Quick Reference for Rashes, Pt 2

Communicable

Bacterial meningitis.  There may or may not be a generalized skin rash—flat pinhead-sized red spots that have the appearance of bleeding into the skin.  These spots may or may not have a small reddish or yellow blister in the center. 

Meningococcal meningitis. With meningococcal meningitis only (caused by Neisseria bacteria, and thus treated with antibiotics), a rash of small, irregular purple or red spots (petechiae) may appear.  This rash does not blanch (fade) with pressure.  It is best identified pressing a clear drinking glass against the trunk or lower extremities, where the rash most frequently appears.[1]

Smallpox.  The rash begins as small red spots on the tongue and mouth.  These spots become sores that rupture and spread the virus into the mouth and throat.  The rash spreads to the skin, starting on the face and spreading to the arms and legs, then the hands and feet, covering the body within 24 hours.  As the rash spreads, the fever diminishes and the person starts to feel a little better.  By the 4^th day, the skin sores start to fill in with thick fluid and have a dent in the center.  As the skin sores fill with fluid, the fever may spike again until the sores scab over.

Typhoid fever.  About 25% of patients develop a rose-colored rash of flat spots on the trunk of the body that fade with pressure.[2]

Typhus.  One to two weeks after being infected, the illness begins with the sudden onset of a high fever.  Other flu-like symptoms, especially rapid breathing and headache, follow.  Five to nine days after the initial onset, a rash begins, usually on the trunk, and then spreading to the limbs, but sparing (and this is key in diagnosis) the face, palms of the hands, and soles of the feet. 

Respiratory

Strep throat.  Two less common signs of strep are a rash on the abdomen and tiny red spots on the roof of the mouth.

Skin

Cellulitis. As the rash of cellulitis spreads (and this can happen very quickly), the skin is stretched a bit, usually making it look a bit shiny.  In lighter skinned people the skin color may range from a little pink to bright red.  In people with darker skin, change in skin color may be more difficult or even impossible to discern.  The affected skin will be warm and may be slightly raised.  It will be painful to the touch.

Contact dermatitis (poison ivy, oak, etc.).  Following exposure, the rash may take from a few hours to two weeks to appear as red, itchy bumps.  Because the rash may not occur all at once, patients often think the rash is spreading.[3]

Ringworm. The round or oval elevated rash spots are usually dry, slightly pink, and sometimes itchy.  While they are most often found on the extremities, they may occur anywhere.  With time, the center of the spot often clears, leaving behind a ring-like lesion that is darker on the outside.[4] [5] Ringworm may cause bald patches if it occurs in a hairy area.  Like with athlete's foot, scratching will cause blistering and oozing.[6]

Shingles. Before the shingles rash appears, many patients report feeling an itchiness or tingling sensation and can even feel it moving through the body.  The first sign is a line or patch of painful blisters that suddenly appears, most often on the face, neck, chest, or back, and usually only on one side of the body.  The pain of these blisters may be excruciating.  The blisters last 2-3 weeks and then disappear, but the pain may last much longer. 

Urogenital

Secondary syphilis.  Rash all over the body may be painless or painful.[7]

Vaginal infection. Pain, rash, blisters, or soreness develop around the vagina.

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[1] Joseph Alton, Alton’s Antibiotics and Infectious Disease, 72.

[2] https://www.cdc.gov/typhoid-fever/symptoms.html

[3] Cynthia Koelker, Armageddon Medicine 2012, 230.

[4] Cynthia Koelker, Armageddon Medicine, 220.

[5] The Survival Medicine Handbook,189.

[6] The Survival Medicine Handbook,189.

[7] https://www.cdc.gov/std/tg2015/syphilis.htm