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rash_local

localised rashes

Usually self-evident acute skin pathology

  • physical trauma - bruises, etc
  • thermal burns
  • chemical caustic burns - acids, alkalis, skin irritants
  • radiation burns
  • prolonged exposure to a direct heat source giving the classical reticular “rash” of erythema ab igne
  • insect or spider bite - usually a central vesicle with surrounding wheal
  • localised infection:
    • impetigo
    • cellulitis
    • erysipelas
    • abscess
    • herpetic whitlow
    • fungal infection
    • molluscum contagiosum
    • tinea corporis
    • tinea pedis
    • tinea cruris
    • orf in sheep farmers
    • syphilis - primary chancre

Acute rashes with patterns

involving only areas NOT covered by clothing

  • exposure to UV radiation / sun:
    • sunburn
    • photosensitivity reaction to medications, etc
      • phototoxic reaction (exaggerated sunburn without any immune response)
      • photoallergic reaction (eczematous photodermatitis associated with a delayed immune hypersensivity response)
      • common medications:
      • common phototoxic chemicals:
        • psoralens in plants, vegetables, fruit; fragrances in cosmetics; sunscreen chemicals; dyes and disinfectants
        • pseudoporphyria: induced by drugs and/or renal insufficiency.
    • photoexacerbated condition describes a flare of an underlying skin disease on exposure to sunlight
    • primary or idiopathic photodermatoses:
      • polymorphic light eruption
      • Juvenile spring eruption
      • rare conditions:
    • metabolic photodermatoses:
      • porphyria cutanea tarda
      • erythropoeitic protoporphyria
      • variegate porphyria
      • erythropoeitic porphyria (Gunther disease)
      • pellagra (initial photosensitivity)
    • rarely, genetic photodermatoses:
      • xeroderma pigmentosum, Bloom syndrome, Rothmund-Thomson syndrome, Cockayne syndrome, Hartnup disease
  • exposure to cold:
    • chilblains
    • frostbite
  • other causes of exposure-related rashes:
    • acne vulgaris due to follicular occlusion by sebum and keratin
    • contact or irritant dermatitis due to makeup and suntan lotions, industrial chemicals, etc
    • airborne contact dermatitis due to plant pollens, such as sesquiterpene lactone.
    • mosquito bites
    • biting midge / “sand fly” bites - very itchy, red papulovesicular lesions 12-24hrs after bites - often mainly on legs if exposed.
    • papular urticaria
  • in addition, there are some relatively specific conditions related to the face primarily:

involving only areas covered by clothing

  • exposure to warm conditions:
    • prickly heat rash
    • fungal infections eg. tinea cruris, pityriasis versicolor
  • exposure to inadequately warm clothes in very cold weather:
    • chilblains
    • frostbite
  • exposure to chemicals in the clothing
    • contact dermatitis eg. rubber gloves
    • caustic or irritant dermatitis eg. inadequately washed clothes, contaminated clothing
  • NB. many of the exanthems only involve trunk and limbs sparing face, palms - see acute rashes in adults

linear or serpiginous lesions

mainly face

mainly trunk

mainly groin

legs only

  • cellulitis
  • folliculitis
  • tinea corporis
  • nodules on shins suggest erythema nodosum
  • venous dermatosis from venous insufficiency
  • varicose dermatitis overlying varicosities
  • gravitational dermatitis
  • capillaritis
  • pretibial pruritic papular dermatitis
  • prurigo nodularis
  • pretibial myxoedema
  • lichen simplex from scratching, rubbing, etc
  • contact dermatitis
  • psoriasis (knees mainly)
  • lichen planus
  • superficial basal cell carcinomas
  • necrobiosis lipoidica
  • panniculitis
  • vasculitis
  • asteatotic eczema “crackled dry skin” most commonly affects the shins and is common in the elderly
  • biting midges / “sand fly” bites often predominantly affect lower legs

feet only

  • corns
  • pressure blisters
  • foreign body reactions to embedded objects
  • cellulitis
  • diabetic foot ulcers
  • arterial insufficiency
    • arterial ulcers
  • plantar warts
  • cracked heels
  • tinea pedis
  • pitted keratolysis
    • associated with Kytococcus sedentarius and foul foot odour from sweaty feet
  • contact dermatitis
    • eg. rubber in shoes, chemical contact
  • lichen planus (esp. ankles)

mainly hands and feet

  • hand, foot and mouth disease (mainly children, causes purplish blisters as well as fevers, malaise)
  • juvenile palmar-plantar dermatosis “sweaty-sock syndrome” (mainly toddlers, school-aged children)
  • atopic dermatitis (may cause chronic hand and foot dermatitis)
  • secondary syphilis (multiple red lesions on palms and soles)
  • erythema multiforme (may present as target lesions mainly on palms)
  • gononoccoccal (rarely can cause small, painful, red spots or pustules mainly of palms and soles)
  • palmoplantar pustulosis (PPP) / pustular psoriasis (rare, recurrent/chronic red scaly / pustular rash)
  • contact dermatitis
  • dyshidrotic eczema (causing small, itchy blisters)
  • hand-foot syndrome (a chemotherapy side effect causing redness and swelling)
  • tinea pedia / tinea mannuum
  • acute cutaneous lupus erythematosus
  • adult-onset Still's disease
  • palmar erythema / plantar erythema (non-painful red warm skin mainly proximal palms and heels)

Chronic localised rashes / skin pathology

  • fungal infections
  • ulcers:
    • venous leg ulcers
    • arterial / diabetic foot ulcers
    • pyoderma gangrenosum - starts like an insect bite, usually very painful, develop a purple undermined edge
  • atopic eczema / dermatitis - usually mainly on flexure surfaces
  • psoriasis - usually mainly on extensor surfaces
  • contact dermatitis with repeated exposure
  • chronic urticarias
  • lichen simplex - repeated injury eg. scratching
  • lichen planus - esp. wrists, ankles
  • lupus
  • plus there are many other chronic dermatoses
rash_local.txt · Last modified: 2025/09/28 07:24 by gary1

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