RASHES

Our "on call" experience suggests to us that rashes are a cause of tremendous anxiety which is almost always misplaced. The one rash that really justifies this level of concern is the meningococcal rash which most people, especially those with children, have heard of. However, it is not an easy rash to describe but if you understand how it is caused then I think that helps.

The meningococcal bacteria when they get into the bloodstream cause the tiny capillaries to leak blood into the tissues. It is this that causes the typical rash which looks like blood spattering and which does not fade on pressure which other rashes do. There are other causes of this type of rash (called purpura) but they should be checked out with the doctor on call unless the rash has been present for 24 hours or more virtually unchanged and the patient is well but even then an appointment during the next working day should be requested. When the rash is due to meningococcus it often progresses quite quickly so you can almost see it developing in front of your eyes. Meningitis is not always present so there is not always a headache but the patient will always be unwell with symptoms of varying degree from a "fluey" feeling to coma. There is genuine urgency in this situation as an antibiotic injection followed by immediate transfer to hospital is potentially life-saving and time is of the essence.

A representation of the meningococcal rash is present on the Meningitis Trust site: website.

The meningococcal rash is quite uncommon (most GP's only see a handful of cases in their whole career). Also very uncommon nowadays (because of the highly successful immunisation programme) is measles. Rashes we frequently see are:

• Non-specific viral rashes. Many viruses cause a fine pink slightly raised rash on the body - especially babies. Sometimes this is Rubella (German measles) but increasingly rarely nowadays because of immunisation. The patient is rarely more than mildly ill and no treatment is usually required beyond perhaps Paracetamol. Exclusion from public places (including school) is wise whilst the rash lasts.
• Allergic rashes. These can vary from a very fine pink rash to large weals (hives, nettle-rash). The rash is often very itchy, tends to come and go and you may be aware of what caused it (which may be something taken internally). Occasionally these reactions may be serious if there is swelling of the throat or the patient suddenly collapses - this serious kind of reaction tends to be with such things as bee stings, nut allergies and antibiotics. If there is just a rash on the skin this is rarely serious and simply requires an anti-histamine taken orally (not as a cream) - your pharmacist can advise although we can prescribe these.
• Chicken pox. This is a unique rash consisting of water-blisters with reddened inflamed skin around it. The spots tend to start on the trunk but come in crops even spreading to the throat and ears. In children it is almost always mild but chickenpox can be serious for the following groups:
  • People on steroids - usually prednisolone.
  • Pregnant women - especially just before birth.
  • People with impaired immunity - cancer patients having chemotherapy, patients with HIV and patients with congenital immune deficiency.
  • People with serious chronic disease.
  • The newborn - especially if acquired just prior to birth from their mother.
• Shingles. Caused by the chickenpox virus this is almost always restricted to one nerve root and one or other side of the body. Commonly it affects the chest area but can occur anywhere being most unpleasant around the eyes where specialist care may be necessary. Both shingles and chickenpox in at risk individuals can be treated with anti-viral drugs if started early enough.
• Hand, foot and mouth also causes blistering but confined to the soles of the feet, palms of the hands and ulcers in the mouth. It can be unpleasant and can cause outbreaks but is not serious.
• Other rashes which may need treatment from us but which are not urgent include eczema, dermatitis, athlete's foot, ringworm and scabies.

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