Friday, September 01, 2017

The Rashes of Summer

Written by  Dr. Eva Hersh, MD

Part 1 of 2–more colorful rashes next issue!

Because of the warm weather and spending more time outside, people get more skin rashes in summer than any other time of year. Some rashes are easy to recognize; identifying others takes some detective work. Any skin infection that comes with a fever, headache, shortness of breath, or abdominal pain should be evaluated by a medical professional. This series of articles will cover seven summer rashes: heat rash, jock itch, poison ivy, chiggers, scabies, Lyme disease rash, and impetigo.

1) Heat rash – Heat rash (other names are “prickly heat and “miliaria”) is a red or pink rash with small bumps that may look like whiteheads. It appears in warm weather on areas of the body covered by close-fitting clothing, like the back, shoulders, or chest. Heat rash develops because sweat ducts become blocked and swell up, causing discomfort and itching.

Treatment for heat rash is simple. Keep the affected skin cool and dry. If the rash remains tender, apply 1% OTC HC (over-the-counter hydrocortisone cream) in small amounts twice a day. To prevent heat rash, wear loose clothes made of cotton or linen (not synthetics like polyester) to allow better airflow to the skin.

2) Tinea cruris (Latin for “crotch fungus”) is caused by a skin fungus. It can occur at any time of year, especially in athletes, but it is most common during the summer. Tinea cruris looks like a red, brown, or pink to purplish area on the inner thighs. The rash has a clearly seen margin, which may be raised (see photo). It is slightly itchy to very itchy. Once the fungus has become established it grows into the skin. For this reason, even though it is not a dangerous problem, Tinea cruris can take weeks or months to cure. Like all warm weather rashes, Tinea cruris cannot be healed unless the area of the rash is kept cool and dry. Sprinkling an over the counter antifungal powder onto the rash twice a day for four weeks will clear up most cases. Antifungal creams can be applied instead but are not as good as powders for keeping the area dry. Some anti fungal medicines that are effective for Tinea cruris include butenafine (Lotrimin Ultra), miconazole (Desenex, Lotrimin AF, and generic brands), and tolafnate (Tinactin, Lamisil, and generic brands). Fungal infections can be very hard to get rid of. Many people find that they treat the rash and it goes away, but then recurs weeks or months after stopping treatment. In that situation, prescription antifungal pills can be tried.

3) Poison Ivy – Of all the rashes listed in this article series, poison ivy is the easiest to avoid, by avoiding contact with the poison ivy plant. Poison ivy is not found just in the woods – it is a pioneer plant which grows well in parks, yards, and schoolyards. Poison ivy grows as vines, often growing high up into trees, and as low shrubs. It is recognizable by its leaves, which grow in triads, with three leaves growing from each stem (see photos). An oil in the leaves causes the skin reactions. Remember the Girl Scout saying: “Leaves of three, let it be.” Poison ivy leaves take many shapes, so leaf shape is not useful to help identify it. In the late summer and fall, the leaves often become shiny, with an oily sheen, and may turn red. Touching any part of the poison ivy plant can cause red, swollen skin with blisters and severe itching, sometimes within hours after exposure. There is wide variation in sensitivity to poison ivy. Many people develop severe blistering rashes after being exposed to it, but some have no reaction or only a slight reaction. If you may have been in contact with poison ivy, taking a thorough shower with soap can prevent the rash. Skin irritation does not start until several hours after contact, so you may be able to wash off the oil before the rash starts.

Poison ivy rash usually clears up on its own within a few weeks. Cool compresses are helpful. Over the counter hydrocortisone cream is helpful for swollen, painful areas, but not for areas that are draining. Over-the-counter antihistamines – diphenhydramine (the active ingredient in Benadryl) or loratadine (in Claritin) – may relieve itching.

For severe cases such as those involving the face or genitals, prescription steroid pills are helpful. Some people benefit from a short course of a sleeping pill to stop nighttime scratching.

4) Chiggers – Chigger bites look like small insect bites, from flesh-colored to bright red. The bites may increase in size for the first few days. Usually, there are many bites and they are very itchy. Chiggers are tiny insects, a type of mite. They live in tall grass and shrubs. Immature chiggers, called larvae, feed on humans and other animals. Adult chiggers get their nourishment from soil. Chigger larvae inject enzymes into the host’s skin, which cause skin cells to dissolve so that the larvae can drink it. Chiggers often bite areas that have thinner, more delicate skin – like the ankles, behind the knees, the crotch, armpits, or under the belt line. Chiggers do not burrow into the skin, and they do not feed on blood. Also, in North America they do not transmit any infections to humans. (In other parts of the world, chiggers do transmit infections.) Redness and itching start three to six hours after the bite. Itching lasts several days, and the bites may take up to 2 weeks to heal. Cool showers, cold compresses, antihistamines – diphenhydramine (in Benadryl) or loratadine (in Claritin) – and OTC hydrocortisone cream provide relief from itching. Avoiding chiggers: they are most active in early evening and night. Use DEET-based insect repellent on your skin and clothes.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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