Skin rash
Description:
Skin rash is one of the brightest clinical manifestations of a large number of diseases in dermatology. Correct analysis of this symptom, differential diagnosis with some other diseases with similar signs allow our specialists to establish competently the diagnosis and to select adequate treatment.
Skin rash is various on the coloring, a form, the sizes and localization. Its emergence can be connected with penetration into an infection organism, development of allergic reaction, changes in an organism or aggressive influence of environmental factors.
Symptoms of Skin rash:
Roseola (roseola) - a speck of light pink, red color from 1 to 5 mm in size. The form roundish or wrong, edges accurate or indistinct, over the level of skin does not act, disappears during the pressing and stretching of skin. The roseola meets at many infectious diseases, is especially typical for a typhoid. (According to M. P. Konchalovsky: "One star yet not the star sky, but one roseola forces to think of a typhoid".) Multiple roseolas of 1-2 mm in size are usually described as a punctate rash (at scarlet fever), in the course of permission they become covered by scales or disappear completely.
The spot (makula) has the same coloring as a roseola, the size - from 5 to 20 mm, does not act over skin level. Form most often wrong. The spot disappears when pressing on skin and again appears after the termination of pressure. Multiple spots from 5 to 10 mm in size are described as melkopyatnisty rash (for example, at a rubella). Spots of 10 in size - 20 mm form krupnopyatnisty rash (for example, at measles, an allergy).
Erythema (erythema) - extensive sites of hyperemic skin of red, purple-red or purple color. Results from merge of the large spots formed by vasodilatation not only a papillary layer of skin, but also a subpapillary vascular texture. The spots more than 20 mm in size tending to merge should be considered as an erythema. The erythema is most typical for an erysipelatous inflammation, thermal, ultra-violet burns.
Hemorrhage (haemorrhagia) - hemorrhage in skin as a result of destruction of vessels of skin. Has an appearance of points or spots of various size and a form, does not disappear at extension of skin. Color in the beginning red, purple or violet, then, in process of a hemorrhage rassasyvaniye, becomes flavovirent and, at last, yellow (formation of hemosiderin at an erythrocytolysis). Discolorations are well noticeable at larger hemorrhages.
Dot hemorrhages are called petechias (petechia). Multiple hemorrhages of rounded shape from 2 to 5 mm in size are described as a purpura (a rigrig of hayetogghagioe). Hemorrhages of irregular shape more than 5 mm in size are called ecchymomas (eshutoses). Hemorrhages can accumulate on other elements of rash. In such cases speak about petekhialny transformation of roseolas, spots, papules. As a rule, it is observed at a severe disease. Hemorrhagic rashes come to light at a sapropyra (often in combination with roseolas - rozeolezno-petekhialny rash), other rickettsioses, hemorrhagic fevers, sepsis. Hemorrhagic elements of irregular shape on a dense basis (star-shaped rash) are characteristic of a meningococcemia, pneumococcal sepsis. Ecchymomas with a diameter more than 10 mm in the subsequent are exposed to a nekrotization. Small hemorrhages can have also a noninfectious origin (a capillary toxicosis, a toksiko-allergic vasculitis, avitaminosis With, etc.). The hemorrhages located linearly in the form of strips, are called вибицес. Bruises are called with igullyation, larger bruises - suffuziya.
Papule (papula) - the rash element towering over skin level that quite often is defined to the touch. Has a flat or dome-shaped surface, the size - from 1 to 20 mm. A form and coloring same, as at roseolas and spots. Papules often leave behind pigmentation and a peeling of skin. Depending on a form and the size of a papule happen miliary, size about prosyany grain, is more often than conical shape and with an arrangement around a hair follicle; in the center of such element the horn stopper or a hair is noticeable. Lentikulyarny papules of the size of lentil or a pea can be convex, oval, round, flat, many-sided. Numulyarny, monetovidny, are the papules which resulted from merge among themselves with a peripheral growth of large papules of a flat form. The papules which merged among themselves form plaques, and at merge of the last there are platforms which are located on big sites of an integument, size about a palm more. Quite often at usual clinical inspection of the child very difficult or it is even absolutely impossible to distinguish roseolas from papules. On the other hand, the same sick child at the same time can have both roseolas, and papules (a typhoid, paratyphus, an infectious mononucleosis), papules and spots (measles). In such cases it is reasonable to describe rash as rozeolezno-papular or spotty and papular. Thereby at the same time the size of papules is specified: rozeolo-papules have the size to 5 mm, makulo-papules - from 5 to 20 mm.
Hillock (tuberkulum) - the limited, dense, acting over the surface of skin bespolostny education with a diameter from 1-2 to 5-10 mm. Hillocks are formed as a result of accumulation in a derma of specific inflammatory infiltrate. Clinically the hillock is similar to a papule, however differs from it in the fact that at palpation of a hillock always plotnovaty infiltrate in skin clearly is defined. Besides, hillocks, unlike papules, at involution are exposed to a necrosis, often form ulcers and leave behind a hem or a cicatricial atrophy of skin. Hillocks are most typical for a skin leushmaniosis, a leprosy and tubercular damages of skin, tertiary and late inborn syphilis.
Node (nodus) - the bespolostny, limited, deeply going to depth of skin consolidation, often vystoyashchy over skin level. The size of nodes - from hazelnut to egg and more. Are formed as a result of accumulation of cellular infiltrate in hypodermic cellulose and actually on a derma. Nodes of inflammatory character have a soft or pasty consistence, indistinct borders, skin over them red color, they are inclined to bystry permission. The nodes which appeared owing to a specific inflammation (kollikvativny tuberculosis, a syphiloma) have a dense consistence, are sharply delimited from surrounding fabrics, are inclined to disintegration and an ulceration with the subsequent scarring.
The blister (urtica) - the ostrovospalitelny, a little towering over the level of skin bespolostny element from 2-3 to 10-15 cm and more, has the round or oval form, often is followed by an itch. Color - from white to light pink or light-red. The blister is formed usually quickly and quickly disappears, without leaving behind any trace. Results from limited ostrovospalitelny hypostasis сосочковогб a layer of skin and a simultaneous trichangiectasia. Emergence of urtikarny elements is characteristic of allergic reactions of a different origin (a medicinal, food, cold allergy) including the infectious nature. Sometimes meets in the preicteric period of hepatitis B.
The bubble (vesicula) - a strip element from 1 to 5 mm in size, represents epidermis amotio. Usually bubbles are filled with transparent, muddy or bloody contents, can shrink and give transparent or brown color a crust. If the cover of a bubble is opened, then the erosion - the becoming wet surface of pink or red color limited to the bubble sizes is formed. Bubbles do not leave behind hems on skin. In case of accumulation in a bubble of a large number of leukocytes it turns into a pustule - a pustule (pustula). Inflammatory changes in the basis and around a bubble are noted. Pustules are differentiated on single-chamber (chicken pox) and multichamber (natural smallpox). The group of bubbles which is located on the inflamed skin is called herpes (herpes). Vesicles are characteristic of a herpes and enteroviral infection, chicken and natural pox, an erizipeloid and a foot-and-mouth disease.
The bubble (bulla) - a strip element with a diameter up to 3-5 cm, is located in upper layers of epidermis and under epidermis. Contents of bubbles can be serous, bloody, purulent. They can be fallen down, forming a crust, be opened, forming the erosive surface turning into unstable pigmentation. The bubble arises more often against the background of an erythematic spot, is more rare - against the background of not changed skin (pemphigoid of newborns). Elements can be located as in epidermis, in an awl-shaped layer (a vulgar pemphigus), and under epidermis (a polymorphic exudative erythema, a herpetiform dermatosis). It is observed at a violent form of an ugly face, sometimes at chicken pox, thermal burns.
Secondary morphological elements are formed as a result of evolution of primary elements of rash.
Hyperpegmentation (hyperpigmentatio) - change of coloring of skin as a result of increase in it in melanin or adjournment of hemosiderin of primary elements.
Depigmentation (depigmentatio) results from reduction of content of melanin in skin, is observed after disappearance of a small knot, a hillock - permission spotty shelled (a chromophytosis, ekzematoida) and papular (psoriasis) elements.
Scale (sguama) - accumulation of the tearing-away cells of a corneous layer, the epidermis layers which sometimes are subject to it. Scales happen on primary morphological elements - papules (psoriasis, syphilis), hillocks, after permission of bubbles (eczema) etc. Depending on a form and the size of scales differ mukoobrazny (scales scaly) when the surface of skin looks as if the sprinkled flour (xerodermia), and a lamellar peeling - horn plates of various sizes, up to the pergamentoobrazny masses separating from considerable sites of an integument (a desquamative erythrosis of Leyner).
Erosion (erosio) - the defect of skin within epidermis as a result of opening of a bubble, a bubble, a pustule repeating their form and size. At merge of bubbles and pustules of an erosion have scalloped edges. Erosion can result and macerations of skin in the field of folds or at maceration of other elements of a rash, most often from papules. When healing an erosion of a hem does not remain, usually there is only a temporary pigmentation.
Graze (excoriatio) - having combed the disturbance of integrity of skin arising owing to, scratches, other damages. Grazes can be superficial - within epidermis, sometimes with involvement of a papillary layer of a derma, and heal without hem. Deeper grazes, with involvement of deep layers of a derma, leave behind a hem. Grazes are characterized by tendency to infection.
Ulcer (ulcus) - the deep defect of skin reaching a derma, a hypodermic fatty tissue, a fascia, muscles, bones. Results from disintegration of fabric of primary element (a hillock, a node, an ecthyma). Its size - from 1 mm to the sizes of a coin or a palm more; the form can be round, oval, linear, oblong, wrong. Surrounding fabric or is inflamed (hypostasis, a hyperemia), or an infiltrirovana. Ulcers always heal with formation of hems.
Cracks, anguishes (fissura, rhagades) - linear injury of skin in the form of its gap arising owing to excessive dryness because of loss of elasticity at inflammatory infiltration or skin restretchings. Cracks can be located within epidermis and a derma. Usually they are localized in mouth corners, interdigital folds, on palms, soles, over joints, in the field of an anus. The superficial crack after healing does not leave marks. After healing of deep cracks there are linear hems.
The crust (crusla) is formed on skin as a result of the drying separated the becoming wet surface (a bubble, a bubble, a pustule, an ulcer, an erosion). Crusts can have various color (at serous exudate transparent with a yellowish shade; at purulent - yellow, greenish or brown; at hemorrhagic - brown or black) and a form (layered, ustritsepodobny - syphilitic rupee), impetiginous - similar to drops of the dried-up honey.
Hem (cicatrix) - formation of connecting fabric on site deep defect. Arises after healing of deep defects of skin on site изъязвившихся hillocks, deep pustules, nodes, deep burns, wounds. Formation of a hem is followed by death grease and sweat glands, hair follicles, vessels and elastic fibers, disappearance of the skin drawing. Usually hems are located lower than the level of skin or are at its level, rise over skin level less often - hypertrophic hems (keloid - their version).
Lichenification (lichenificatio) - the center of the strengthened drawing of skin which is followed by its thickening and consolidation, a hyperpegmentation, dryness. The centers of lichenification are most often localized in a neck, elbow and subnodal bends, radiocarpal and ankle joints, inguinal folds, a scrotum and arise at the chronic dermatosis which is followed by an itch (eczema, neurodermatitis).
Vegetation (vegetatio) - the sosochkovidny thickening of skin arising owing to growth of an awl-shaped layer of epidermis and a papillomatosis of a derma at is long the existing inflammatory process. More often it is formed in the field of papular elements and ulcers. Vegetations can be eroded, bleed, are inclined to accession of a consecutive piokokkovy infection.
Reasons of Skin rash:
Enanthesis (exanthema) and mucous membranes (enanthema) can be not only at viral and bacterial infections, but also at diseases of the noninfectious nature. Rash can be manifestation as acute (measles, scarlet fever, chicken pox, etc.), and chronic (syphilis, tuberculosis, etc.) infectious diseases. However diagnostic Value ekzanty at infectious diseases is ambiguous. So, at one infectious diseases (measles, chicken pox, scarlet fever) of a rash appear surely, at Others (a rubella, tifo-paratyphoid diseases) meet often (50-70%), at the third (an infectious mononucleosis, leptospirosis, a viral hepatitis) are observed seldom.
Treatment of Skin rash:
Carry out treatment of a basic disease. Only the attending physician has to appoint treatment.
In some cases rash will pass itself – viral infectious diseases, like measles, a rubella, chicken pox.
In case of detection of an itch mite it is necessary to carry out simple treatment.
If rash of the allergic nature, then it is necessary to define allergen by means of skin tests and to exclude its impact on an organism.
In case of skin diseases it is necessary to be treated, they will not pass, but only the doctor can appoint treatment, considering the general condition of an organism.
If skin rash dry or pruritic, it is possible to reduce symptoms by means of the ointments containing corticosteroids. In very hard cases corticosteroids enter in the form of injections.
