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Thursday, September 14, 2017

The Rashes of Summer-Part 2

Written by  Dr. Eva Hersh, MD

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 column – the second of two – covers scabies, Lyme disease rash, and impetigo.

5) Scabies is a severe, persistent itch that seems way out of proportion to the usually mild appearance of the rash. The itch is so severe that people scratch deep grooves through their skin. This rash is also called “the seven-year itch.” Scabies is caused by infestation of the skin by the human itch mite, Sarcoptes scabiei. The mite is passed by skin contact between people – even a handshake can lead to transmission. It may take six weeks after acquiring the mite before the itch begins.

The initial symptoms of scabies are small red, raised bumps that are intensely itchy. There may be tiny blisters. A magnifying glass may show short, wavy lines of red skin, which are the burrows made by the mites.

Treatment is with any of several scabicide medications – a prescription lotion applied to the skin or by taking prescription pills; both methods are effective. Scabies often occurs on the wrists, in between fingers, in the armpits, around the waist, and in the genital area. The second picture, above, shows is scabies in between the fingers. Scabies is one of the few rashes that can be found between the fingers.

6) Lyme disease has been found in every state, but it is by far most common in the Northeast and Mid-Atlantic regions. It is feared because long-term infection can cause permanent damage to the joints, heart, and spinal nerves. Most cases occur in the late spring and summer. Lyme is caused by a bacteria, Borrelia bergdorferi, which is carried by a small tick called the black legged tick or deer tick. This tiny tick (the size of a poppy seed) is found in shrubs and tall grasses, especially in woods and cleared areas next to woods. The tick does not attach to the person until 24 hours after it lands on the skin. The bacteria is not transmitted until the tick has been attached to a person for a blood meal for at least 24 hours. (The tick likes a leisurely meal!) If a tick is removed within 24 hours of the time it attaches (48 hours after it arrives) infection is much less likely. Since the tick does not attach until 24 hours after arriving, a thorough shower after your hike or outside work can do a lot to remove any ticks that have come home with you. In addition to showering and removing all ticks as soon as you find them, check yourself again for ticks, completely unclothed and with a mirror or a friend to view areas you can’t see, about 24 hours after you leave a potentially tick infested area. If you do find a tick, remove it gently with tweezers by pulling it away from your body and slightly upward. If the head remains in your skin, do not try to remove it. It will not harm you and will come out by itself.

About 80% of people who are infected develop a red oval rash (see photos). The rash usually appears seven to 14 days after the tick bite. The rash can be on any part of the body. Sometimes there are two or more separate rashes. The rash is not itchy or painful. If the rash has the target pattern (first photo), it is almost certainly a sign of Lyme, and the person should be treated with oral antibiotics. Anyone who gets a new rash after removing a tick should be seen by a medical professional.

If a tick has been removed and no rash appears, monitor for fever, muscle aches and headaches, and contact a health care provider if any of these occur.

Avoiding tick bites: Wear long pants and long sleeves if you expect to be in a wooded area. Tuck your pants into your shoes: ticks often attach to ankles. Use a DEET-based insect repellent applied to any exposed skin, and spray DEET spray on your clothes. Consider postponing hikes in the woods until the fall.

There is now a Lyme disease vaccine for dogs. We can hope there will soon be one for people.

7) Impetigo is a very contagious bacterial skin infection that is common in children but also can occur at any age. Impetigo develops when bacteria that are common, harmless colonizers on the surface of the skin enter deeper layers of the skin through tiny breaks in the surface.

Impetigo starts as small red patches on the face, arms or legs. It often develops around a child’s nose and mouth, or on the arms and legs in areas where insect bites have been scratched. The red areas become fragile blisters, which quickly burst and drain fluid. This dries to form honey-colored crusts. In most cases, impetigo will get better in a few days with gentle washes to remove loose crusts and use of over the counter bacitracin or triple antibiotic ointment. If the rash does not improve, see your health care provider to confirm the diagnosis. Prescription antibiotics or oral antibiotics help to clear up impetigo and prevent if from spreading to others.

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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