Special forms/dangerous courses | Skin rash

Special forms/dangerous courses

In addition to the frequent courses, such as drug allergies or generalized allergic reactions, which usually disappear again after the triggering factors have ceased to exist, there are also some rarer and severe, sometimes even life-threatening courses of skin rashes. One such example is the so-called Lyell Syndrome, which, in addition to an initial rash, causes a kind of peeling of the entire skin surface. In most cases, the cause is drugs such as sulfonamides or antiepileptic drugs. An outbreak is an absolute emergency that must be treated with a plasmapharesis. For this reason, the patient survey with exact recording of the medication taken plays a central role in diagnostics.

Various forms of skin rashes

An allergic reaction to certain things can manifest itself in different forms.Some people react with a swelling in the mouth and throat area (for example in case of food intolerance), others with itchy eyes and constant sneezing (for example in case of pollen or house dust allergy). The body can also react to the allergen in the form of a skin rash. This rash can look very different: a sudden, slight redness (exanthema), a redness with severe itching (eczema), wheals or pustules filled with or without liquid.

Besides itching, dandruff may also occur. Weeping blisters usually become encrusted after some time. The skin is part of the external protective barrier of our immune system and is the organ that reacts first to “antigens”.

In the case of an allergic reaction to a certain food, for example, our immune system recognizes the food as “foreign”. It reacts to a harmless substance with an enormous release of messenger substances. This is mainly histamine.

Histamine is an important mediator of inflammatory reactions and is formed and released by certain cells of the immune system (basophilic granulocytes and mast cells). In our body, histamine causes blood vessels to dilate, resulting in increased blood flow to the affected areas. On the skin, this manifests itself in a reddening.

Histamine also increases the “permeability” of the tissue, resulting in swelling and edema. In the case of a skin rash, this results in blisters, wheals and itching. These “allergens” have different ways to enter the body.

On the one hand, it can be caused by direct contact (for example by a nickel-containing watch, latex gloves or a new pair of tights against which there are intolerances). In this form of allergy, the rash usually occurs in the places where the contact was previously made. During food intake, the “allergens” (such as nuts) enter the body directly through the mouth via mucous membranes or via the digestive tract.

The skin rash can occur in a variety of places. The third way for an allergen to enter the body is via the airways during breathing (for example, house dust, pollen, hay). The smallest particles are often enough to trigger a reaction.

In the lungs, histamine causes a narrowing of the airways, so that some allergic reactions can lead to additional breathing difficulties. So if a rash occurs without a directly identifiable cause, the person affected should bear these factors in mind and consider whether it might be related to the ingestion of certain foods or, for example, wearing a new watch. An allergy test can be very helpful in identifying the allergen.

As a therapy for a rash that occurs due to an allergic reaction, it is often helpful to avoid the allergen in order to reduce the rash. Otherwise, drugs such as antihistamines, which reduce the effect of histamine, and immunosuppressants such as cortisol help to weaken the reaction of the immune system. The skin is a very sensitive organ and reacts differently to different environmental influences.

It often reveals unmistakable psychological processes that we process. It is also said that the skin is “the mirror of our soul. “Stress in particular has a considerable influence on the skin’s appearance and promotes the formation of red spots, blisters or dandruff on the skin.

This is due to the fact that the skin plays a major role in the immune system, forms the first protective barrier and thus is the first instance of recognizable reaction. This is how inflammatory changes form in certain regions of the skin, sometimes also as a reaction to defense processes inside the body. Itching can occur in the respective areas as an accompanying symptom.

Since rashes caused by stress are not a permanent skin disease, a soothing natural cream, plenty of fresh air and the reduction of stress often helps to reduce the irritation. If this is not the case, a visit to a dermatologist is recommended. There it can also be ruled out that it is a rash due to intolerances or bacterial/viral infections.

It is important to note that every person reacts differently to stress and not all of them develop such an “exanthema” when their mental state changes.Skin diseases with blistering are characterized by fluid-filled blisters, where a distinction is made between small blisters and so-called bullae or in which layer of the skin they occur (above in or below the epidermis). On the one hand, they are caused by the loss of adhesive bonds or cell contacts between the cells that hold them together. This is then called acantholysis.

On the other hand, blisters can also be caused by oedema (swelling), which is called spongiosis, or by the detachment of the epidermis from the dermis. These are the top two layers of skin. Examples of the loss of adhesion molecules or cell connections can be autoimmune reactions of the body, where the antibodies are directed against the body’s own structures.

Congenital diseases can also cause the loss of cell contacts, e.g. epidermolysis bullosa. In addition, contact with toxic substances or infections with bacteria (e.g. staphylococcal infection) or viruses, e.g. herpes simplex or herpes zoster (chickenpox) can be responsible for blistering.

Treatment depends on the cause, e.g. immunosuppressants, antibiotics or antiviral drugs. Some blistering diseases can be life-threatening, so a doctor should always be consulted when symptoms occur. These diseases include staphylogenic toxic epidermal necrolysis (TEN), herpes simplex or zoster spread throughout the body and purpura fulminans.

The skin, like other organ systems, undergoes normal physiological changes during pregnancy. In some cases, pathological skin changes can occur that only occur during pregnancy. This includes the pemphigoid gestationis.

It usually occurs in the second or third trimester or after birth and manifests itself in the formation of wheals around the navel, which spread rapidly. This disease is treated with cortisone and ointments. The best known and most common disease is PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy) and occurs mainly in first-time mothers in the last trimester of pregnancy.

Initially, wheals with severe itching (urticaria) form in so-called stretch marks, later papules and plaques dominate. These can spread to the extremities. Treatment is with cortisone to relieve the symptoms.

Eczema can also occur on all kinds of skin areas. A typical skin disease during pregnancy is pustular psoriasis, in which reddened plaques with rings of pustules form, which are encrusted in the middle. The disease can occur at any time during pregnancy.

Typically, it starts on the upper body and spreads to the extremities; the face, hands and soles of the feet are usually spared. Here, too, cortisone is used locally as a treatment. Many children suffer from skin rashes from time to time, as with adults, this can have various causes.

Children often react sensitively with a rash on detergents or care products. This is particularly likely if the rash appears after switching to new products and disappears again after omitting the corresponding products. In addition, the localization of the rash can be a determining factor.

If the rash occurs exclusively on the buttocks, it is probably diaper dermatitis. The nature of the rash may also be decisive; if it is a dry, scaly rash accompanied by itching, the child may suffer from psoriasis. A dry, reddened rash with skin tears on the earlobe, the crook of the arm or other specific parts of the body can be an indication of neurodermatitis, which is a chronic inflammatory skin disease.

Finally, a skin rash often occurs in conjunction with an infectious disease. Often the children here have other symptoms, depending on the underlying disease, such as fever, fatigue, etc. In addition, the rash appears relatively suddenly at the beginning or during the course of the disease.

The form of the rash is sometimes very characteristic for the respective disease and is decisive for the diagnosis of the disease. Chickenpox is accompanied by slight fever and aching limbs, usually on the trunk and head. These heal after a few days without scarring, the disease is a visual diagnosis for the doctor and many laymen.Measles is also characterized by a reddening of the palate and then a large rash.

Here, too, the rash recedes of its own accord after a few days. With rubella, the rash typically begins on the face and spreads to the trunk and extremities. However, these are individual spots.

It is often accompanied by fever, swelling of the lymph nodes and headache or aching limbs. A rash in babies usually occurs in connection with childhood diseases. Of course it can also be an allergic reaction of the child.

Childhood diseases associated with skin rash are mainly chickenpox, scarlet fever, rubella, measles, rubella ringworm and three-day fever. In addition to the observed skin changes, symptoms characteristic of the particular disease occur. The type of rash also indicates the underlying disease.

Chickenpox: Itchy blisters and red spots all over the body; the blisters dry out after several days. It can take several weeks before the rash disappears completely. Scarlet fever: Characterized by a bright red tongue (raspberry tongue) in combination with red spots spread all over the body.

Rubella: The rash begins in the face and behind the ears. It is blotchy and can spread further over the body. Measles: This disease typically starts with bright spots on the oral mucosa.

Later, a purple-red rash develops behind the ears and on the face, which spreads further over the body. Ringed rubella: The children first get red cheeks and then develop a rash consisting of red spots. The spots partially merge and remain for about ten days.

Three-day fever: At first red spots appear on the face, later on the whole body. There is no itching. Diaper rash: Babies’ skin rashes can also have other causes.

Particularly in the diaper area, the delicate baby skin is subjected to great stress from urine and bowel movements in the diaper. This can lead to a red rash in the diaper region (diaper dermatitis). If fungi also settle in the inflamed region, the disease is known as diaper rash.

To prevent this, diapers must be changed every 3-4 hours at the latest. Parents should always make sure that the diaper area of their child is always sufficiently dry and pay attention to the skin care of the baby. Care products containing fragrances and preservatives should be avoided.

Also, if possible, the diaper should not be too tight so that air can still get into the baby’s intimate area. Neurodermatitis: Last but not least, babies can already develop skin diseases that are accompanied by rashes, such as neurodermatitis. The first symptom here is often the so-called milk crust, which appears from about the 3rd month of life.

The baby usually has reddish blisters on the scalp, which remain as white crusts after healing (hence the name “milk crust”). In severe cases the cradle cap can spread over the whole body. It is not unusual for neurodermatitis to develop from this later.

Typically, the rash is then found in the back of the knee, the crook of the arm and on the neck. After a vaccination, redness or even a skin rash may occasionally appear, usually in the area where the vaccine was injected. Usually, such a reaction does not require special therapy and disappears relatively quickly on its own.

Skin rashes on the face can have various causes and take on different forms. The diagnosis is made by the dermatologist, who can often already deduce a cause from the medical history and close inspection of the rash and start a therapy. Often a rash on the face is associated with considerable suffering for the person affected.

Often a so-called contact dermatitis is the trigger; in this case a rash is caused by irritants such as pollen (skin rash caused by pollen), certain foods, cosmetics or animal hair. If the irritant is avoided, the rash typically recedes. Eczema on the face, which is a small spot-like inflammation of the skin, is also often caused by environmental influences or cosmetics.

A frequent cause, especially in adolescence, is acne disease, which is typically accompanied by purulent pustules. In childhood, skin rashes on the face often occur as part of infectious diseases such as chickenpox, measles or rubella, all of which are highly contagious.Chronic inflammatory diseases such as neurodermatitis or psoriasis also often manifest themselves on the face. In adults, venereal diseases can also lead to rashes on the face, often accompanied by symptoms on the genitals such as itching or rashes.

Many germs such as bacteria or certain fungi can also lead to rashes and inflammation of the face. In addition, certain medications such as antibiotics can also lead to rashes on the face (rash after antibiotics). In this case, the temporal occurrence of the rash a few hours to days after taking the medication should be avoided.

It is also not uncommon for excessive exposure to sunlight to cause a rash on the face (e.g. Mallorca acne). Red patches or rashes on the neck rarely occur on their own. Often rashes start on the upper body and spread to areas in the immediate vicinity.

A rash on the neck can occur for a variety of reasons. Mostly it is the reaction of the skin to certain factors, for example as a defense reaction against certain pathogens or as an allergic reaction. It is very important to clarify the exact cause in order to treat the rash.

For this purpose, the doctor treating the patient takes a detailed medical history. If it is the reaction to a certain pathogen, other symptoms besides the rash will appear, which suggests many different pathogens. In addition to measles, chickenpox, ringworm, folliculitis, herpes and shingles, a bacterial infection can be behind it.

To identify the pathogen, the course or change of the rash can provide decisive clues. Since each pathogen requires different treatment, differential diagnosis is crucial. In the case of an allergic reaction, the decisive food or medication against which the intolerance exists should be found urgently.

The person affected should pay attention to whether the rash occurs after certain activities (for example wearing nickel-containing jewelry) or after eating certain things (for example nuts). If there is an intolerance to metals such as nickel, contact dermatitis occurs after contact, which belongs to the category of allergic reactions of type IV. This is an allergic reaction that occurs after one or two days (delayed type) and manifests itself in the form of reddening of the skin and itching.

Prolonged exposure to the sun should be avoided if the skin is irritated. Stress can also be the reason for redness on the neck. If this is the case, the rash should usually disappear after overcoming the stress.

Another cause can be cosmetic products that are applied and poorly tolerated at this point. Acne can also be responsible for red spots on the neck. However, a rash typical of measles can also start on the neck and then spread, just like other bacterial or viral diseases (see above).

A redness or rash can appear on the stomach for a variety of reasons. It can be widespread or sporadic and can take on different forms. In addition to reddening, pustules or papules may develop, which may occur without fluid or be “weeping”.

Even very dry skin can trigger an exanthema with dandruff formation. If these areas are also itchy, they are also called eczema. Some viral pathogens trigger a rash on the stomach particularly frequently: the hepatitis viruses or the chickenpox pathogen “herpes zoster“.

The resurgence of herpes zoster usually occurs when the immune system is acutely weakened. Then the virus spreads along the nerve tracts in a belt-shaped manner in the abdominal and chest area and causes painful exanthema. This disease is therefore also called “shingles“.

In addition to viral and bacterial childhood infections such as rubella, ringworm, scarlet fever, measles or chickenpox (which usually cause other symptoms in addition to a rash on the abdomen), a fungal infection is also possible. But not only bacterial and viral pathogens are possible causes of a rash. Allergies or intolerances can also cause exanthema on the stomach.

Here also a preceding antibiotic intake or a new detergent, to which one reacts allergically, must be considered. If an intolerance is the reason for the rash, the food or item should be avoided in the future. An accurate diagnosis is extremely important for an appropriate therapy.Therefore, the person affected should observe the occurrence and course of the rash very carefully and be in contact with his treating family doctor.

In most cases, a rash is accompanied by less severe to very severe itching. This is particularly true for most infectious diseases, such as chickenpox, in which very itchy blisters develop. However, there are also rashes that occur without itching at all.

Here too, the causes are manifold. In general, it should be noted that each person can react very individually to stimuli from the environment. While in one person the rash manifests itself as severe itching in one person, in another person it is merely a reddening of the skin without itching.

The exact circumstances and causes of the rash must therefore be examined individually in each case. Measles: Measles is the best-known infectious disease, which typically manifests itself as a rash without itching. Measles is most frequently contracted by children.

Characteristic red-violet spots appear, which run into each other and can spread all over the body, starting behind the ears and in the face – typically without itching. Systemic lupus erythematosus (SLE): SLE is an autoimmune disease that predominantly affects young women of childbearing age. It causes chronic inflammatory reactions in various organs and tissues.

A characteristic symptom of this disease is a rash on the face, which develops especially in the nose-cheek area (so-called butterfly erythema). This skin change usually does not itch or hurt. Under therapy, the butterfly erythema can completely disappear.

In addition to the skin changes on the face, smaller, scaly redness can also occur on the rest of the body. Exposure to sunlight often worsens the rash in SLE. Lyme disease: Borreliosis transmitted by tick bites manifests itself in about 50% of cases by a wandering redness (erythema migrans), which can develop around the bite site after a few days to weeks and then spread and wander over the body.

This rash is circular with a brightening in the middle and can occur with or without itching. Approximately 1-4 weeks after HIV infection, the affected person may develop non-specific symptoms that can easily be mistaken for a flu-like infection. Most patients suffer from fever, swelling of the lymph nodes and pharyngitis during the acute HIV infection.

Skin rashes are also among the possible symptoms of an acute HIV infection (in 50-70% of infected persons). This rash occurs mainly on the face and trunk (back, chest, abdomen), arms and legs are less frequently affected. It consists of small red spots interspersed with small nodules.

It is also called a maculopapular exanthema. The lesions are usually accompanied by no or only slight itching. The rash often disappears on its own after 24-48 hours.

Infectious rash under HIV: Since the immune system is weakened in HIV, pathogens (bacteria, fungi, viruses) can easily settle on the skin and lead to rashes and redness. Therefore, some forms of rash are more common in HIV, e.g. thrush (fungal infection of the skin). Rash due to HIV therapy: If the patient is already being treated for his or her HIV infection, a rash may still occur under these circumstances, which can be caused by a reaction to the corresponding drug (drug rash).

It is important to distinguish between this and infection-related rashes, as HIV patients are generally more susceptible to any kind of infection. If the rash is definitely drug-related, the drug should be discontinued and replaced. Kaposi sarcoma: In advanced HIV disease, Kaposi sarcoma may develop.

These are malignant skin tumors that can occur in connection with a weakened immune system, as is the case with HIV. Kaposi’s sarcoma typically manifests itself as a violet or brownish-blue, nodular skin change and usually occurs first in several places on the legs, and later in the mouth, among other places. With adequate HIV therapy it usually recedes, as the immune system can then fight the degenerated cells.

Skin rash is a relatively common adverse reaction of antibiotics. Depending on the type of intolerance, the rash appears a few minutes, hours or days after the first intake of antibiotics.So-called beta-lactam antibiotics such as penicillin or cephalosporin most frequently cause rashes. Up to 3-10% of all people react to such antibiotics with rashes, most of them in the context of a pseudo-allergic reaction, less frequently with a classic allergic reaction.

In order to find out whether there is a real allergy to the antibiotic in question, a prick test can be performed. This is an allergy test with injection of the suspected allergen into the forearm and observation of the reaction on the skin. Another possibility is the detection of antibodies in the blood.

In most cases the rash is harmless and disappears a few hours and days after the antibiotic is stopped. In very rare cases the rash appears immediately after taking the antibiotic and a strong allergic reaction occurs in the form of an anaphylactic shock with shortness of breath and imminent suffocation. Skin rashes after antibiotics are particularly common in elderly people whose liver and kidney function is impaired and thus the antibiotic remains in the body longer.

Also the intake of many medicines favors the occurrence of a rash. It is important to consult the prescribing physician or family doctor after the rash appears. Possibly an allergy test should take place, in order to diagnose or exclude a genuine allergy.

In the consequence the affected and structure-similar antibiotics should be avoided, the physician can issue an allergy passport for this. With some humans it comes after a flu-like infection to a reaction of the skin with redness, swelling and also with blistering. In the affected areas, pain, burning or itching can also occur.

The reason for such a rash of the skin after a flu is usually the immune system’s defensive reaction to the virus causing it. Certain cells (mast cells), which play an important role in the immune system, release the messenger substance “histamine” during the defence against pathogens. The cells are mainly located in the dermis (stratum corneum) and in the mucous membrane.

In the surrounding tissue, histamine triggers swelling, improved blood circulation (this leads to redness) and pain. This leads to the body’s reaction being visible externally. The immune system is often still weakened by the previous infection.

The spread and course of the exanthema varies greatly and can give the treating doctor information about the cause. A doctor should also be consulted in order to be able to exclude infectious diseases such as measles, rubella, scarlet fever and chickenpox as the cause. If drugs have been taken to treat influenza, the rash may also be caused by an intolerance to them.

Many medications (including antibiotics) cause a rash as a side effect and should be taken with caution. Overall, older people are more sensitive to the side effects of the medication. Allergies can also often cause skin reactions.

Since the treatment of the rash depends very much on the cause, it is recommended that this be clarified. If a skin reaction in the form of a rash occurs after consumption of tomatoes, a possible sensitization with development of intolerance should be considered. Skin rashes are also called exanthema.

They have a characteristic course consisting of onset, peak after some time and healing. Depending on the cause of the rash, the time it takes to spread may vary. In many cases the face, neck, arms and legs, back or trunk are affected by exanthema.

Exanthema may appear completely free of symptoms in addition to the visual appearance or may be associated with itching, burning or even severe pain. The causes of a rash can be allergic reactions (e.g. after applying a new skin cream or wearing a nickel earring). The skin and the nerves of the upper skin layer are irritated first.

The actual allergic skin rash is then triggered by the cells of the blood vessels, which cause the vessels to dilate and increase the blood supply to the corresponding area of skin (reddish color of the exanthema). Only an interaction between skin cells and vascular cells allows the development of a rash. The most common cause of an exanthema is drugs.

They account for about 80% of cases. Triggering drugs can be: Ampicilins, sulfonamides, penicilins, cephalosporins, salicylates, ACE inhibitors, carbamazepine, phenytoin and allopurinol.Furthermore, infectious relationships are a frequent cause of a skin rash. The classic childhood diseases such as measles, scarlet fever and rubella should be mentioned, which occur with a rash in varying degrees of severity, chronological sequence and localization.

Depending on how the rash spreads, it can often be suspected that the disease is the cause. Bacterial infections can also be responsible for a rash. The rarely occurring lues should be mentioned here.

A further classification besides the triggering factors is also the external appearance. Exanthema can be divided into macular exanthema (not raised only in the skin level), papular exanthema (raised skin changes), pustular exanthema (corresponding to the pimple), serous exanthema (deflating skin changes) and urticarial exanthema (flat, roundish, red and raised). The diagnosis consists on the one hand of a gaze diagnosis, which can provide an indication of an exanthema, and on the other hand a detailed anamnesis (patient interview).

This should include a discussion of how long the symptoms have been present, whether a new skin cream or a new drug has been used and whether there are any accompanying symptoms (such as fever, etc.). The therapy depends on the triggering factor. The basic principle is that the triggering factor must be eliminated.

Triggering skin creams must be discontinued and appropriate medications must be replaced with alternative preparations. In the case of allergic exanthema, an attempt should be made to treat it with cortisone ointments or cortisone tablets. Since allergic reactions are mostly histamine-mediated, treatment can also be attempted with drugs from the group of histamine blockers (cetirizine).

In addition, a reduction in symptoms can be achieved with cooling bandages and gels. As a rule, a reduction of the rash is achieved by a combination (avoidance of the triggering factors, anti-inflammatory medication and symptomatic therapy). If the cause is an infectious disease such as measles, the healing of the disease must be awaited.

For the few bacterial infections that can trigger an exanthema, treatment with an antibiotic can be started. Exanthems are usually harmless, but they are a serious warning sign. In some rare and severe cases, a rash may indicate a beginning emergency.

The so-called Lyell syndrome, which is a hypersensitivity reaction to various groups of drugs, should be mentioned here. The exanthema is followed by flaking of the skin. Without treatment, the disease is fatal and for this reason the only treatment is plasma paresis.

Patients who get exanthema due to an allergic reaction should also be issued with an allergy card, which should state the type of allergy and which substances should be avoided. An allergy pass is particularly important in the case of drug allergies.