[18F] With new onset splotchy rash and regular joint pains

Patient Description

An 18-year-old female reports waking up with a splotchy rash on the upper front of her thigh and two red circle rashes near her chin and on the opposite side of her elbow. The thigh rash spreads slowly, is reddish, itches, and spreads more if scratched. The rash has been present for one day. The patient also experiences itchy eyes but no rash on the eyes. There has been no contact with new soaps, lotions, or other potential irritants. The rash improves after swimming but remains unchanged when outside. The patient has regular joint pains and occasional swelling in fingers, toes, or knee cap, but no new or unusual swelling in joints and no fever. No swelling of the face or lips, or difficulty breathing. The patient takes Claritin and fluoxetine (100mg) regularly, about 3-4 times a week, and has allergies to moxocillin and penicillin.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  • Contact Dermatitis: This is a skin reaction that occurs after exposure to an allergen or irritant. Given that you have been swimming and have pets, it is possible that something in the pool or on your pets could be causing the rash.

    • Treatment: Avoid the suspected irritant, use over-the-counter hydrocortisone cream, and take antihistamines like Claritin to reduce itching.
  • Eczema (Atopic Dermatitis): This is a condition that makes your skin red and itchy. It is common in children but can occur at any age. Eczema can be triggered by environmental factors such as pollen, pet dander, or even stress.

    • Treatment: Moisturize your skin regularly, use gentle soaps, and apply topical corticosteroids as prescribed by a doctor.
  • Ringworm (Tinea Corporis): This is a fungal infection that causes a ring-shaped, red, itchy rash. It can spread through direct contact with an infected person or animal.

    • Treatment: Over-the-counter antifungal creams can be effective. If the rash does not improve, you may need a prescription-strength antifungal medication.
  • Hives (Urticaria): These are raised, itchy welts that can appear on the skin as a result of an allergic reaction. The fact that your rash gets better after swimming suggests that water might be soothing the irritation.

    • Treatment: Antihistamines like Claritin can help reduce itching and swelling. Avoid known allergens and irritants.

What you can do

While you wait to see a healthcare provider, you can try the following to alleviate your symptoms:

  1. Avoid Scratching: Scratching can make the rash worse and cause it to spread. Try to keep your nails short and consider wearing gloves at night.
  2. Cool Compresses: Applying a cool, damp cloth to the affected areas can help reduce itching and inflammation.
  3. Moisturize: Use a fragrance-free moisturizer to keep your skin hydrated.
  4. Over-the-Counter Creams: Hydrocortisone cream can help reduce inflammation and itching. Antifungal creams can be used if you suspect ringworm.
  5. Antihistamines: Continue taking Claritin to help manage the itching.

What you should look out for

Seek medical attention if you experience any of the following:

  • The rash spreads rapidly or becomes more severe.
  • You develop a fever or feel generally unwell.
  • You notice any signs of infection, such as increased redness, warmth, swelling, or pus.
  • You experience difficulty breathing or swelling of the face and lips, which could indicate a severe allergic reaction.

Remember, while these suggestions can help manage your symptoms, it's important to consult a healthcare provider for a formal diagnosis and appropriate treatment.

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7 mo ago

People Also Ask


What are the common causes of a splotchy rash that spreads when scratched?

A splotchy rash that spreads when scratched can be caused by conditions like contact dermatitis, eczema, or hives. These conditions can be triggered by allergens, irritants, or stress, and scratching can exacerbate the rash by causing further irritation or spreading the irritant.


How can swimming improve skin rashes?

Swimming can improve skin rashes because the water can soothe the skin and reduce inflammation. Additionally, chlorine in pool water has mild antiseptic properties that might help reduce bacteria on the skin, although it can also dry out the skin, so moisturizing afterward is important.


What are the differences between eczema and contact dermatitis?

Eczema (atopic dermatitis) is a chronic condition characterized by red, itchy skin and is often linked to a genetic predisposition and environmental triggers. Contact dermatitis, on the other hand, is an acute reaction to direct contact with an allergen or irritant. Both conditions can cause similar symptoms, but their triggers and management strategies may differ.


When should I seek medical attention for a rash?

You should seek medical attention for a rash if it spreads rapidly, becomes more severe, is accompanied by fever or general unwellness, shows signs of infection (such as increased redness, warmth, swelling, or pus), or if you experience difficulty breathing or swelling of the face and lips, which could indicate a severe allergic reaction.


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