Missy Gough
(847) 240-1734
[email protected]
Karen Klickmann
(847) 240-1735
[email protected]
EMBARGOED UNTIL MARCH 13, 2000
NO SUCH THING AS A SIMPLE RASH: THE SERIOUS SIDE OF RASHES
SAN FRANCISCO (March 13, 2000) - Throughout life, a person may have many skin concerns - from diaper rash in infancy to acne in adolescence and shingles in later years. While most skin problems are easily diagnosed and treated by a dermatologist, some rashes can be dangerous or even deadly. Rocky Mountain spotted fever, acute meningococcal meningitis and toxic shock syndrome are among the diseases characterized by rashes as early diagnostic clues.
Speaking today at the American Academy of Dermatology's 2000 Annual Meeting in San Francisco, dermatologist Lisa A. Drage, MD, assistant professor of medicine in the Department of Dermatology at the Mayo Clinic, Rochester, Minn., discussed rashes that can be a valuable diagnostic clue for patients and their physicians.
Rashes have many visible signs including pimples, lumps, bumps and blisters. Often they are dry, scaly, red and itchy. To the untrained eye, all of these rashes may look alike and seem easily treatable with a topical anti-inflammatory medication like cortisone or cortisone-like cream. However, proper treatment depends on the right diagnosis and the diagnosis may determine an underlying problem much more serious than a simple rash.
"Many people don't understand that skin rashes can be important clues to serious diseases," said Dr. Drage. "Although most rashes are not life-threatening, some must be treated seriously. A dermatologist is trained to tell which rashes require more extensive medical testing and treatment."
Simple itching may be a symptom of a serious underlying disorder of the kidney, liver, thyroid or even Hodgkin's disease. Distinctive skin rashes or lesions can be seen in association with other medical disorders such as diabetes, inflammatory bowel disease, thyroid abnormalities or connective tissue diseases like lupus.
"There is a separate side of dermatology where we take care of people who are in reality seriously ill, but often come to a physician simply with a persistent rash," Dr. Drage noted. "This is where our specialized training really helps patients."
A few rashes indicate infectious diseases that cause significant rates of illness and, on occasion, death. For these rashes, appropriate life-saving treatment can be facilitated by a prompt diagnosis. Many of these diseases have prominent skin signs that can lead to further diagnostic testing. Four of the most serious are Rocky Mountain spotted fever, meningococcal disease (acute meningcoccemia and meningococcal meningitis), staphylococcal toxic shock syndrome and streptococcal toxic shock syndrome.
Rocky Mountain spotted fever is a seasonal disease caused by human-tick contact. While most prevalent in the southeastern and south central United States, cases have been reported in nearly every state. After flu-like symptoms, a rash typically appears on the fourth day on the wrists and ankles, spreading to the palms and soles. Eventually it spreads to the arms, legs and trunk of the individual. If left untreated, it can cause gangrene to develop. Between five percent and 25 percent of patients die from Rocky Mountain spotted fever. Early treatment can prevent death.
Meningococcal disease, one of the most common causes of meningitis, is transmitted through respiratory droplets like sneezes or coughs. Outbreaks occur mostly in crowded settings like college dormitories, military settings and other crowded facilities. Most cases occur in the winter and spring in patients younger than 20 years of age, typically those under age five. Ten percent to 20 percent of these patients die. Skin lesions are common and an important early diagnostic clue to this rapidly progressing illness.
Staphylococcal toxic shock syndrome is caused by an infection or colonization with a bacteria that produces toxins such as toxic shock syndrome toxin 1 and staphylococcal enterotoxins B and C. While this illness was first described in association with tampon use in women, now it is more common for the disease to occur among both sexes as a result of infections after influenza, surgical wound infections, barrier contraceptives, nasal packing due to surgery or injury, or a localized staphylococcal infection. The skin findings associated with staphylococcal toxic shock syndrome are often striking and include a sunburn-like rash followed by a scaly rash, especially on the hands and feet. The death rate has decreased to less than 5 percent from menstrual-related cases, but is 10 percent to 15 percent in other cases.
Streptococcal toxic shock syndrome is caused by an invasive infection with group A streptococcus bacteria publicized as the "flesh eating bacteria." This occurs most often in soft tissue wounds like a burn site, laceration, surgical incision, skin ulcer or childbirth trauma. The skin around the wound site will often have swelling, tenderness, redness or blisters. Thirty percent to 70 percent of patients diagnosed with streptococcal toxic shock syndrome will die. Individuals in the age range of 20 to 50 are most at risk for this illness.
"Many times the first physician to see a patient with a life-threatening rash is not a dermatologist," said Dr. Drage. "It is important that dermatologists work closely with other medical specialties to educate them about the importance of properly diagnosing rashes and the role dermatologists can play in making the appropriate diagnosis."
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of over 13,000 dermatologists worldwide, the Academy is committed to: advancing the science and art of medicine and surgery related to the skin; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care; and promoting a lifetime of healthier skin, hair and nails.
For more information, contact the AAD at
1-888-462-DERM or http://www.aad.org.
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