rash_local
Table of Contents
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
- dermatomal - herpes zoster (shingles)
- 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:
- thiazides, tetracyclines, non-steroidal anti-inflammatory drugs (NSAIDs), phenothiazines, voriconazole, quinine, vemurafenib
- 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
- cutaneous lupus
- dermatomyositis
- Darier disease
- acne rosacea
- pemphigus vulgaris
- pemphigus foliaceus
- atopic dermatitis
- primary or idiopathic photodermatoses:
- polymorphic light eruption
- Juvenile spring eruption
- rare conditions:
- actinic folliculitis
- actinic prurigo
- solar urticaria
- chronic actinic/photosensitivity dermatitis
- hydroa vacciniforme (associated with EBV / glandular fever / infectious mononucleosis)
- 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:
- see facial rashes
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
- see facial rashes
mainly trunk
- pityriasis rosea
- pityriasis versicolor but may involve neck/arms, yellow-green flourescent on Wood's lamp
- Grover's disease (transient acantholytic dermatosis) - common in middle age
- scabies - also usually hands
mainly groin
- tinea cruris
- primary syphilis chancre
- contact dermatitis eg. to rubber condoms
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
- see also the painful foot
- 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
- see also: the linear skin lesion or rash
- 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