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Dermatology Library

R

Rash:

The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are:

  • Scaly patches of skin not caused by infection.
  • Scaly patches of skin produced by fungus or bacterial infection.
  • Red, itchy bumps or patches all over the place.

Rectal itch:

See: Pruritus (Itching)

Rhinophyma:

This is the condition that gave the late comedian W.C. Fields his trademark nose. Rhinophyma usually occurs in men and happens in advanced stage rosacea, when the oil glands on the nose become enlarged and the nose becomes bumpy, red and enlarged.

Also see: Rosacea

Ringworm (tinea):

Ringworm is a skin infection caused by a fungus. Ringworm can affect skin on your body (tinea corporis), scalp (tinea capitis), groin area (tinea cruris, also called jock itch), or feet (tinea pedis, also called athlete's foot).

Rosacea:

Rosacea is a very common benign skin disorder that affects many people worldwide. As of 2008, it is estimated to affect at least 14 million people in the United States alone. The main symptoms of this facial condition include red or pink patches, visible broken blood vessels, small red bumps, red cysts, and pink or irritated eyes. Most people with the disease may not even know they have rosacea or that it is a diagnosable and treatable condition. Many patients may just assume they blush easily or have gotten sunburned.

Symptoms - Rosacea is considered a chronic (long-term), non-curable skin disease with periodic ups and downs. As opposed to traditional acne, most adult patients do not "outgrow" rosacea. It characteristically involves the central region of the face, causing persistent redness or transient flushing over the areas of the face and nose that normally blush -- mainly the forehead, the chin and the lower half of the nose. It is commonly seen in people with fair or light skin, and particularly in those of Irish and Scottish backgrounds. Some famous people with rosacea have included former President Bill Clinton and W.C. Fields.

Red cheeks are a common symptom of rosacea. The redness, often aggravated by flushing, may cause small blood vessels in the face to enlarge (dilate) and become more visible through the skin, appearing like tiny red lines (called telangiectasias). Continual or repeated episodes of flushing may promote inflammation, causing red bumps that resemble teenage acne. In fact, rosacea can frequently be mistaken for common acne. Rosacea is also referred to as acne rosacea.

Causes - The exact cause of rosacea is still unknown and remains a mystery. The basic process seems to involve dilation of the small blood vessels of the face. Suspected causes of rosacea include but are not limited to genetic factors, genetics plus sun exposure, a mite sometimes found in hair follicles (Demodex folliculorum), the bacteria Helicobacter pylori (that is associated with stomach ulcers), gastrointestinal disease, and medications that cause blood vessels to widen. There seems to be a hereditary component in some people.

Rosacea tends to affect the "blush" areas of the face and is more common in people who flush easily. Additionally, a variety of triggers are known to cause rosacea to flare. Emotional factors (stress, fear, anxiety, embarrassment, etc.) may trigger blushing and aggravate rosacea. A flare-up can be caused by changes in the weather like strong winds or a change in the humidity. Sun exposure and sun-damaged skin is generally associated with rosacea. Exercise, alcohol consumption, emotional upsets, and spicy food are other well-known triggers that may aggravate rosacea. Many patients may also notice flares around the holidays, particularly Christmas and New Year's holidays.

Typical signs and symptoms include facial flushing, redness, burning, red bumps, and cystscysts. The symptoms tend to come and go. The skin may be clear for weeks, months, or years and then erupt again. Rosacea tends to evolve in stages and typically causes inflammation of the skin of the face, particularly the forehead, cheeks, nose, and chin.

When rosacea first develops, it may appear, then disappear, and then reappear. However, the skin may fail to return to its normal color and the enlarged blood vessels and pimples arrive in time. Rosacea may rarely reverse itself. Rosacea generally lasts for years, and, if untreated, it tends to worsen.

Rosacea treatment - There are many treatment choices for rosacea depending on the severity and extent of symptoms. Available medical treatments include antibacterial washes, topical creams, antibiotic pills, and lasers.

Mild rosacea may not necessarily require treatment if the individual is not bothered by the condition. More resistant cases may require a combination approach, using several of the treatments at the same time. A combination approach may include home care of washing with a prescription sulfa wash twice a day, applying an antibacterial cream morning and night, and taking an oral antibiotic for flares.

Topical creams - With the proper treatment, rosacea symptoms can be fairly well controlled. Popular methods of treatment include topical (skin) medications applied by the patient once or twice a day. Topical antibiotic medication such as metronidazole applied one to two times a day after cleansing may significantly improve rosacea. Azelaic acid (Finacea gel 15%) is another effective treatment for patients with rosacea. Both metronidazole and azelaic acid work to control the redness and bumps in rosacea.

Some patients elect combination therapies and notice an improvement by alternating metronidazole and azelaic acid: using one in the morning and one at night. Sodium sulfacetamide (Klaron lotion) is also known to help reduce inflammation. Other topical antibiotic creams include erythromycin and clindamycin (Cleocin).

Oral antibiotics - Oral antibiotics are also commonly prescribed to patients with moderate rosacea. Tetracycline, doxycycline, minocycline, and amoxicillin are among the many oral antibiotics commonly prescribed and they actually help reduce inflammation and pimples in rosacea. The dose may be initially high and then be tapered to maintenance levels. Common side effects and potential risks should be considered before taking oral antibiotics.

Sun protection - Sun exposure is a known flare for some rosacea sufferers. Sun protection using a wide-brimmed hat and sunscreens are generally encouraged. Because rosacea tends to occur in mostly fair-skinned adults, the use of an appropriate daily sunscreen lotion and overall sun avoidance is recommended. Zinc-based sunscreens (SPF 30 or higher) may provide adequate sun protection.

Triggers to avoid - While not all rosacea patients are exactly the same, there are some common rosacea triggers. Avoiding these potential triggers may also help relieve symptoms and disease flares.

Smoking, spicy foods, hot drinks, and alcohol may cause flushing and should be avoided. Exposure to sunlight and to extreme hot and cold temperatures should be limited as much as possible.

Smoking, spicy foods, hot drinks, and alcohol may cause flushing and should be avoided. Exposure to sunlight and to extreme hot and cold temperatures should be limited as much as possible.

Potent cortisone medications on the face should be avoided because they can promote widening of the tiny blood vessels of the face. Some patients experience severe rosacea flares after prolonged use of topical steroids.

Submitted by: Laura L. Mays, PA-C

Rubella (German measles):

A disease caused by the rubella virus. The virus usually enters the body through the nose or throat. The disease can last 1-5 days. Children recover more quickly than adults. Symptoms of rubella include swollen glands, fever, rash, flaking, dry skin, inflammation of the eyes, nasal congestion, joint pain, and swelling pain in the testicles. Rubella can affect anyone of any age and is generally a mild disease. However, rubella can cause congenital rubella syndrome in the fetus of an infected pregnant woman. Fewer cases of rubella occur since a vaccine became available in 1969. Most people are vaccinated against rubella as children at 12-15 months of age. A second dose is required before age 11. Symptoms are usually treated with acetaminophen until the disease has run its course.

Also see: Rubeola

Rubeola (measles):

Measles, also called rubeola, is a highly contagious - but rare - respiratory infection that's caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose.

Since measles is caused by a virus, symptoms typically go away on their own without medical treatment once the virus has run its course. But while your child is sick, it's important to make sure that he or she has plenty of fluids and rest, and to keep your child from spreading the infection to others.

SIGNS AND SYMPTOMS

While measles is probably best known for the full-body rash that it causes, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and watery red eyes. Another marker of measles are Koplik's spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash typically has a red or reddish brown blotchy appearance, and first usually shows up on the forehead, then spreads downward over the face, neck, and body, then down to the feet.

Measles is highly contagious. When someone with measles sneezes or coughs, he or she can spread virus droplets through the air and infect others. Measles is very rare in the United States. Due to widespread immunizations, the number of U.S. measles cases has steadily declined in the last 50 years. There were thousands of cases of the measles in 1950, but in 2002 there were just 44. Most of the time, the cases occur in settings where there are lots of kids, some of whom haven't gotten vaccinated or whose immunity has diminished since they got the vaccine.

The most important thing you can do to protect your child from measles is to have him or her vaccinated according to the schedule prescribed by your child's doctor.

PREVENTION

Infants are generally protected from measles for 6 to 8 months after birth due to immunity passed on from their mothers. Older kids are usually immunized against measles according to state and school health regulations.