Can you spot the deadly rash? Expert reveals what they really mean and when you need to seek help
GOOGLE the word “rash” and you will see more than 200million results.
Skin conditions cost the NHS £723million a year, with around 13.2million people visiting their GP with a rash-related problem.
But whether it’s itchy or flaky, your skin could be trying to give you a warning sign.
From Covid-19 to cancer, there are plenty of serious conditions that start with an itch or a rash. But how do you know if it is serious?
Dr Susan Mayou, consultant dermatologist at the Cadogan Clinic in central London () has more than 30 years’ experience in dermatology and is spokeswoman and a trustee of the British Skin Foundation.
Here, she tells Clare O'Reilly what different rashes really mean, and when you need to seek help.
Covid toe
ONE of the surprising symptoms of Covid-19 has been skin rashes caused by the virus, Sars-CoV-2.
In May, Spanish doctors identified five types of skin lesions they were seeing in corona patients.
Dr Mayou says: “One of these is Covid toes – chilblain-like lesions on the toes.
“They are itchy and painful and generally occur in 19 per cent of cases of younger patients.
“A similar eruption can occur on the fingers and it is probably one of the immunological responses of the body to the Covid virus.
“We are learning more every day about coronavirus symptoms and associated signs. But Covid toes seemed to be associated with mild disease.
“Over-the-counter steroids such as Eumovate or 1 per cent hydrocortisone do help against the symptoms of swelling, itching and irritation.
“But if the pain is bad or you have other symptoms of Covid, then it is best to seek medical advice and follow the Government guidelines.”
Kawasaki disease
THIS is a condition that typically affects children under the age of five, and it is characterised by a rash, high fever, enlarged lymph nodes, red eyes, lips and mouth, and swollen, red hands and feet.
In most cases symptoms last between four and eight weeks.
Dr Mayou says: “The angry rash can be measles-like in appearance, or red and patchy, with redness inside the mouth and a strawberry tongue and swelling of the hands and feet.
“The skin may peel during the later stages of the illness but the cause of Kawasaki is unknown.
“It is not contagious but it causes inflammation of blood vessels, which can include the heart, which can lead to angina and heart attacks if untreated.
“Patients are treated in hospital with high doses of intravenous antibodies to fight the disease and aspirin to reduce pain, discomfort and reduce the temperature.
“It is imperative to seek treatment for Kawasaki disease at the earliest stage as it can lead to long-term heart damage if left untreated.”
Case study 1: Lewie's rash
WHEN a rash appeared on little Lewie Johnston’s arm, his mum didn’t expect the diagnosis she got from doctors. They said the three-year-old had acute lymphoblastic leukaemia.
Katie, 25, from Wokingham, Berks, said: “The rash appeared on April 22, so given it was lockdown we sent some photos by email and the doctors arranged a blood test.
Lewie had bruises all over his legs, but the GP initially thought it was due to an iron deficiency or anaemia. However, hours after arriving at hospital, Katie was devastated to be told her son had cancer.
“Because of Covid, I was alone with him when they told me,” she says.
“It was terrifying. They reassured me his type of leukaemia was the easiest to cure and had a 90 per cent success rate but I hadn’t for a second thought about anything cancer-related.”
On April 27, Lewie had his first round of chemotherapy at the John Radcliffe Hospital in Oxford.
A Hickman line – a catheter to administer treatments – was inserted into his chest, a bone marrow sample was taken and a lumbar puncture was carried out to check his cerebrospinal fluid.
Katie says: “His spinal fluid and brain were negative for any leukaemia cells and his bone marrow showed there was no mutation to his cells, so he had the best possible outcome.
“On May 27, he had a bone marrow test to check the chemo was working and fortunately it was – Lewie only had a few cancerous cells left.”
Two weeks later, Katie was delighted to hear her son was cancer-free.
“He gained lots of weight from the steroid treatment and could barely walk for a few months, which was tough, but he’s been determined,” Katie says.
The tot is still having oral chemo every day as well as monthly chemo sessions in hospital to manage his condition. But doctors hope he will be in remission by the end of October.
“I never thought a rash could lead to this diagnosis,” Katie says.
Atopic eczema allergy
ONE of the most common skin conditions, eczema, causes dry, red, itchy, cracked and inflamed skin.
Dr Mayou says: “In severe cases it may weep, crust and even bleed.”
It most commonly appears on the backs of the knees, insides of the elbows, and on the hands, face and scalp but it can also present over the entire body.
“It can be extremely painful and, if left untreated, it can cause serious skin infections because the itching and scratching of the skin can lead to bacterial issues,” Dr Mayou warns.
“Dry skin is itchy so the first line of treatment is to use moisturisers.
“Topical steroids help to reduce the inflammation and reduce the itching and inflammation.
“Triggers for flare-ups can include stress, allergies, soaps, detergents and food allergies.
“So it’s important to monitor these to better understand the condition.”
You should consult a dermatologist as soon as you spot the first signs of eczema, so they can help to devise a management programme.
Impetigo
IMPETIGO is another common complaint in children – but unlike eczema, it is highly contagious.
Adults can also be affected by this condition, which is brought on by the bacteria staphylococcus aureus or streptococcus pyogenes.
Dr Mayou says: “It is characterised by a well- defined red patch with a honey- coloured crust but can appear as a blister.
“It normally starts on exposed areas of the body such as the hands or face but can spread all over the body. The condition can be painful, itchy and very uncomfortable.
“It’s generally not harmful but it is infectious, so it’s important to seek treatment if you suspect you have impetigo.
“Antibiotic creams or tablets are used to treat impetigo and the sores should be kept clean and dry.
“You should also avoid scratching the sores, in order to reduce risk of infection and scarring.
“You should seek medical advice to treat impetigo at the earliest opportunity if you suspect you may have developed it.”
Psoriasis
WHAT do Kim Kardashian, Liam Gallagher and Cara Delevingne have in common? They have all suffered psoriasis.
It’s a condition that is most common in adults under the age of 35, and causes red, scaly patches, most often on the knees, elbows, scalp and face.
Dr Mayou explains: “It is caused by an increased cell-turnover rate and inflammation.
“It looks like inflamed skin, with well-defined patches of thickened skin with silvery scales on the surface.
“While psoriasis is not harmful, it can affect your confidence, self-esteem and mood.”
Dr Mayou advises that topical steroids and UV light therapy can be used to treat it.
She adds: “It’s also advisable to review lifestyle factors such as diet, allergies, stress and the skin products you use to identify any triggers.”
Seek advice from a dermatologist if you suspect you have it, and they can develop a treatment plan.
Facial rosacea
IT can flare up when you drink alcohol, eat spicy foods and sit in the sun – rosacea is a chronic skin condition that causes the cheeks and face to appear red.
While it’s not harmful, it can impact on a person’s quality of life, leaving them self-conscious.
Dr Mayou says: “It typically occurs in people with fair skin between the ages of 30 and 50, and is more common in women.”
It’s caused by a dilation of the blood vessels that lie directly beneath the skin, which causes redness of the face and spider-like blood vessels, often around the nose.
In advanced cases those spider-like veins can appear bulbous.
Dr Mayou explains: “The skin can be sensitive and readily irritated and may feel burning or stinging, and there may be papules and pustules on the cheeks and forehead.
“In 15 per cent of cases the eyes can be affected, with redness and soreness of the eyelids.”
Treatments vary from topical creams to anti- biotics and laser and light-based therapies.
Dr Mayou advises that if you have the type of rosacea that causes pustules, it’s worth seeing a specialist for treatment.
Case study 2: Eric's toe
WHAT started as a tiny scrape on little Eric’s toe turned into a nightmare that nearly claimed his life.
Julia Etherington, a mother of four from Nailsea in Somerset, took the three-year-old son she has with partner Doug, 46, to see the doctor after he cut his toe on a tiny metal bracket on his bed.
While getting it checked in hospital the next morning, Eric threw up all over the floor.
Julia says: “The nurse said he must have a bug, but the next day when he developed a rash, our local GP said the strawberry-like spots on his tongue indicated scarlet fever.”
Two days later, the 42-year-old took her son back to the same doctor, as the antibiotics Eric was taking wouldn’t stay down.
The tot was prescribed new medication.
But by day five an enormous and very angry-looking blister had formed on Eric’s toe where he had injured it.
“Eric was so lethargic that he could barely open his eyes,” Julia says.
“Panicking and fearful of what was wrong, I carried him into the surgery and was sent straight to Bristol Royal Hospital for Children.”
There, doctors examined Eric and he was diagnosed with Toxic Shock Syndrome. He was one of just 40 people a year to develop the life-threatening condition.
“They needed to operate to remove the poison tracking up his leg from his infected toe,” Julia says.
“But with the toxins shutting down his organs – his kidneys, liver and heart were all failing – we had to wait until the antibiotics they were pumping into his veins began to work.
"I waited for two hours outside the intensive care theatre, praying they would save his life, and cried tears of relief when he was out of theatre.
“But they warned me he was dangerously ill. We realise how lucky we are he didn’t die, and that we were able to bring him home almost a week later.
“What started with a rash had almost turned into every parent’s worst nightmare.”
Mycosis fungoides
THIS is rare cancer of the blood and immune system that manifests itself on the skin.
It is not known what causes the disease, but it first appears as a red rash, often in areas that are not exposed to the sun, Dr Mayou explains.
She says of the condition: “The secondary phase sees the rash develop into patches.
“It then transforms into small, raised bumps – later followed by the final phase where it will develop into tumours or bumps.
“It can be hard to diagnose because the patches can resemble eczema or psoriasis. But it can be extremely harmful and can spread to the lymph nodes and other organs.”
Dr Mayou says the condition is rarely cured, but can be managed during the early stages – with medicine to target the skin, including gels and creams.
She adds: “Phototherapy radiation and UV light therapy may also be used as part of the treatment, and chemotherapy for later stages.”
But she says act quick if you believe you may have this.
She says: “If you suspect that you have this, it’s vital you see your doctor at the earliest stage.”
Human ringworm
DESPITE the name, worms do not cause ringworm.
In fact, it’s a common, contagious fungal infection that affects kids and adults and can appear anywhere on the body.
Dr Mayou says its appearance is “usually ring-shaped, unless it appears on the neck, face or scalp.
“There it appears as a red, scaly patch that gradually enlarges and can be linked to hair loss.”
It’s not harmful but does need treating in order to prevent it from spreading to others, Dr Mayou advises.
There are a whole host of antifungal creams, gels, sprays and shampoos, which can be bought over the counter, to treat the condition.
So it is worth speaking to a pharmacist.
If the infection fails to improve after two weeks of antifungal treatment, you should book an appointment with your doctor.
Paraneoplastic rash
MOST people who see a rash would not suspect that the underlying cause is cancer, but in rare cases it can be a sign of the disease.
They are known as paraneoplastic rashes, and generalised itching is the most common symptom.
The rashes are typically a sign of blood cancers including lymphoma and leukaemia, and lung and gastric cancers.
“The rash itself isn’t harmful but it’s important to find what the underlying cancer is,” Dr Mayou says.
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“Emollients and topical steroids can help to relieve the itching.
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“However it is vital that you seek help to find out what the underlying malignancy is.”
You should book an appointment to see your doctor as soon as possible if you suspect that you might be suffering from a paraneoplastic rash.
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