Learn to Differentiate Rashes to Find Appropriate Treatments

A rash is an area of irritated and/or swollen skin. Many rashes are itchy, painful, and red. Some can also lead to blisters or areas of raw skin. A rash can be a symptom of many different medical issues, allergies, or irritating substances. Some rashes develop immediately, and some may form over several days. Most rashes clear up relatively quickly, but some are long lasting and need chronic treatment. It is important to know what is causing the rash before treatment.

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Acne

Acne is a common skin condition caused by clogged hair follicles in the skin. Excess dead skin and skin oils (sebum) in the pores allow bacteria that normally live on the skin to grow. This can cause heat, pain, redness, and swelling. Plugged follicles form lesions, including the following¹:

• Blackheads: plugged follicles that open up
• Cystic acne: deep, painful, pus-filled lesions
• Nodules: large, painful, solid lesions deep beneath the skin
• Papules: inflamed lesions that are typically pink and tender to the touch
• Pimples/pustules: papules that are topped by white or yellow pus-filled lesions
• Whiteheads: plugged follicles that stay beneath the skin and produce white bumps

Individuals of all ages and races can get acne, although it is most common in teens and young adults. For most individuals, acne resolves by the time they reach their 30s, but many continue to have skin problems.¹

Topical medications come in a variety of forms, such as creams, gels, lotions, pads, and soaps. They can include the following²:

• Antibiotics: usually used with other topical medications. Benzoyl peroxide kills bacteria and may reduce sebum production.
• Resorcinol: helps break down blackheads and whiteheads.
• Retinoids: derived from vitamin A; can prevent acne formation and reduce inflammation and scarring.
• Salicylic acid: helps break down blackheads and whiteheads and reduces the shedding of skin cells.
• Sulfur: helps break down blackheads and whiteheads.

Oral medications are also prescribed to treat acne, often in conjunction with topical treatments. Oral treatments include the following²:

• Antibiotics: help slow or stop the growth of bacteria and reduce inflammation.
• Corticosteroids: usually reserved for severe nodular acne and can help reduce inflammation. May also be injected into the affected areas of skin.
• Hormone therapy: typically prescribed for women and reduces the effect of androgens on sebaceous glands.
• Retinoids: aid in opening pores, preventing acne formation, and reducing scarring.

Atopic Dermatitis (Eczema)

Atopic dermatitis is a common rash. It usually begins in childhood although it can occur at any age. For many, atopic dermatitis resolves by the teen years. Unfortunately, some individuals continue to have symptoms throughout adulthood.³

Atopic dermatitis causes extremely itchy skin. Scratching further irritates the skin by producing cracking, redness, and swelling. At times, the lesions can produce a clear discharge that results in crusting.³

This condition cycles through periods of remission when skin is clear and flares when skin gets worse.³

Treatment goals for atopic dermatitis are to control dry skin, manage itching, prevent flares and infection, promote healing, and reduce inflammation. Treatment usually requires combination therapy and depends on the area infected, patient age, and the severity of infection.⁴

Calcineurin inhibitors decrease inflammation and prevent flares. These include cyclosporin and tacrolimus.Injectable biological medications, such as dupilumab, block specific functions of the immune response.

Moisturizing creams can restore the skin barrier.

Oral Janus kinase inhibitors, such as tofacitinib, are reserved for more severe disease and require close monitoring.

Steroid creams and ointments help decrease inflammation.

Topical phosphodiesterase-4 inhibitors are indicated for refractory inflammation. These include apremilast, crisaborole, and roflumilast.

Rosacea

Rosacea is a chronic, common inflammatory skin condition that typically affects the areas around the cheeks, chin, forehead, and nose. It is occasionally seen on the chest, neck, or other areas and presents with broken blood vessels, pimples, and redness. Rosacea usually occurs after middle age and is more common in individuals with fair skin and women in menopause.⁵

Rosacea has 4 Subtypes5:

• Erythematotelangiectatic rosacea presents with flushing, redness, and visible blood vessels.
• Ocular rosacea appears with red eyes, swollen eyelids, and/or what looks like a stye.
• Papulopustular rosacea produces acne-like breakouts, redness, and swelling.
• Phymatous rosacea causes thick skin and has a bumpy texture.

Encourage patients to seek treatment. Rosacea can spread to the eye (ocular rosacea) and affect both long- and short-term vision. The goals of treatment include improving quality of life, prevention of complications and worsening, and symptom control. Topical medications are usually prescribed first for mild symptoms, but if symptoms are moderate to severe, oral medications may be used.⁶

Topical creams, gels, and ointments containing antibiotics, antiparasitics, or vasoconstrictors are used to treat flushing and redness. Ophthalmic preparations containing antibiotics, immunosuppressants, and lubricants can be used in patients with eye irritation.⁶

Oral medications containing antibiotics can be used in moderate to severe rosacea or in patients with ocular involvement, because of both their antibiotic and anti-inflammatory properties. For more severe cases, try isotretinoin.⁶

Urticaria (Hives)

Urticaria—also known as hives, nettle rash, weals, or welts—is an itchy, raised rash. It can affect a large or small area. First-line treatment of hives includes 1 or more OTC or prescription antihistamines. Nondrowsy antihistamines are preferred. In severe cases, a corticosteroid or an immune modulator may be administered along with the antihistamine(s). If the urticaria is accompanied by swelling of the throat or tongue, an epinephrine injection may be required.⁷

Sunburn

It is certainly easier to prevent sunburn than to treat it and a lot less painful. Too much exposure to UV light turns the skin red. This may be hot to the touch and painful. A sunburn may even blister and/or peel away. Having repeated sunburns, especially as a child, increases the risk of skin cancer later in life.⁸

Minor sunburns can be treated with acetaminophen, aspirin, or ibuprofen for headache and pain and by applying an aloe, hydrocortisone, or lidocaine cream or topical moisturizer.⁸

Blistering sunburn requires more care. Do not break blisters open, as they will take longer to heal, and this increases the risk of infection. Blistered areas should be bandaged and kept dry. Once blisters break, use antibiotic ointment or topical hydrocortisone.⁸

References

1. Overview of acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Updated August 2020. Accessed May 11, 2023. https://www.niams.nih.gov/health-topics/acne

2. Acne: diagnosis, treatment, and steps to take. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Updated August 2020. Accessed May 11, 2023. https://www.niams.nih.gov/health-topics/acne/diagnosis-treatment-and-steps-to-take

3. Overview of atopic dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Updated November 2022. Accessed May 11, 2023. https://www.niams.nih.gov/health-topics/atopic-dermatitis

4. Atopic dermatitis: diagnosis, treatment, and steps to take. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Updated November 2022. Accessed May 11, 2023. https://www.niams.nih.gov/health-topics/atopic-dermatitis/diagnosis-treatment-and-steps-to-take

5. Rosacea: overview. American Academy of Dermatology Association. Accessed May 11, 2023. https://www.aad.org/public/diseases/rosacea/what-is/overview

6. Rosacea: diagnosis, treatment, and steps to take. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Updated May 2021. Accessed May 11, 2023. https://www.niams.nih.gov/health-topics/rosacea/diagnosis-treatment-and-steps-to-take

7. Hives. American College of Allergy, Asthma and Immunology. Updated June 11, 2018. Accessed May 11, 2023. https://acaai.org/allergies/allergic-conditions/skin-allergy/hives/

8. Sun exposure – sunburn. CDC. Updated May 31, 2018. Accessed May 11, 2023. https://www.cdc.gov/niosh/topics/sunexposure/sunburn.html#:~:text=Print-,Sunburn,increased%20risk%20of%20skin%20cancer

About the Author

Kathleen Kenny, PharmD, RPh, is a clinical medical writer for Healthline Media in Colorado Springs, Colorado.