Diagnose skin rash – send a photo

1. Where is it?
   The rash is on my face and arms
2. What does it look and feel like?
   It is sore and weepy and in places it crusts and blisters
3. Has it changed?
   It started as small sores/blisters and has spread across my face
4. How are you feeling in yourself?
   I am feeling a bit under the weather
5. Has anybody else got the rash?
   My son had the same rash and was sent home from school

The doctor’s advice

It sounds like you have impetigo. Impetigo in adults is less common than in children, but can occur, particularly in damaged skin, such as from shaving. It is an infection often caused by a combination of bacteria called staphylococcus and streptococcus and it needs treatment with antibiotics.

What to do

It is very contagious and you must be careful about hand washing and not sharing flannels and towels. You will need to use fucidin cream which you should apply to the rash three or four times day. It is also recommended that you also take oral antibiotics particularly if it is a big area or in more than one place (flucloxacillin or erythromycin if you are allergic to penicillin). You would be best advised to stay away form work for a few days until the sores have crusted over but at least for 48hrs after you have started using the fucidin cream.

1. Where is it?
   It is all over my body
2. What does it look and feel like?
   It started as small red spots but they became blistery after a few days and it itches
3. Has it changed?
   It started on my face and then moved to the rest of my body. Every so often a new patch of red spots appears which then become blistery
4. How are you feeling in yourself?
   I felt like I was going down with the flu before the rash came out
5. Has anybody else got the rash?
   One of my friend’s children had chicken pox recently

The doctor’s advice

I think you have caught chickenpox. The incubation period for chickenpox is 10 – 21 days. It is likely that you were never exposed as a child and it can make you feel pretty bad. It is typical to have a sore throat and flu-like symptoms before the rash appears. The spots start like tiny red dots and then develop into small raised blisters which are itchy. They occur in successive crops absolutely anywhere and everywhere on the body including the mouth and genitals.

What to do

Adults can become very ill with chickenpox and are best treated with aciclovir. There is not much else you can do apart from taking paracetamol and making sure you drink plenty of fluids. You should stay away from pregnant women who have not had chicken pox or people who are taking immunosuppressant medication. Pregnant women should definitely be treated with aciclovir.

1. Where is it?
   It is over my back, tummy and in my armpits
2. What does it look and feel like?
   It is a fine rash that feels a little prickly and it does itch a bit
3. Has it changed?
   Not really but it is very irritating
4. How are you feeling in yourself?
   OK
5. Has anybody else got the rash?
   No

The doctor’s advice

It sounds like heat rash or prickly heat and there is not much you can do apart from avoiding situations when you will get too hot. Let your skin breathe more, but still protect yourself against sunburn.

What to do

You can try Calamine lotion. As it is caused by a problem with your sweat glands you should try and avoid excessive heat and humidity in the future. If the itching becomes intolerable then you can try using hydrocortisone cream which is available over the counter at your pharmacist. Using an antibacterial soap can also be helpful.

1. Where is it?
   The rash is over my chest, back, tummy, neck, upper arms and upper thighs. Luckily there is none on my face
2. What does it look and feel like?
   My rash is small, raised and scaly with patches that are approximately 0.5cm to 1.5cm across, oval in shape and pink in colour. I initially had one patch on my trunk for several days then all the others came out. It isn’t painfull but it is a little itchy. My husband says that on my back it looks like a Christmas tree and I can see in the mirror that they form a v-shape across my chest.
3. Has it changed?
   As it progressed I got more patches then it has remained fairly static for a few weeks now
4. How are you feeling in yourself?
   OK but the rash feels worse when I am sweaty or wearing tight-fitting clothing
5. Has anybody else got the rash?
   No

The doctor’s advice

This sounds like a condition called pityriasis rosea. The patch you had to start with is called a ‘herald patch’ and is a classic sign of this condition. If you look carefully at the oval patches the scale seems to be around the peripheral edge.

What to do

There is no specific treatment required and it usually clears up by itself within 2 to 12 weeks. If the itching becomes intolerable then you may need to apply a steroid cream. If you need one then please contact Dr Morton’s by phone or email and we can arrange for some cream to be sent for next day delivery.

I have come out in a rash and am worried about it being contagious. My grandchildren are coming to stay at the weekend and I do not want to pass anything on to them.

1. Where is it?
   It is just in one distinct area under my left breast
2. What does it look and feel like?
   The rash is itchy/painful with blister-like sores filled with a clear fluid
3. Has it changed?
   I had some pain where the rash is for a few days before it appeared
4. How are you feeling in yourself?
   I did feel like I was going down with the flu before the rash appeared
5. Has anybody else got the rash?
   No

The doctor’s advice

It sounds like you have shingles. With regard to the visit of your grandchildren you should read our article Is Shingles Contagious?

What to do

The pain of the rash can be lessened by applying a cold compress (a flannel soaked in cold tap water works well) and you may benefit from taking aciclovir which is an antiviral medicine used to treat cold sores and other herpes infections. Ring Dr Morton’s straight away and they can be with you tomorrow.

1. Where is it?
   All over my body
2. What does it look and feel like?
   It is very itchy and looks like I have fallen in a patch of stinging nettles
3. Has it changed?
   It appeared very quickly and the small spots are joining up. Soon I will be completely covered in the rash
4. How are you feeling in yourself?
   OK
5. Has anybody else got the rash?
   No

The doctor’s advice

It sounds as though you have hives. The proper medical term is urticaria. It is an allergic reaction usually provoked by eating certain foods such as shellfish or peanuts and sometimes to an antibiotic or other medicine. Beware that sometimes the allergic reaction may affect not only the skin but also cause swelling of the face and larynx. This would make it difficult to breathe and in its most extreme form leads to anaphylactic shock, which requires immediate hospital treatment. It is for this reason that highly atopic people carry an EpiPen, which is injectible adrenaline. This can be life-saving!

What to do

It should get better in a few days but if it is very itchy then you may want to take some anti-histamine tablets. Fexofenadine would be a good choice, so if you ring Dr Morton’s now it could be with you tomorrow, or you might have some in a Dr Morton’s Travel Pack©

Do you think I have eczema? I had a similar rash as a child but only behind my knees. I used to use a steroid cream and remember having to have antibiotics once when it flared up

1. Where is it?
   My rash is sometimes all over my arms and legs especially in the folds of my elbows but I now have a new rash around my neck after having worn a necklace my husband bought for me on holiday
2. What does it look and feel like?
   The rash is extremely itchy and my skin is very dry. The rash is also scaly and can become sore
3. Has it changed?
   It comes and goes but is worse when I am tired or stressed but the rash around my neck is only very recent
4. How are you feeling in yourself?
   OK
5. Has anybody else got the rash?
   Nobody else has the rash but I have been abroad. We went to Greece for a holiday which is where my husband bought a necklace for me and it is since then that the rash appeared

The doctor’s advice

It does sound like eczema but the rash on your neck is more likely to be what we call ‘contact dermatitis’ and is likley to be caused by nickel in the necklace. Dermatitis and eczema are pretty much synonymous and the treatment is the same. They refer to an inflammation of the skin, with itchy redness and sometimes tiny blisters, and weepy crusting patches. Both require avoidance of the trigger and the application of a topical steroid. Give Dr Morton’s a ring or send an email and our doctors will be able to prescribe for you. Poison ivy refers to a localised skin rash due to contact with poison ivy and related plants which contain urushiol oil. This oil may produce an immediate or more delayed response, producing a very itchy, raised rash only where actual skin contact was made. This is a true contact dermatitis.

What to do

Most imporatantly you will need to stop wearing the necklace! Don’t forget that if needs be Dr Morton’s GP will be able to prescribe some betamethasone which is a medium strength steroid cream which cannot be bought over the counter. This could be delivered to your home or work by 1pm tomorrow.

1. Where is it?
   All over my body. There are even spots on the roof of my mouth
2. What does it look and feel like?
   They look like small raised bumps on top of flat red spots
3. Has it changed?
   It began as flat red spots that appeared on my face at my hairline and spread downward to my neck, body, arms, legs, and feet. The spots joined together as they spread
4. How are you feeling in yourself?
   Before the rash came out, I felt like I was going down with a bad cold. I had a high fever, a runny nose, I was sneezing, had a sore throat, and a hacking cough. The lymph nodes in my neck were swollen. I also felt very tired and had diarrhoea. My eyes were red and sore. As the rash appeared my temperature went up to nearly 40 degrees
5. Has anybody else got the rash?
   No

The doctor’s advice

I am afraid that it does sound like you have measles. Adults can get measles especially if, like you, they did not have the MMR jab when they were younger. Unfortunately it can make you feel quite ill.

What to do

You are best advised to take regular paracetamol, drink plenty of fluids and rest in bed. You should start to feel better in a week or so. You should also inform your GP as this is a notifiable disease and needs reporting to public health who will confirm the diagnosis to track any outbreaks in your community.

1. Where is it?
   It’s on my leg. I think I have been bitten by a mosquito
2. What does it look and feel like?
   It is flat, hot and red and jolly tender; and about the size of a dinner plate
3. Has it changed?
   Yes, it has got bigger over the last 24 hours
4. How are you feeling in yourself?
   I’m fine but a bit worried that the redness is getting worse
5. Has anybody else got the rash?
   No

The doctor’s advice

This sounds like cellulitis. This is the term used for spreading redness from a wound and it indicates inflammation and infection of damaged tissues. The wound may be as minor as a mosqito bite as in your case or as large as an abdominal incision for bowel surgery or a caesaren section. Sometimes it is a reacation to a foreign body with or without superimposed infection. Removal of the foreign body, say a splinter or surgical stitch, may be all that is needed. Your bite may benefit from applying some Fucidin H which will cover both an allergic reaction and infection. Spreading cellulitis along the course of a blood vessel or around a surgical wound or injury, particularly if you have a fever, needs urgent treatment with antibiotics. Flucloxacillin will treat staphylococcus bacteria and a cephalosporin or ampicillin will treat a streptococcus. These may need to be given intravenously.

What to do

If you have some Fucidin H (perhaps in a Dr Morton’s Travel Pack^©) apply that 4 times daily and it should be obviously better by 2 days. If it continues to spread you might take a 5 day course of an oral antibiotic, but speak with Dr Morton’s first and send a picture.

1. Where is it?
   It is around my nose, tummy button and in my groin
2. What does it look and feel like?
   It is red, itchy with flaky scales, it looks a bit like dandruff
3. Has it changed?
   No
4. How are you feeling in yourself?
   OK
5. Has anybody else got the rash?
   No

The doctor’s advice

From the photograph and your symptoms I think you have a condition called seborrheic dermatitis

What to do

There is no need for any specific treatment but you can try using an anti-dandruff shampoo on the affected parts of your body. If it does not resolve in a few weeks you may need some anti-fungal medication with some mild steroid in it which we can provide. Please contact Dr Morton’s again if it has not gone away within a week.