung by an insect or spider?
    Yes
    Insect or spider bite or sting
    No
    Insect or spider bite or sting
    Do you have symptoms of shock?
    Yes
    Symptoms of shock
    No
    Symptoms of shock
    Could you be having a severe allergic reaction?
    This is more likely if you have had a bad reaction to something in the past.
    Yes
    Possible severe allergic reaction (anaphylaxis)
    No
    Possible severe allergic reaction (anaphylaxis)
    Do you have any abnormal bleeding?
    Yes
    Abnormal bleeding
    No
    Abnormal bleeding
    Do you feel lightheaded or dizzy, like you are going to faint?
    It's normal for some people to feel a little lightheaded when they first stand up. But anything more than that may be serious.
    Yes
    Feels faint
    No
    Feels faint
    Are you bleeding now?
    Yes
    Abnormal bleeding now present
    No
    Abnormal bleeding now present
    Are there any symptoms of infection?
    Yes
    Symptoms of infection
    No
    Symptoms of infection
    Are there red streaks leading away from the area or pus draining from it?
    Yes
    Red streaks or pus
    No
    Red streaks or pus
    Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
    "Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
    Yes
    Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
    No
    Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
    Do you think you may have a fever?
    Yes
    Possible fever
    No
    Possible fever
    Did you take your temperature?
    Yes
    Temperature taken
    No
    Temperature taken
    How high is the fever? The answer may depend on how you took the temperature.
    High: 104F (40C) or higher, oral
    High fever: 104F (40C) or higher, oral
    Moderate: 100.4F (38C) to 103.9F (39.9C), oral
    Moderate fever: 100.4F (38C) to 103.9F (39.9C), oral
    Mild: 100.3F (37.9C) or lower, oral
    Mild fever: 100.3F (37.9C) or lower, oral
    How high do you think the fever is?
    High
    Feels fever is high
    Moderate
    Feels fever is moderate
    Mild or low
    Feels fever is mild
    How long have you had a fever?
    Less than 2 days (48 hours)
    Fever for less than 2 days
    At least 2 days but less than 1 week
    Fever for at least 2 days but less than 1 week
    1 week or more
    Fever for 1 week or more
    Do you have a rash that looks like a sunburn?
    Yes
    Sunburn-like rash
    No
    Sunburn-like rash
    Do you have a health problem or take medicine that weakens your immune system?
    Yes
    Disease or medicine that causes immune system problems
    No
    Disease or medicine that causes immune system problems
    Yes
    Symptoms of serious illness
    No
    Symptoms of serious illness
    Have tiny red or purple spots or bruises appeared suddenly?
    Yes
    Sudden appearance of red or purple spots or bruising
    No
    Sudden appearance of red or purple spots or bruising
    Is the rash:
    All over the body?
    Rash is all over the body
    In one area only?
    Rash is in one area of the body
    Is the rash a red, peeling rash that leaves very large areas raw and oozing fluid?
    Yes
    Red, peeling rash with large areas that are raw and ooze fluid
    No
    Red, peeling rash with large areas that are raw and ooze fluid
    Do you have a sore throat?
    Certain illnesses can cause a rash and a sore throat. You may need to be seen sooner if you have both.
    Yes
    Sore throat
    No
    Sore throat
    Are there sores or a rash in the genital area, inside the mouth or nose, or in the eyes?
    Yes
    Rash or sores in the genital area, mouth, nose, or eyes
    No
    Rash or sore in the genital area, mouth, nose, or eyes
    Have you had a skin sore or ulcer for more than a week?
    Yes
    Skin sore or ulcer for more than 1 week
    No
    Skin sore or ulcer for more than 1 week
    Do you have a new rash on only one side of your body? The rash may be in a strip or band.
    Yes
    New band-shaped rash on one side
    No
    New band-shaped rash on one side
    Do you think that a medicine could be causing the rash?
    Think about whether the rash appeared after you began using a new medicine or a higher dose of a medicine.
    Yes
    Medicine may be causing rash
    No
    Medicine may be causing rash
    Is the rash itchy?
    Yes
    Itchy rash
    No
    Itchy rash
    Is the itching severe?
    Severe means that you are scratching so hard that your skin is cut or bleeding.
    Yes
    Severe itching
    No
    Severe itching
    Has the itching interfered with sleeping or normal activities for more than 2 days?
    Yes
    Itching has disrupted sleep or normal activities for more than 2 days
    No
    Itching has disrupted sleep or normal activities for more than 2 days
    Does the rash hurt?
    Yes
    Painful rash
    No
    Painful rash
    Have you had the rash for more than 2 weeks?
    Yes
    Rash for more than 2 weeks
    No
    Rash for more than 2 weeks

    Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

    • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
    • Long-term alcohol and drug problems.
    • Steroid medicines, which may be used to treat a variety of conditions.
    • Chemotherapy and radiation therapy for cancer.
    • Other medicines used to treat autoimmune disease.
    • Medicines taken after organ transplant.
    • Not having a spleen.

    Symptoms of infection may include:

    • Increased pain, swelling, warmth, or redness in or around the area.
    • Red streaks leading from the area.
    • Pus draining from the area.
    • A fever.

    Try Home Treatment

    You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

    • Try home treatment to relieve the symptoms.
    • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

    Temperature varies a little depending on how you measure it. For adults and children age 12 and older, these are the ranges for high, moderate, and mild, according to how you took the temperature.

    Oral (by mouth) temperature

    • High: 104 F (40 C) and higher
    • Moderate: 100.4 F (38 C) to 103.9 F (39.9 C)
    • Mild: 100.3 F (37.9 C) and lower

    Ear or rectal temperature

    • High: 105 F (40.6 C) and higher
    • Moderate: 101.4 F (38.6 C) to 104.9 F (40.5 C)
    • Mild: 101.3 F (38.5 C) and lower

    Armpit (axillary) temperature

    • High: 103F (39.5C) and higher
    • Moderate: 99.4 F (37.4 C) to 102.9 F (39.4 C)
    • Mild: 99.3F (37.3C) and lower

    Many prescription and nonprescription medicines can cause a rash. A few common examples are:

    • Antibiotics.
    • Aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).
    • Pain medicines, such as codeine.
    • Seizure medicines.

    Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

    Symptoms of shock (most of which will be present) include:

    • Passing out.
    • Feeling very dizzy or lightheaded, like you may pass out.
    • Feeling very weak or having trouble standing.
    • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

    Abnormal bleeding means any heavy or frequent bleeding or any bleeding that is not normal for you. Examples of abnormal bleeding include:

    • Nosebleeds.
    • Vaginal bleeding that is different (heavier, more frequent, at a different time of month) than what you are used to.
    • Rectal bleeding and bloody stools.
    • Bloody or pink urine.
    • Gums that bleed easily when you eat or gently brush your teeth.

    When you have abnormal bleeding in one area of your body, it's important to think about whether you have been bleeding anywhere else. This can be a symptom of a more serious health problem.

    Symptoms of serious illness may include:

    • A severe headache.
    • A stiff neck.
    • Mental changes, such as feeling confused or much less alert.
    • Extreme fatigue (to the point where it's hard for you to function).
    • Shaking chills.

    Sudden tiny red or purple spots or sudden bruising may be early symptoms of a serious illness or bleeding problem. There are two types.

    Petechiae (say "puh-TEE-kee-eye"):

    • Are tiny, flat red or purple spots in the skin or the lining of the mouth.
    • Do not turn white when you press on them.
    • Range from the size of a pinpoint to the size of a small pea and do not itch or cause pain.
    • May spread over a large area of the body within a few hours.
    • Are different than tiny, flat red spots or birthmarks that are present all the time.

    Purpura (say "PURR-pyuh-ruh" or ?PURR-puh-ruh?):

    • Is sudden, severe bruising that occurs for no clear reason.
    • May be in one area or all over.
    • Is different than the bruising that happens after you bump into something.

    Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

    • Your age. Babies and older adults tend to get sicker quicker.
    • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
    • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
    • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
    • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
    Rash, Age 11 and Younger
    Tick Bites

    If you're not sure if a fever is high, moderate, or mild, think about these issues:

    With a high fever:

    • You feel very hot.
    • It is likely one of the highest fevers you've ever had. High fevers are not that common, especially in adults.

    With a moderate fever:

    • You feel warm or hot.
    • You know you have a fever.

    With a mild fever:

    • You may feel a little warm.
    • You think you might have a fever, but you're not sure.
    Insect Bites and Stings and Spider Bites

    Call 911 Now

    Based on your answers, you need emergency care.

    Call 911 or other emergency services now.

    Symptoms of a severe allergic reaction (anaphylaxis) may include:

    • The sudden appearance of raised, red areas (hives) all over the body.
    • Rapid swelling of the throat, mouth, or tongue.
    • Trouble breathing.

    A severe reaction can be life-threatening. If you have had a bad allergic reaction to a substance before and are exposed to it again, treat any symptoms as an emergency. Even if the symptoms are mild at first, they may quickly become very severe.

    Seek Care Today

    Based on your answers, you may need care soon. The problem probably will not get better without medical care.

    • Call your doctor today to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care today.
    • If it is evening, watch the symptoms and seek care in the morning.
    • If the symptoms get worse, seek care sooner.

    Seek Care Now

    Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

    • Call your doctor now to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care in the next hour.
    • You do not need to call an ambulance unless:
      • You cannot travel safely either by driving yourself or by having someone else drive you.
      • You are in an area where heavy traffic or other problems may slow you down.

    Make an Appointment

    Based on your answers, the problem may not improve without medical care.

    • Make an appointment to see your doctor in the next 1 to 2 weeks.
    • If appropriate, try home treatment while you are waiting for the appointment.
    • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

    Home Treatment

    Most rashes will go away without medical treatment. Home treatment can often relieve pain and itching until the rash goes away.

    If you have come in contact with a substance such as poison ivy, oak, or sumac , immediately wash the area with large amounts of water.

    After a rash has developed, leave it alone as much as possible.

    • Use soap and water sparingly.
    • Leave the rash exposed to the air whenever possible.
    • Do not scratch the rash.

    If you have a rash, you should not be in contact with children or pregnant women. Most viral illnesses that cause a rash are contagious, especially if a fever is present.

    Relief from itching

    • Keep the itchy area cool and moist. Put cloths soaked in ice water on the rash a few times a day. Too much wetting and drying will dry the skin, which can increase itching.
    • Keep cool, and stay out of the sun. Heat makes itching worse.
    • Try an oatmeal bath to help relieve itching. Wrap 1 cup of oatmeal in a cotton cloth or sock and boil as you would to cook it. Allow it to cool to room temperature, and use it as a sponge and bathe in cool water without soap. You may also buy a product at the store, such as Aveeno Colloidal Oatmeal bath.
    • Avoid scratching as much as possible. Scratching leads to more scratching. Cut nails short or wear cotton gloves at night to prevent scratching.
    • Wear cotton clothing. Do not wear wool and synthetic fabrics next to your skin.
    • Use gentle soaps, such as Basis, Cetaphil, Dove, or Oil of Olay, and use as little soap as possible. Do not use deodorant soaps.
    • Wash your clothes with a mild soap, such as CheerFree or Ecover, rather than a detergent. Rinse twice to remove all traces of the soap. Do not use strong detergents.
    • Do not let the skin become too dry, which may make itching worse.
    • Take several breaks during the day to do a relaxation exercise, particularly before going to bed if stress appears to cause your itching or make it worse. Sit or lie down, and try to clear your mind. Managing your stress by relaxing every muscle in your body, starting with your toes and going up to your head, may help your symptoms.

    Nonprescription medicines for itching

    Carefully read and follow all label directions on the medicine bottle or box.

    • Try calamine lotion for a rash caused by contact dermatitis , such as poison ivy or poison oak rashes.
    • For severe itching from contact dermatitis, apply hydrocortisone cream 4 times a day until the itch is gone. Do not use this cream on a fungal rash, because this can make the rash worse.
    • Try an oral antihistamine to help the scratch-itch cycle. Examples include chlorpheniramine maleate, such as Chlor-Trimeton, and diphenhydramine, such as Benadryl. Oral antihistamines are helpful when itching and discomfort are preventing you from doing normal activities, such as work and sleep. Antihistamines may cause drowsiness. Do not drive or operate any type of equipment if you are taking any of these medicines. And don't give antihistamines to your child unless you've checked with the doctor first.
    Medicine you can buy without a prescription
    Try a nonprescription medicine to help treat your fever or pain:

    Talk to your child?s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

    Safety tips
    Be sure to follow these safety tips when you use a nonprescription medicine:
    • Carefully read and follow all directions on the medicine bottle and box.
    • Do not take more than the recommended dose.
    • Do not take a medicine if you have had an allergic reaction to it in the past.
    • If you have been told to avoid a medicine, call your doctor before you take it.
    • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
    • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

    Symptoms to watch for during home treatment

    Call your doctor if any of the following occur during home treatment:

    • Other symptoms, such as a fever, feeling ill, or signs of infection, are severe or become worse.
    • A rash lasts longer than 2 weeks.
    • Symptoms become more severe or happen more often.

    Prevention

    If you have a known allergy, avoid contact with the substance that causes the allergy.

    Avoid all infectious diseases that cause skin rashes, such as chickenpox, measles, and some types of sexually transmitted infections (STIs).

    Treat your skin gently:

    • Do not bathe too much. Soap and water dries your skin of the essential oils that hold in moisture.
    • Do not scratch your skin or rub it roughly with towels.
    • Avoid exposure to chemicals that may irritate the skin, such as rubbing alcohol, soaps, detergents, or solvents.

    Preparing For Your Appointment

    To prepare for your appointment, see the topic Making the Most of Your Appointment.

    You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

    • What is the history of your rash, including:
      • When did the rash start?
      • Where did the rash start?
      • Has the rash spread?
      • Has the rash changed?
      • Have you been in contact with anything that may have caused the rash?
      • Have you been around anyone recently who has a similar rash?
      • Has anything made the rash better or worse?
    • Have you had this rash before? If yes:
      • What were the circumstances?
      • When did you last have it?
      • How was it treated?
      • How long did it last?
    • What other symptoms have you had? Symptoms may include itching, burning, stinging, tingling, numbness, pain, or tenderness to the touch.
    • Have you used a new food, medicine, or product, such as cosmetics, cleaning agents, detergents, soaps, chemicals, fabrics, lotions, or nonprescription medicines?
    • Have you been exposed to poisonous plants. such as poison ivy, oak, or sumac?
    • Have you had any other health problems during the past 3 months?
    • Have you recently traveled to a rural area or to another country?
    • Have you been under an unusual amount of stress at home, work, or both?
    • Does anyone in your family have a skin disorder or an allergy? If so, to what?
    • Are your shots and vaccines up-to-date?
    • Do you have any symptoms of a sexually transmitted infection (STI) ?
    • What home treatment measures have you tried? Did they help?
    • What nonprescription medicines have you tried? Did they help?
    • Do you have any health risks?

    Credits

    By Healthwise Staff
    Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
    Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
    Last Revised February 21, 2012

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