[50F] With sudden rash and fatigue

Patient Description

A 50-year-old female presents with a sudden onset rash located under the breasts, characterized by two large patches that are hot, red, and slightly itchy. The rash appears bruised in photographs and is smooth to the touch, with swelling about the size of an egg and a half. The patient applied Benadryl, which reduced some redness, but the rash remains hot and itchy at times. The patient reports feeling very tired over the last four days, with headaches that have been severe at times, reaching a 9 or 10 on a scale of 1 to 10, but currently at a 2. She also experienced occasional nausea and a fever on the second day, which resolved after rest. The patient denies any recent changes in skincare products, laundry detergents, or exposure to new foods, medications, or environments. She wore a new bra, but the rash is localized under the breasts. The patient has a medical history of lupus, Hashimoto's thyroiditis, vitamin B12, D2, iron, and folic acid deficiency, high blood pressure, anxiety and depression, spondylitis, dextroconvex scoliosis, and osteoporosis. Currently, she is not taking any medications due to difficulties with doctor visits, but was previously prescribed hydroxychloroquine, levothyroxine, vitamins, and medications for anxiety and depression. No known medication allergies.

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Arora's Assessment

What might be happening

Based on your symptoms and medical history, here are some possibilities:

  1. Allergic Reaction or Contact Dermatitis: The sudden appearance of a rash under your breasts, especially after wearing a new bra, suggests a possible allergic reaction or contact dermatitis. This can occur when your skin comes into contact with an irritant or allergen, such as certain fabrics or chemicals in clothing. The heat and itchiness are common symptoms, and the bruised appearance could be due to inflammation.

  2. Lupus Flare: Given your history of lupus, it's possible that your symptoms, including fatigue, headaches, and rash, could be related to a lupus flare. Lupus can cause a variety of symptoms, including skin rashes, fatigue, and headaches.

  3. Viral Infection: The combination of fatigue, headaches, nausea, and a transient fever could indicate a viral infection. Viral infections can sometimes cause skin rashes as well.

Typical treatments or testing might include:

  • For contact dermatitis, avoiding the irritant and using topical corticosteroids or antihistamines can help.
  • For lupus, managing flares often involves medications like corticosteroids or immunosuppressants.
  • If a viral infection is suspected, supportive care such as rest, hydration, and over-the-counter pain relievers may be recommended.

What you can do

Rash and Itchiness:

  • Avoid wearing the new bra or any clothing that might irritate the area.
  • Continue using over-the-counter antihistamines like Benadryl to help with itching.
  • Apply a cool compress to the rash to reduce heat and discomfort.
  • If the rash worsens or doesn't improve, consider seeing a healthcare provider for further evaluation.

Fatigue and Headaches:

  • Ensure you are getting adequate rest and staying hydrated.
  • Try to maintain a regular sleep schedule to help manage fatigue.
  • Over-the-counter pain relievers like acetaminophen or ibuprofen can help with headaches, but use them as directed.
  • If headaches become severe or persistent, seek medical advice.

General Health:

  • Given your medical history, it's important to manage your chronic conditions. If possible, try to reconnect with a healthcare provider to discuss your symptoms and any necessary medications.
  • Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider when you can.

What you should look out for

  • If you experience difficulty breathing, swelling of the face or throat, or a rapid spread of the rash, seek emergency medical care as these could be signs of a severe allergic reaction.
  • Monitor for any new or worsening symptoms, such as increased fatigue, persistent fever, or joint pain, which could indicate a lupus flare or other underlying condition.
  • If your symptoms do not improve or you have concerns about your health, consider seeking medical attention for a thorough evaluation.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.

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27 d ago


People Also Ask


What are common causes of a sudden rash under the breasts?

Common causes of a sudden rash under the breasts include allergic reactions or contact dermatitis from new clothing or fabrics, fungal infections due to moisture, and skin conditions like eczema or psoriasis.


How can I differentiate between a lupus flare and an allergic reaction?

A lupus flare may present with systemic symptoms such as joint pain, fatigue, and headaches, in addition to a rash, whereas an allergic reaction is often localized to the area of contact and may include itching and redness. A healthcare provider can help differentiate between the two based on a full assessment.


What are some effective treatments for contact dermatitis?

Effective treatments for contact dermatitis include avoiding the irritant, applying topical corticosteroids to reduce inflammation, using antihistamines to relieve itching, and keeping the affected area clean and dry.


When should I seek medical attention for a rash?

You should seek medical attention for a rash if it is accompanied by difficulty breathing, swelling of the face or throat, a rapid spread of the rash, or if it does not improve with over-the-counter treatments. Persistent or severe symptoms should also be evaluated by a healthcare professional.

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