[18F] Experiencing a painful skin rash and other symptoms

Patient Description

An 18-year-old female is presenting with a painful, pinkish-red, raised skin rash with small red dots, scaly, dry patches, and small bumps. The rash began as a welt on her upper left arm and has spread to her shoulders, back, arms, and legs over the course of two weeks. She reports no known triggers but has minor food sensitivities. Additionally, she is experiencing ear pain with fullness, sharp pain upon popping, and a painful bump on the outer ear. She also has a stuffy nose, enlarged lymph nodes in her neck, and oily skin on her face and chest that started about 4-5 days ago. The patient has been struggling with insomnia for multiple years, exacerbated by ADHD, and has worsened since the rash developed. She experiences oversleeping, irritability, and headaches due to the lack of sleep. She also reports joint pain in her hands, shoulders, and ankles, as well as occasional difficulty breathing through her nose, which she attributes to anxiety. There is pressure in her right eye associated with sinus pain and a difficulty in fully focusing her eyes. She denies any recent travel, exposure to others with similar symptoms, or new activities that could explain her symptoms. She has not experienced any fever but does have chills and night sweats.

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Arora's Assessment

What might be happening

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

  • Atopic Dermatitis (Eczema): This is a condition that makes your skin red and itchy. It's common in children but can occur at any age. Atopic dermatitis is long-lasting (chronic) and tends to flare periodically. It may be accompanied by asthma or hay fever.

    • Treatment typically involves hydrating the skin, reducing inflammation and itch, and preventing flare-ups.
  • Contact Dermatitis: This is a type of inflammation of the skin that's either triggered by irritants that strip the skin of its natural oils, or by allergens that cause an allergic reaction. Your description of a painful, itchy, red, and scaly rash is consistent with this condition.

    • Treatment involves avoiding the irritants or allergens that cause the reactions. Topical creams or ointments can also help to relieve the symptoms.
  • Seborrheic Dermatitis: This is a common skin condition that mainly affects your scalp. It causes scaly patches, red skin, and stubborn dandruff. It can also affect oily areas of the body, such as the face, sides of the nose, eyebrows, ears, eyelids, and chest.

    • Treatment often includes a combination of shampoos, creams, and ointments to control symptoms.
  • Insomnia: Difficulty falling asleep, staying asleep, or waking up too early are all characteristics of insomnia. This condition can affect your mood, energy levels, and overall health. It can be related to stress, anxiety, depression, or a health condition.

    • Treatment can involve improving sleep habits, lifestyle changes, and cognitive behavioral therapy.

Please note that these are just possibilities and not a definitive diagnosis.

What you can do

  1. For your skin rash, try to avoid scratching the affected areas, keep your skin moisturized, and avoid irritants or allergens that seem to trigger or worsen your rash. Over-the-counter creams or ointments containing hydrocortisone may help reduce inflammation and itching.

  2. For your insomnia, try to maintain a regular sleep schedule, create a restful environment, limit daytime naps, and exercise regularly. Avoid caffeine and large meals before bedtime.

  3. For your greasy skin, wash your face twice a day with a gentle face cleanser. Avoid oil-based cosmetics and use water-based products instead.

  4. For your ear pain, try over-the-counter pain relievers like acetaminophen or ibuprofen. A warm compress might also help relieve pain.

What you should look out for

Seek immediate medical attention if:

  • Your skin rash spreads, becomes more painful, or is accompanied by other worrying symptoms such as fever.
  • Your insomnia is causing significant distress and is affecting your ability to function during the day.
  • Your ear pain becomes severe, is accompanied by high fever, or you experience hearing loss.

Remember, this advice is intended to be general in nature, and specific causes may need different approaches. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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10 mo ago

People Also Ask


What are the common causes of a skin rash with red, scaly patches and small bumps?

Common causes of a skin rash with red, scaly patches and small bumps include atopic dermatitis (eczema), contact dermatitis, and seborrheic dermatitis. These conditions can be triggered by allergens, irritants, or changes in skin oil production.


How can insomnia related to ADHD be managed effectively?

Insomnia related to ADHD can be managed by maintaining a regular sleep schedule, creating a restful sleep environment, limiting screen time before bed, and possibly using cognitive behavioral therapy for insomnia (CBT-I). Consulting with a healthcare provider for personalized strategies is also beneficial.


What are the possible reasons for ear pain and fullness without a fever?

Ear pain and fullness without a fever can be caused by conditions such as earwax buildup, Eustachian tube dysfunction, or an outer ear infection. It's important to monitor symptoms and consult a healthcare provider if they persist or worsen.


How can oily skin be managed, especially when it suddenly appears?

Oily skin can be managed by washing the face twice daily with a gentle cleanser, using non-comedogenic and water-based skincare products, and avoiding heavy or oil-based cosmetics. Regular exfoliation and using products containing salicylic acid or benzoyl peroxide can also help control oil production.


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