Rashes Treatment

Our dermatology providers take the time and put in the effort that is often needed to diagnose and treat rashes.

Rashes have many causes. Examples include:

  • allergic and drug reactions
  • infections
  • infestations, hives,
  • autoimmune diseases
  • psoriasis
  • pityriasis
  • bug bites, etc.

Sometimes we can diagnose a rash immediately based on appearance. Often, we perform a biopsy. The tissue is then sent to a pathologist who looks at it under the microscope. There are cases that require even more time and thought. In those cases, we look for internal causes of the rash.

Our dermatology providers prescribe treatments to offer immediate relief from the rash. Once we have established the cause, we discuss different treatments and help you choose which option is best for you.

COVID 19 and Your Skin

The Covid 19 virus has the ability to affect any organ system in the body, including the largest one, your skin. In fact up to 20 percent of cases will involve skin. Covid causes a wide range of rashes, many of which can also be seen in patients with non-Covid skin problems, making it sometimes difficult to determine whether the rash is actually due to Covid. The majority of the rashes represent an immune response to the virus. Here are a few of the most common skin findings associated with Covid infections.
  • Covid toes – Patients can develop red-purple, itchy or tender bumps on the toes, feet and hands. The lesions do not require treatment unless the itching or pain is problematic. In these cases, symptoms can be managed with Benadryl and analgesics. Covid toes are seen in patients with mild or even asymptomatic Covid illness. The rash usually goes away within an average of 15 days but so called “ long haulers” can have the eruption for 60 days or more.
  • Urticaria (Hives) – Hives are a very common occurrence in healthy individuals and the list of potential causes is long. However, a Covid19 infection should be considered in anyone with widespread hives and a fever. Hives are considered an early manifestation of the infection and have been seen in 1-2% of Covid cases They are associated with pulmonary symptoms such as shortness of breath in 50% of patients.
  • Pityriasis Rosea – like rash – This rash appears as scaly pink spots across your back, chest or abdomen that resemble a pine-tree pattern. It has been reported in Covid infections but can also be associated with other upper respiratory illnesses. The rash may cause itching which is occasionally severe and can persist for 6-12 weeks.
  • Morbilliform rash – This type of rash is often generalized over the whole body and has the appearance of tiny pink flat or slightly raised spots. This skin sign is uncommon in children and is more likely to be seen in adults with severe Covid infection. It typically lasts an average of 9 days.
  • Vascular Reactions – Petechiae are tiny purple dots that do not go away with pressure. They have been reported to occur in 1-2 % of cases and are associated with mild illness. However, large purple bruises or mottled dusky areas that follow the pattern of blood vessels, particularly on the lower extremities, are an indication of microvascular thrombosis, serious illness and require immediate attention. These findings are usually seen in hospitalized patients.
  • Hair Loss – Patients with severe Covid symptoms such as high fevers or those requiring hospitalization can develop hair loss months later. It is temporary yet still very distressing. Dermatologists can help manage this problem and rule out other non-Covid reasons for hair loss.

Patients with possible Covid associated rashes should have a nasal swab. Unfortunately since skin symptoms sometimes present weeks or months after the infection, the results can be negative. The etiology of the rash will then have to be made based on clinical parameters alone.

There are many other less common rashes associated with Covid Please visit www.Covidskinsigns.com to learn more about all types of Covid skin eruptions. This is a website funded by the British Association of Dermatologists and shows images collected by the Covid Symptom Study app, the largest community monitoring Covid in the world.

Common Dermatologic Conditions Related to Precautions for Covid 19:

  • Maskne -The term ‘maskne’ describes a combination of facial acne and itching that has been reported in one third of health care providers wearing N95 masks. It is also seen in patients who wear surgical and cloth masks. Some of those affected have never had a problem with acne and are now coming to the office with acne that ranges from mild to severe. Cleansing and moisturising the face with bland medical emollients after wearing a mask for a prolonged period can be helpful. Healthcare / essential workers should remove their masks as much as possible during breaks. Over the counter acne medication can be effective but if the acne is persistent or severe, see a dermatologist who can prescribe medication for the problem.
  • Hand dermatitis – The World Health Organization has recommended that to help stop the spread of Covid, hands should be washed thoroughly for at least 20 seconds, using lukewarm water and soap after being in public areas, before meals, after coughing or sneezing and after going to the bathroom. All of this necessary washing can cause irritant hand dermatitis or can flare atopic dermatitis or psoriasis. To help combat this, make sure to wash with mild cleansers (antibacterial cleansers are not necessary as long as you follow the WHO guidelines) such as Cera Ve or Cetaphil and use a good hand moisturizer every time you wash. If your skin becomes very inflamed, consult your dermatologist who can prescribed topical steroids along with other anti-inflammatory treatments.
  • Covid 19 Vaccine Reactions (so-called Covid arm / Vaccine arm) – This is a red angry non-scaly rash that develops at the vaccination site and represents a delayed hypersensitivity reaction. It can be itchy or painful and takes days (average 8-9) to appear. It is not serious and should go away in a week. According to experts, there is no need to avoid the second dose of the vaccine although doctors have begun recommending people get the second dose in the other arm. In one study, half the patients did not get the reaction after the second shot and the remainder had the same or less reaction. The majority of cases have occurred after the Moderna vaccine but cases are now being reported following vaccination with the Pfizer vaccine.
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