Rashes and Burns

RASHES

 

iStock_67990101_LARGE.jpgRash can happen from a variety of reasons. It could be infectious (herpes, Lyme disease, syphilis), allergic (Poison Ivy), Drug eruption (Bactrim), or a more serious underlying disease like kidney disease or cancer.

A systematic approach is crucial for establishing a timely diagnosis and determining early therapy when appropriate.

We look for the following:

Age of the patient

Season of the year

Travel history

Geographic location

Exposures including to insects (especially ticks and mosquitoes), animals (both wild and domestic), and ill contacts

Medications

Immunizations and history of childhood illnesses

Features of the rash are also important to consider, including:

Characteristics of the lesions

Distribution and progression of the rash

Timing of the onset in relation to fever

Change in morphology, such as papules to vesicles or petechiae

Symptoms associated with the rash (eg, pain, pruritus, numbness)

A number of infections characterized by fever and rash have a distinct seasonal predisposition. As examples, nonpolio enteroviral infections occur in the summer and fall months; Kawasaki syndrome, meningococcal infection, and parvoviral infections present most commonly in the winter or early spring months; measles and rubella are more frequent in the spring; tickborne diseases such as Lyme disease, ehrlichiosis/anaplasmosis, and Rocky Mountain spotted fever (RMSF) primarily occur in the spring and summer; tularemia and plague are usually seen in the summer.

Exposures to food, water, plant materials, animals, and infected human secretions can lead to rashes and can be associated with both occupational and nonoccupational contacts.

A thorough sexual history is essential in evaluating the patient with a rash of unknown etiology. Genital or rectal ulcerations may be caused by a variety of infectious agents, including syphilis, herpes simplex, lymphogranuloma venereum , chancroid, and donovanosis

Several infections associated with fever and rash constitute emergencies that must be recognized promptly by the evaluating clinician. Such infections include meningococcal infection, bacterial endocarditis, Rocky Mountain spotted fever, necrotizing fasciitis (including Fournier gangrene), toxic shock syndrome, and miliary tuberculosis.

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A history of the rash should include the following questions:

•Do you have any fever, chest pain, headaches, abdominal pain? 

Where and when did the rash start?

How has the rash progressed anatomically?

What symptoms are associated with the rash?

Has the rash changed in appearance?

Has any treatment been instituted for the rash?

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Dr.Paul might order some labs based on the presentation of your rash:

Appropriate laboratory testing includes:

Nonspecific tests such as complete blood count and urinalysis

Blood cultures (including specific media and isolation methods for work-up of bacterial, mycobacterial, and fungal organisms) should be inoculated prior to beginning antimicrobial therapy

Serologic tests, when appropriate (eg, for Coccidioides immitis, hepatitis B, Toxoplasma gondiiBorrelia burgdorferiTreponema pallidum, dengue virus, and HIV)

Antigen tests, when appropriate (eg, serum cryptococcal antigen)

Fluid from vesicular, pustular, petechial, ulcerative, and bullous lesions can be examined. Vesicular lesions should be unroofed so that the base of the lesion can be swabbed; herpes simplex virus and varicella-zoster virus can be diagnosed with direct fluorescent antibody or polymerase chain reaction (PCR) assays. Viral culture can also be performed. Aspirated fluid from pustules and bullous lesions should be Gram stained and cultured by the microbiology laboratory.

Skin biopsy can be particularly useful in establishing a diagnosis for nodular lesions but can also be obtained for petechial-purpuric, maculopapular, and ulcerative rashes. Biopsy material should be sent to the microbiology and pathology laboratories for appropriate culture and histopathologic evaluation.

BURNS

When you have a burn, it needs care and treatment.

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What are the symptoms of a skin burn? 

 The symptoms depend on how bad your skin burn is. Here are the terms doctors use to describe different types of burns:

Superficial skin burn (used to be called a “first-degree burn”): The burn is only on the top layer of your skin. Your skin will be dry, red, and painful. When you press the burn, it turns white. Superficial skin burns heal in 3 to 6 days without leaving a scar.

Superficial partial-thickness burn (used to be called a “second-degree burn”): The burn is on the top 2 layers of your skin, but does not go deep into the second layer. Your skin will hurt with a light touch or if the air temperature changes. The skin will be red and leak fluid, and you might get blisters. The burn will turn white when you press it. Superficial partial-thickness burns take 7 to 21 days to heal, and the area of skin that was burned might be darker or lighter than it used to be. The burn might or might not leave a scar.

Deep partial-thickness burn (used to be called a “third-degree burn”): This kind of burn also affects the top 2 layers of skin, but is deeper than a superficial partial-thickness burn. The burn will hurt when you press it hard, but it will not turn white. You will get blisters. This kind of burn takes more than 21 days to heal, and will probably leave a scar.

Full-thickness burn (used to be called a “fourth-degree burn”): Full-thickness burns include all the layers of the skin and often affect the fat and muscle underneath. The burn does not usually hurt, and the burned skin can be white, gray, or black. The skin feels dry. Your doctor will treat this kind of burn with surgery. You might also need to stay in the hospital for a time and take medicines.

Should I see a doctor or nurse? 

See your doctor or nurse right away if you are not sure how bad your burn is, or if the burn:

Involves your face, hands, feet, or genitals

Is on or near a joint, such as your knee or shoulder

Goes all the way around a part of your body (such as your arm or leg)

Is bigger than 3 inches across or goes deep into the skin

Causes a fever of at least 100.4°F (38°C) or shows other signs of infection. Infected skin gets more and more red, is painful, and might leak pus.

Goes deeper than the top layer of skin AND you have not had a tetanus shot in more than 5 years

People younger than 5 years or older than 70 years, people who have trouble fighting infection, for example because they have cancer or HIV, should see a doctor if they have a burn that goes deeper than a superficial burn.

Is there anything I can do on my own to feel better? — If your burn is not too severe, you can take the following steps:

Clean the burn: Take any clothes off of the area and wash it with cool water and plain soap. If your clothes stick to the burn, go to the emergency room.

Cool the burn: After you have cleaned the skin, you can put a cool cloth on it or soak your skin in cool water. Do not use ice to cool the burn.

Prevent infection: If the burn goes deeper than the top layer of skin, you are at risk of infection. To help prevent infection, you can use aloe vera gel or cream, or an antibiotic cream. If your burn forms blisters, cover it with a clean, non-stick bandage and change the bandage once or twice a day. Do not pop the blisters, because that can lead to infection.

Treat pain: If the burn hurts, try raising the burned part of your body to a level above your heart. For instance, if you burned your foot, try lying down and propping your foot up on pillows. This slows blood flow to the area and can prevent swelling and ease pain. You can also take over-the-counter pain medicine, such as tylenol (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin).

Do not scratch the burn: Scratching can increase the risk of infection.

How is a skin burn treated? — If the burn does not need a doctor’s care right away, you can start by trying the steps above to clean your burn, prevent infection, and treat your pain. If you have a more serious burn, our doctor might give you a stronger medicine for pain or apply special bandages. For a severe burn, our doctor might suggest surgery to repair the area that was burned. Dr.Paul also prescribe medicines to prevent infection.

Can skin burns be prevented? — You can reduce the chances that you or your children will get burned by:

Keeping candles, matches, and lighters away from children

Keeping any hot objects away from the edge of the table or stove (examples include foods or liquids, or the handles of pots and pans)

Using a humidifier with cool mist, not warm mist or steam

Keeping children away from hot stoves, fireplaces, and ovens

Having a smoke detector on each floor of your home

Dressing your children in clothes that do not catch fire easily – especially at night. Clothes made from cotton are a good choice.

Setting your hot-water heater no higher than 120°F (49°C)

Covering car seats and seat belts with a cloth if the car is sitting in the sun on a hot day

Using sunscreen if you are going to be in the sun

If you have a rash or a burn injury or any other skin lesion that should be looked at and treated, please visit our clinic at your earliest convenience.

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