Rash is a very broad medical term. It can vary greatly in appearance, and have many potential causes. What can skin rashes indicate? What signs should you look out for if you have a rash? Should you take the rash seriously and what diseases can cause the rash? This is discussed in detail in our article.

Causes of the rash

Contact dermatitis

One of the most common causes of rash is contact dermatitis. It occurs as a reaction to touch. The skin may become red and inflamed, and the rash becomes moist over time. Common triggers are:

• Dyes in clothes
• Cosmetic products
• Poisonous plants such as poison ivy and sumac
• Chemicals such as latex or rubber

Medicines

Medicines can also cause rashes. In addition, some medications, including antibiotics, cause photosensitivity - they make a person more sensitive to sunlight. The photosensitivity reaction looks like a sunburn.

Infections

Infections caused by bacteria, viruses, or fungi can also cause a rash. These rashes vary depending on the type of infection. For example, candidiasis, a common fungal infection, causes an itchy rash that usually appears in the folds of the skin.

If you suspect an infection, it is important to consult a doctor.

Autoimmune conditions

An autoimmune condition occurs when a person's immune system begins to attack healthy tissue. There are many autoimmune diseases, some of which can cause rashes. For example, lupus is a condition that affects a number of body systems, including the skin. When the disease occurs, a butterfly-shaped rash appears on the face.

Let's talk in more detail about what diseases and situations can lead to skin rashes.

Insect bite

Many insects can cause a rash with their bite. Although the reaction may vary between individuals and animals, symptoms often include:

• Redness and rash
• Swelling at or around the bite site

Stikker's disease

Stikker's disease, also known as erythema infectiosum and slapped cheek syndrome, is caused by parvovirus B19. One of the symptoms is a rash, which appears in three stages:

• A patchy red rash on the cheeks with clusters of red papules
• After 4 days, a network of red spots may appear on the arms and torso
• In the third stage, the rash appears only after exposure to sunlight or heat

Impetigo

Impetigo is a highly contagious skin infection that most often affects children. The first sign is usually a red, itchy patch. There are two types of impetigo:

• Nonbullous impetigo- red sores appear around the mouth and nose.
• Bullous impetigo- less common, usually affects children under 2 years of age. Medium to large blisters appear on the torso, arms, and legs.

Scabies

Scabies is a skin disease caused by a microscopic mite. It is highly contagious and spreads easily through personal contact. Symptoms include:

• Severe itching - often worse at night.
• The rash looks like a line. Blisters are sometimes present.
• Sores may appear at the site of the rash.

Eczema

It is one of the most common skin diseases. It often develops during childhood. Symptoms depend on the type of eczema and the person's age, but often include:

• Dry scaly patches on the skin
• Severely itchy rash
• Cracked and rough skin

hay fever

Hay fever or allergic rhinitis is an allergic reaction to pollen. Symptoms may be similar to those of a cold, such as:

• Runny nose
• Watery eyes
• Sneezing

Hay fever can also cause a rash similar to hives. The rash will appear as itchy red spots.

Rheumatic fever

Rheumatic fever is an inflammatory response to a streptococcal infection such as acute pharyngitis. Most often it affects children aged 5-15 years. Symptoms include:

• Small, painless bumps under the skin
• Red skin rash
• Swollen tonsils

Mononucleosis

Caused by a virus. The illness is rarely serious, but symptoms may include:

• Pink, measles-like rash
• Body aches
• High temperature

Ringworm

Ringworm, despite its name, is caused by a fungus. The fungal infection affects the top layer of skin of the body, scalp and nails. Symptoms vary depending on the location of the infection, but may include:

• Itchy, red, ring-shaped rash - sometimes slightly raised
• Small patches of scaly skin
• Hair loss in the affected area

Measles

This is a highly contagious disease caused by the rubeola virus. Symptoms include:

• Reddish-brown rash
• Small grayish-white spots with bluish-white centers in the mouth
• Dry cough

Sepsis

Sepsis, often called blood poisoning, is a medical emergency. Sepsis develops as a result of a massive immune response to infection. Symptoms vary but may include:

• Rash that doesn't go away with pressure
• Fever
• Increased heart rate

Lyme disease

This is a bacterial infection transmitted to humans by the bite of an infected tick. Symptoms include a migratory rash that often appears early in the disease.

The rash begins as a small red area that may feel warm to the touch but is not itchy. Soon the central part loses color, giving the rash an apple-like appearance.

The rash does not necessarily appear at the site of the tick bite.

Toxic shock syndrome

It is a rare disease caused by a bacterial infection. It develops quickly and can be life-threatening. All people with toxic shock syndrome experience a fever and rash with the following characteristics:

• Looks like a sunburn and covers most of the body
• The rash is flat
• Turns white when pressed

Acute HIV infection

In the early stages of HIV, levels of the virus in the blood are very high because the immune system has not yet begun to fight the infection. Early symptoms include a rash with the following:

• Mainly affects the upper body
• Flat or barely raised small red dots
• Doesn't itch

Acrodermatitis

Acrodermatitis, a type of pustular psoriasis, is also known as Gianotti-Crosti syndrome. The disease is associated with viral infections. Symptoms include:

• Itchy purple or red blisters
• Enlarged lymph nodes
• Bloated belly

Hookworm

• A red, itchy, swollen skin rash in one specific area.
• Difficulty breathing.
• Extreme fatigue.

Kawasaki disease

Kawasaki disease is a rare syndrome that affects children. It is characterized by inflammation of the walls of arteries throughout the body. Symptoms include:

• Rash on the legs, arms and torso, between the genitals and anus.
• Rash on the feet and palms, sometimes with peeling skin.
• Swollen, cracked and dry lips.

Syphilis

Syphilis is a bacterial infection that is sexually transmitted. The disease is treatable, but does not go away on its own. Symptoms vary depending on the stage of the disease and include:

• Initially - painless, hard and round syphilitic ulcers (chancres).
• Later, a non-itchy red-brown rash that begins on the torso and spreads throughout the body.
• Oral, anal and genital warts.

Atypical pneumonia

Atypical is less severe than the typical form. Symptoms may include:

• Rash (rare)
• Weakness and fatigue
• Chest pain, especially when breathing deeply

Erysipelas

Erysipelas is a skin infection that affects only the top layers of the skin. The skin becomes:

• Swollen, red and shiny
• Sensitive and warm to the touch
• Red streaks over the affected area

Reye's syndrome

Reye's syndrome is rare and most often occurs in children. It can cause severe damage to the body's organs, especially the brain and liver. Early symptoms include:

• Rash on the palms of the hands and feet.
• Repeated severe vomiting.
• Lethargy, confusion and headaches.

Addisonian crisis

Addisonian crisis, also known as adrenal crisis and acute adrenal insufficiency, is a rare and potentially fatal condition in which the adrenal glands stop working properly. Symptoms include:

• Skin reactions, including rash
• Low blood pressure
• Fever, chills and sweating

Chemical burns

Relatively common, they can occur when a person comes into direct contact with a chemical or its vapor. Symptoms vary but may include:

• Skin that appears black or dead
• Irritation, burning, or redness in the affected area
• Numbness and pain

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis is the most common form of arthritis in children. They used to call him juvenile rheumatoid arthritis. Symptoms vary depending on the subtype, but may include:

• Random rashes
• Scaly psoriasis-like rash
• Fever outbreaks

Histoplasmosis

Histoplasmosis is a fungal infection of the lungs. Sometimes it has no symptoms, but other times it causes symptoms similar to pneumonia:

• Chest pain
• Red bumps on shins

Dermatomyositis

Dermatomyositis is a disease that causes muscle weakness and rash. The rash may be red and blotchy or bluish-purple, and appears in places such as:

• Shoulders and upper back
• Fingers
• Palms
• Around the eyes

Ichthyosis vulgaris

Ichthyosis vulgaris is a hereditary skin disease that often begins in childhood. It is caused by a mutation in the gene that codes for the protein filaggrin. Features include:

• The surface of the skin becomes dry, thick and scaly.
• Dryness is often accompanied by small, white or scaly skin flakes.
• The disease usually affects the elbows, legs, face, scalp and torso.

Pemphigoid

Pemphigoid is a group of rare autoimmune conditions that primarily cause rashes and blistering of the skin. There are three main types:

• Bullous pemphigoid- formation of blisters on the lower torso, groin, armpits, inner thighs, feet and palms.
• Cicatricial pemphigoid- most often affects the mucous membranes.
• Pemphigoid gestation- develops during pregnancy and affects mainly the upper body.

Phenylketonuria

Phenylketonuria is a genetic condition that affects how phenylalanine is broken down by the body. Affects 1 in 10,000 children in the United States. If the condition is not treated, phenylalanine accumulates, causing:

• Skin rashes such as eczema
• Lightening of skin and eyes due to abnormal melanin levels
• Seizures

Porphyria

Porphyria refers to a group of genetic disorders that can affect the nervous system or skin. Symptoms vary but may include:

• Redness and swelling of the skin
• Burning pain
• Changes in skin pigmentation

Heliotrope rash

Heliotrope rash is often the first noticeable symptom of an inflammatory muscle disease called dermatomyositis. In this condition:

• The skin swells
• Red spots appear
• Skin looks dry and irritated

High levels of uric acid in the body

A person may develop a rash when high levels of uric acid in the blood cause crystals to form and accumulate in and around the joint. This can also lead to gout. Symptoms include:

• Patch rash on the surface of the skin
• Redness, tenderness and swelling of the joints
• Prolonged joint pain for several weeks after the reaction

Home Remedies

Rash comes in many forms and develops for many reasons. However, there are some basic measures that can speed up recovery and ease discomfort:

• Use mild, unscented soap. This soap is specially developed for sensitive or children's skin.
• Do not wash or shower with hot water- choose warm.
• Try to let the rash “breathe.” Do not cover the affected area with adhesive tape or bandage.
• Don't rub the rash, pet it if you feel itchy.
• If the rash is dry For example, for eczema, use unscented moisturizers.
• Do not use cosmetics or lotions products that may cause a rash, such as recently purchased products.
• Avoid scratches to reduce the risk of infection.
• Cortisone creams, which can be purchased over the counter, may relieve itching.
• Calamine may relieve chickenpox rashes, or those caused by poison ivy or poison oak.
• If the rash causes mild pain, acetaminophen or ibuprofen may provide relief, but they are not a long-term solution—they will not treat the cause of the rash.

When to see a doctor?

If the rash is accompanied by the following symptoms, it is important to consult a doctor:

• Sore throat
• Joint pain
• Recent animal or insect bite
• Red streaks near the rash
• Sensitive areas near the rash

Although a rash is usually not a cause for concern, Anyone experiencing the following symptoms should go to hospital immediately:

• Rapidly changing skin color
• Difficulty breathing or a feeling of tightness in the throat
• Increasing or severe pain
• High temperature
• Confusion
• Dizziness
• Swelling of the face or limbs
• Dull pain in the neck or head
• Recurrent vomiting or diarrhea

Parents always perceive the appearance of a rash on a child’s skin with alarm, because everyone knows that the condition of the skin reflects the condition of the entire organism. Is a child's rash always a cause for concern? We will tell you in this article how to understand what is happening to a child and how to help him.

Features of children's skin

Children's skin is different from adult skin. Babies are born with very thin skin - the dermis of newborns is approximately two times thinner than the middle skin layer of adults. The outer layer, the epidermis, thickens gradually as the baby grows older.

In the first month of life, the skin may be red or purple. This is due to the fact that the blood vessels in babies are located close to the surface, and there is not enough subcutaneous tissue, which is why the skin may look “transparent”. This is especially noticeable when the newborn is cold - a marbled vascular network appears on the skin.

The skin of babies loses moisture faster, it is more vulnerable to bacteria, viruses, fungi and mechanical stress. It begins to thicken only at 2-3 years and this process lasts up to 7 years. The skin of younger schoolchildren is already beginning to resemble the skin of adults in its characteristics and functionality. But after 10 years, children's skin faces a new test - this time, puberty.

It is not surprising that thin children’s skin reacts to any external influence or internal processes with rashes of various sizes, colors and structures. And not every childhood rash can be considered harmless.

It is important to understand that there is no causeless rash in children; any pimple or change in pigmentation has a reason, sometimes pathological.

What is a rash?

In medicine, a rash is considered to be a variety of rashes on the skin that in one way or another change the appearance of the skin in color or texture. For parents, all rashes are approximately the same, but doctors always distinguish primary rashes, which formed first, and secondary ones, those that formed later, in place of the primary ones or nearby.

Different childhood diseases are characterized by different combinations of primary and secondary elements.

This is not a complete list of diseases that occur with the formation of a rash.

Most ailments, as can be seen from the table, require mandatory medical consultation; some, for example, meningococcal infection and scarlet fever, require emergency medical care.

If a rash appears in a child that does not resemble acne or prickly heat, you should definitely show your child to a pediatrician or dermatologist to rule out dangerous and serious infectious diseases, pathologies of internal organs that affect metabolism and digestion.

It is important to remember that many infections that appear on the skin can be very contagious. Therefore, you should not take your child to the clinic at your place of residence, so as not to infect others in the general queue. It is best to call a pediatrician at home.

If possible, you can take the child to a specialized infectious diseases hospital, where it is possible to quickly undergo the necessary examination and confirm or refute the infection.

Treatment

Treatment of a rash does not always require only local action; most often it is a whole range of measures aimed at changing the child’s living conditions, revising his diet, and taking medications.

The rash should be treated only after the true cause of its occurrence is known, because incorrect treatment can only worsen the child’s condition. Depending on the true nature of the skin rash, different treatments will be prescribed.

Infectious viral

The rash that accompanies most “childhood” diseases (chickenpox, measles, scarlet fever, etc.) does not require treatment. No medications or folk remedies can affect its duration.

The rash goes away when the immune system produces a sufficient amount of antibodies and completely deals with the virus that has entered the body.

Depending on the severity of the disease itself, the doctor prescribes immunomodulatory drugs, antiviral drugs, vitamins, and antipyretic drugs.

A child with a viral infection is advised to drink plenty of warm fluids.

For the most part, antiviral drugs sold in pharmacies have no effect; they have no proven effectiveness. Many popular homeopathic remedies are also essentially a “dummy” placebo effect.

But nothing else is required from these medications, because viral infections go away on their own, with or without pills. The drugs are prescribed so that parents have something to do while on sick leave and so that the doctor is not accused of inattention.

Typically, treatment of a viral infection takes from 5 to 10 days, after the rash disappears there are no traces left. An exception is chickenpox, in which damaged vesicles can leave quite deep, life-long pits in the skin.

A rash caused by herpes viruses (on the face, on the lower back, on the genitals) is much less itchy and painful if you use Acyclovir cream.

Infectious bacterial

A pustular rash caused by pathogenic bacteria is treated with antibiotics and antiseptics. Moreover, antibiotics are selected after a culture test, when the doctor has clear information about which bacteria caused the suppuration and to which antibacterial agents they demonstrate sensitivity.

Usually children are prescribed penicillins, less often cephalosporins. For mild infections, local treatment with ointments that have an antimicrobial effect is sufficient - Levomekol, Baneocin, erythromycin ointment, gentamicin ointment, tetracycline ointment.

In some cases, for widespread and severe infection or an infection that risks spreading to internal organs, it is prescribed antibiotics orally - for children in the form of a suspension, for preschoolers and adolescents - in tablets or injections.

Preference is given to broad-spectrum drugs, usually of the penicillin group - “Amoxiclav”, “Amosin”, “Amoxicillin”, “Flemoxin Solutab”. If drugs in this group are ineffective, cephalosporin antibiotics or macrolides may be prescribed.

As antiseptics Well-known aniline dyes are often used - a solution of brilliant green (brilliant green) for staphylococcal infections or "Fukortsin" for streptococcus. Damaged skin is treated with salicylic alcohol.

Along with antibiotics, if they are prescribed orally, the child is recommended to take drugs that will help avoid the occurrence of dysbacteriosis - “Bifiborm”, “Bifidumbacterin”. It is also useful to start taking vitamin complexes appropriate for the child’s age.

Some purulent rashes, such as boils and carbuncles, may require surgical intervention, during which the formation is incised crosswise under local anesthesia, the cavity is cleaned out and treated with antiseptics and antibiotics. There is no need to be afraid of such a mini-operation.

The consequences of refusing it can be very dire, because staphylococcal infection can lead to sepsis and death.

Heat rash and diaper rash

If a baby develops prickly heat, this is a signal for parents to change the conditions in which the child lives. The temperature should be at 20-21 degrees Celsius. The heat only makes the prickly heat worse. Irritation from sweat, although it gives the child a lot of excruciating sensations and pain, can be treated fairly quickly.

The main cure for this is cleanliness and fresh air. The child should be washed with warm water without soap or other detergents. Several times a day you need to give your baby naked air baths. You should not wrap your child up, but if he does get sweaty, for example, while walking outside in a warm overall in winter, then immediately upon returning home, bathe the child in the shower and change into clean and dry clothes.

For severe diaper rash, damaged skin is treated 2-3 times a day. Most carefully and thoroughly - after daily evening bathing. After it, Bepanten, Desitin, and Sudocrem are applied to still damp skin with signs of prickly heat. Use the powder with great care, since talc dries out the skin very much.

Baby cream or any other greasy creams or ointments should not be applied to the skin of a child with heat rash, as they moisturize and do not dry out. You should also avoid getting massage oil on diaper rash during evening restorative procedures.

Allergic

If the rash is allergic, treatment will involve finding and eliminating the child's interaction with the allergenic substance that caused the skin rash. To do this, the allegologist performs a series of special tests using test strips with allergens. If it is possible to find the protein that caused the rash, the doctor gives recommendations on eliminating everything that contains such a substance.

If the antigen protein cannot be found (and this happens often), then parents will have to try and exclude from the child’s life everything that poses a potential threat - pollen, food (nuts, whole milk, chicken eggs, red berries and fruits, some types of fresh herbs and even some types of fish, plenty of sweets).

You will have to be especially careful when using baby skin care products.

Usually, eliminating the allergen is more than enough for the allergy to stop and the rash to disappear without a trace. If this does not happen, or in case of severe allergies, the doctor prescribes antihistamines (“Tavegil”, “Cetrin”, “Suprastin”, “Loratadine” and others).

It is advisable to take them simultaneously calcium supplements and vitamins. Locally, if necessary, the child is given hormonal ointments - Advantan, for example. Severe forms of allergies, in which, in addition to a skin rash, there are pronounced respiratory manifestations, as well as internal pathologies, the child is treated as an inpatient.

This is the sudden appearance of various changes on the skin and mucous membranes, differing from normal skin in color and appearance and often accompanied by redness and itching.

The appearance of a rash may be a local reaction of the skin to some external irritant, or it may be one of the symptoms of a general human disease. There are several dozen skin, infectious and other diseases in which a rash always occurs, and several hundred in which it can also appear.

Causes of the rash.

There are several groups of diseases in which a rash may appear on the skin or mucous membranes.

· Allergic diseases.

· Diseases of the blood and blood vessels.

The most common cause of rash is infectious diseases (measles, rubella, chickenpox, scarlet fever, herpes, infectious mononucleosis, erythema infectiosum, etc.). In addition to the rash, other signs are necessarily present: contact with an infectious patient, acute onset, increased body temperature, loss of appetite, chills, pain (throat, head, stomach), runny nose, cough, or diarrhea.

2. Pustule - an element filled with purulent contents. The formation of pustules manifests itself in folliculitis, furunculosis, impetigo, pyoderma, and various types of acne.

4. The blister usually occurs as a result of an allergic reaction and goes away on its own within a few minutes or hours after it appears. It is observed with insect bites, nettle burns, urticaria, toxicoderma.

5. Spots are characterized by a change in color (redness or discoloration) of individual areas of the skin and are observed in syphilitic roseola, dermatitis, toxicoderma, leucoderma, vitiligo, typhoid and typhus. Moles, freckles and tans are pigmented spots.

6. Erythema - a slightly raised, sharply limited area of ​​bright red skin. It often occurs in people with hypersensitivity to foods (strawberries, wild strawberries, eggs, etc.), medications (nicotinic acid, antibiotics, antipyrine, quinidine, etc.), after ultraviolet irradiation, and with erysipelas. In cases of infectious diseases and rheumatism, multiple exudative erythema, as well as erythema nodosum, occur.

7. Purpura - skin hemorrhages of various sizes (from small, pinpoint to large bruises). It is observed in hemophilia (blood clotting disorder), Werlhof's disease (impaired bleeding duration), capillary toxicosis (impaired capillary permeability), leukemia (blood disease), and scurvy (vitamin C deficiency).

· If a rash appears after taking any medications, you should immediately consult an allergist.

· If the appearance of a rash is combined with fever and malaise, you need to consult an infectious disease specialist.

· Consult a dermatologist if the rash is accompanied by a burning, tingling, bleeding, or blistering sensation.

· If you suddenly develop a severe headache, drowsiness, or small black or purple spots on a large area of ​​skin, call an ambulance immediately.

· If a ring-shaped rash spreads from one central red spot, some time after the tick bite (even several months), consult an infectious disease doctor immediately.

· If the same rash appears in several other members of your family, immediately contact an infectious disease doctor.

· If red rashes appear, with sharp outlines resembling a butterfly in shape, protruding above the surface of the skin, located on the cheeks and above the bridge of the nose, consultation with a rheumatologist is necessary.

If a form of rash appears that poses significant difficulties for diagnosis, be prepared for a lengthy examination by a dermatologist.

Home remedies to reduce rashes.

To reduce the appearance of the rash and soothe the itching, you can try the following:

· If there are no signs of infection, you can apply 1% hydrocortisone cream to the areas of the skin rash; Call your doctor if there is no improvement after five or six days;

· Wear smooth, natural cotton clothing to avoid irritation;

· use baby soap or shower gel for washing;

· exclude substances that irritate the skin or may cause an allergic reaction - jewelry, perfumes, cosmetics, washing powders, deodorants.

Causes of the disease

The assessment of the skin process includes determining the nature of the rash, prevalence, localization, order of rashes, whether the rash is acute or long-term; based on the data obtained, differential diagnosis is carried out taking into account medical history (patient's illnesses before the rash, contact with infectious patients, predisposition to allergic diseases, intake medications). In order to understand the huge variety of types of rashes, you must first know their possible causes. First of all, you need to decide whether the rash is infectious (i.e. a rash that occurs as a result of an infectious disease - measles, rubella, chickenpox) or non-infectious (for allergic diseases, diseases of connective tissue, blood, blood vessels, skin). So:

І Rash due to infectious diseases

- “childhood infections” in adults: measles, rubella, chicken pox, scarlet fever

- infectious diseases (meningococcemia, herpes, herpes zoster, typhoid fever, typhus, herpes infection, infectious mononucleosis, erythema infectiosum, sudden exanthema)

ІІ Non-infectious rashes

Allergic rashes

For diseases of connective tissue, blood, blood vessels (scleroderma, systemic lupus erythematosus, thrombocytopenic purpura)

ІІІ Diseases that primarily affect the skin or are limited in manifestation only to the skin.

We have highlighted them separately. They, in turn, can also be infectious and non-infectious. The skin of different parts of the body has its own anatomical, physiological and biochemical characteristics. Therefore, many diseases are characterized by strictly defined localization of rashes (for example, on the face, in the perineum, on the ears, soles). Some in the form of spots, papules, plaques, others in the form of crusts, scales, lechenifications. The list of skin diseases is huge (cutaneous lupus erythematosus, seborrheic dermatitis, acne vulgaris, neurodermatitis (limited, diffuse), nevi (pigmented, sebaceous glands, intradermal, non-cellular, flaming, Otha, blue, Becker), psoriasis, solar keratosis, senile keratoma, malignant neoplasms (squamous and basal cell skin cancer), metastases, dermatophytosis, discoid lupus erythematosus, acute, subacute, chronic pruritic dermatitis, pyoderma, lichen (shingles, pityriasis versicolor, red, Gilbert, white, pink), pemphigus, staphylococcal folliculitis, generalized amyloidosis , molluscum contagiosum, xanthelasma, soft fibroma, perioral dermatitis, Kaposi's sarcoma, syringoma, dermatitis, dermatoses, warts, sarcoidosis, impetigo, syphilis, toxicerma, lentigo (malignant, senile), melanoma, Peutz-Jeghers syndrome, , angiofibroma, dermatomyositis, hereditary hemorrhagic telangiectasia, erysipelas, rosacea, telangiectatic granuloma, eosinophilic folliculitis, erythropoietic protoporphyria, tricholemmoma (Cowden's disease), telangiectatic granuloma, herpes, pathomimia, Lyme disease (borreliosis), lymphoma, McCune-Aul syndrome Bright, leprosy, tuberous sclerosis, insect bites, mycoses, pemphigoid, scabies, diaper rash (red), ichthyosis, etc.)

Mechanisms of occurrence and development diseases(pathogenesis)

The infectious nature of the rash is confirmed by a number of signs characterizing the infectious process:

general intoxication syndrome (fever, weakness, malaise, headache, sometimes vomiting, etc.);

symptoms characteristic of this disease (occipital lymphadenitis with rubella, Filatov-Koplik spots with measles, limited hyperemia of the pharynx with scarlet fever, polymorphism of clinical symptoms with yersiniosis, etc.);

An infectious disease is characterized by a cyclical course of the disease, the presence of cases of the disease in the family, the team, and in people who were in contact with the patient and do not have antibodies to this infectious disease. However, the rash can be of the same nature with different pathologies.

A rash, as a manifestation of an allergy, is not at all uncommon. Thoughts about the allergic nature of the disease and rash arise, as a rule, when there are no signs of infection and there has been contact with something (someone) that could be the source of the allergy - food (citrus fruits, chocolate), medications, inhalation allergens (pollen, paints, solvents, poplar fluff), pets (cats, dogs, rugs)

A rash, in diseases of the blood and blood vessels, occurs for two main reasons: a decrease in the number or dysfunction of platelets (often congenital), impaired vascular permeability. The rash in these diseases takes the form of large or small hemorrhages, its appearance is provoked by injuries or other diseases - for example, an increase in temperature during a common cold.

The morphological elements of skin rashes are the various types of rashes that appear on the skin and mucous membranes. All of them are divided into 2 large groups: primary morphological elements, which appear first on previously unchanged skin, and secondary ones, which appear as a result of the evolution of primary elements on their surface or appear after their disappearance. In diagnostic terms, the most important are the primary morphological elements, by the nature of which (color, shape, size, outline, surface character, etc.) it is possible in a significant number of cases to determine the nosology of dermatosis, and therefore great importance is attached to the identification and description of the primary elements of the rash in the local medical history status.

Primary morphological elements of skin rashes. The subgroup of primary morphological elements includes a vesicle, bubble, abscess, blister, spot, nodule, tubercle, node.

Bubble - a primary cavity morphological element, the dimensions of which are up to 0.5 cm in diameter, having a bottom, a tire and a cavity filled with serous or serous-hemorrhagic contents. The bubbles are located in the epidermis (intraepidermal) or under it (subepidermal). They can occur against a background of unchanged skin (with dyshidrosis) or against an erythematous background (herpes). When the vesicles open, multiple weeping erosions are formed, which subsequently epithelialize without leaving permanent changes in the skin. There are single-chamber vesicles (for eczema) or multi-chamber (for herpes).

Bubble - primary cavitary morphological element, consisting of a bottom, a tire and a cavity containing serous or hemorrhagic exudate. The tire can be tense or flabby, dense or thin. It differs from a bubble in its large size - from 0.5 cm to several centimeters in diameter. The elements can be located both on unchanged skin and on inflamed skin. The blisters can form as a result of acantholysis and be located intraepidermally (with acantholytic pemphigus) or as a result of swelling of the skin, leading to detachment of the epidermis from the dermis, and be located subepidermally (simple contact dermatitis). In place of the opened blisters, erosive surfaces are formed, which subsequently epithelialize without leaving scars.

Pustule - primary cavity morphological element filled with purulent contents. Based on their location in the skin, they distinguish between superficial and deep, follicular (usually staphylococcal) and non-follicular (usually streptococcal) pustules. Superficial follicular pustules form at the mouth of the follicle or cover up to 2/3 of its length, i.e., they are located in the epidermis or papillary layer of the dermis. They have a cone-shaped shape, often permeated with hair in the central part, where the yellowish purulent contents are visible, their diameter is 1-5 mm. When the pustule regresses, the purulent contents may shrink into a yellowish-brown crust, which then disappears. In place of the follicular superficial pustules, there are no permanent skin changes; only temporary hypo- or hyperpigmentation is possible. Superficial follicular pustules are observed with ostiofolliculitis, folliculitis, and ordinary sycosis. During their formation, deep follicular pustules involve the entire hair follicle and are located within the entire dermis (deep folliculitis), often also involving the hypodermis - furuncle, carbuncle. In this case, with a boil, a necrotic rod is formed in the central part of the pustule and after its healing, a scar remains; with a carbuncle, several necrotic rods are formed. Superficial non-follicular pustules - phlyctenes - have a tire, a bottom and a cavity with cloudy contents, surrounded by a rim of hyperemia. They are located in the epidermis and outwardly look like bubbles with precise contents. Observed with impetigo. When the pustule regresses, the exudate shrinks into crusts, after rejection of which temporary de- or hyperpigmentation remains. Deep non-follicular pustules - ecthymas - form ulcers with a purulent bottom, observed in chronic ulcerative pyoderma, etc. Scars remain in their place. Pustules can also form around the excretory ducts of the sebaceous glands (for example, with acne vulgaris) and, since the duct of the sebaceous gland opens at the mouth of the hair follicle, are also follicular in nature. Deep pustules formed around the excretory ducts of the apocrine sweat glands during hidradenitis form deep abscesses that open through the fistulous tracts and leave behind scars.

Blister - a primary non-banded morphological element that arises as a result of limited acute inflammatory edema of the papillary dermis and is characterized by ephemerality (exists from several minutes to several hours). Disappears without a trace. It usually occurs as an immediate, less often delayed, allergic reaction to endogenous or exogenous irritants. It is observed with insect bites, urticaria, toxicoderma. Clinically, the blister is a dense, raised element of round or irregular outline, pink in color, sometimes with a whitish tint in the center, accompanied by itching and burning.

Spot characterized by a local change in the color of the skin, without changes in its relief and consistency. Spots can be vascular, pigmented or artificial. Vascular spots are divided into inflammatory and non-inflammatory. Inflammatory spots are pink-red, sometimes with a bluish tint, and when pressed they turn pale or disappear, and when the pressure is removed they restore their color. Depending on the size, they are divided into roseola (up to 1 cm in diameter) and erythema (from 1 to 5 cm or more in diameter). An example of a roseola rash is syphilitic roseola, an erythematous rash is manifestations of dermatitis, toxidermia, etc. Non-inflammatory spots are caused by dilation of blood vessels or impaired permeability of their walls, and do not change color when pressed. In particular, under the influence of emotional factors (anger, fear, shame), redness of the skin of the face, neck and upper chest is often observed, which is called erythema of modesty. This redness is caused by short-term dilation of blood vessels. Persistent dilation of blood vessels in the form of red spider veins (telangiectasia) or bluish tree-like branching veins (livedo) occurs in diffuse connective tissue diseases, etc. When the permeability of the vascular walls is impaired, hemorrhagic non-inflammatory spots are formed due to the deposition of hemosiderin, which do not disappear with pressure and change color from red to brownish-yellow (“bruise bloom”). Depending on their size and shape, they are divided into petechiae (point hemorrhages), purpura (up to 1 cm in diameter), vibice (stripe-like, linear), ecchymosis (large, irregular shape). Hemorrhagic spots occur in allergic angiitis of the skin, toxidermia, etc. Pigment spots appear mainly when the content of melanin pigment in the skin changes: when there is an excess of it, hyperpigmented spots are observed, and when there is a deficiency, hypo- or depigmented spots. These elements may be congenital or acquired. Congenital hyperpigmented spots are represented by birthmarks (nevi). Acquired hyperpigmented spots are freckles, chloasma, tanning, depigmented spots are leucoderma, vitiligo. Albinism is manifested by congenital generalized depigmentation.

Nodule - a primary cavity-free morphological element, characterized by a change in skin color, its relief, consistency and, as a rule, resolves without leaving a trace. Based on the depth of occurrence, epidermal nodules located within the epidermis (flat warts) are distinguished; dermal, localized in the papillary layer of the dermis (papular syphilides), and epidermodermal (papules in psoriasis, lichen planus, atopic dermatitis). Nodules can be inflammatory or non-inflammatory. The latter are formed as a result of the growth of the epidermis such as acanthosis (warts), the dermis such as papillomatosis (papillomas) or the deposition of metabolic products in the skin (xanthoma). Inflammatory papules are much more common: with psoriasis, secondary syphilis, lichen planus, eczema, etc. In this case, acanthosis, granulosis, hyperkeratosis, parakeratosis can be observed on the epidermis, and a cellular infiltrate is deposited in the papillary layer of the dermis. Depending on the size, the nodules are miliary or millet-shaped (1-3 mm in diameter), lenticular or lenticular (0.5-0.7 cm in diameter) and numular or coin-shaped (1-3 cm in diameter). In a number of dermatoses, peripheral growth of papules occurs and their fusion and formation of larger elements - plaques (for example, in psoriasis). Papules can be round, oval, polygonal (polycyclic) in outline, flat, hemispherical, conical (with a pointed apex) in shape, dense, densely elastic, doughy, soft in consistency. Sometimes a bubble forms on the surface of the nodule. Such elements are called papulovesicles, or seropapules (in prurigo).

Tubercle - a primary cavityless infiltrative morphological element located deep in the dermis. Characterized by small sizes (from 0.5 to 1 cm in diameter), changes in skin color, its relief and consistency; leaves behind a scar or cicatricial atrophy. It is formed mainly in the reticular layer of the dermis due to the formation of an infectious granuloma. Clinically, it is quite similar to papules. The main difference is that the bumps tend to ulcerate and leave behind scars. It is possible to resolve the tubercle without the stage of ulceration with transition to cicatricial atrophy of the skin. The tubercles are observed in leprosy, skin tuberculosis, leishmaniasis, tertiary syphilis, etc.

Knot - a primary bandless infiltrative morphological element, lying deep in the dermis and hypodermis and having large dimensions (from 2 to 10 cm or more in diameter). As the pathological process develops, as a rule, ulceration of the node occurs, followed by scarring. There are inflammatory nodes, for example syphilitic gummas, and non-inflammatory ones, formed as a result of deposition of metabolic products in the skin (xanthoma, etc.) or malignant proliferative processes (lymphoma).

If there is one type of primary morphological element of skin rashes (for example, only papules or only blisters), they speak of the monomorphic nature of the rash. In the case of the simultaneous existence of two or more primary elements (for example, papules, vesicles, erythema), the rash is called polymorphic (for example, with eczema).

In contrast to the true one, false (evolutionary) polymorphism of the rash, caused by the emergence of various secondary morphological elements, is also distinguished.

Secondary morphological elements of skin rashes.

Secondary morphological elements include secondary hypo- and hyperpigmentation, cracks, excoriation, erosion, ulcers, scales, crusts, scars, lichenification, vegetation.

Hypo- and hyperpigmentation may be a secondary morphological element if it appears in place of resolved primary elements (papules, pustules, etc.). For example, in the place of former papules in psoriasis, areas of depigmentation often remain that exactly correspond to the former primary elements, called pseudoleukoderma, and when lichen planus papules regress, hyperpigmentation usually remains, which persists for several weeks and even months.

Crack - a secondary morphological element, which represents a linear violation of the integrity of the skin as a result of a decrease in skin elasticity. Cracks are divided into superficial (located within the epidermis, epithelialized and regress without a trace, for example, with eczema, neurodermatitis, etc.) and deep (localized within the epidermis and dermis, often bleed with the formation of hemorrhagic crusts, regress with the formation of a scar, for example, with congenital syphilis).

Excoriation - manifested by a violation of the integrity of the skin as a result of mechanical damage due to injuries and scratching. An abrasion can sometimes appear primarily (due to injury). Depending on the depth of damage to the skin, excoriations can regress without leaving a trace or with the formation of hypo- or hyperpigmentation.

Erosion occurs when the primary cavity morphological elements are opened and represents a violation of the integrity of the skin or mucous membrane within the epidermis (epithelium). Erosions appear at the sites of vesicles, blisters or superficial pustules and have the same outlines and sizes as the primary elements. Sometimes erosions can also form on papular rashes, especially when they are localized on the mucous membranes (erosive papular syphilides, erosive-ulcerative lichen planus). Regression of erosions occurs through epithelization and ends without a trace.

Ulcer - represents a violation of the integrity of the skin within the connective tissue layer of the dermis, and sometimes even the underlying tissues. Occurs when tubercles, nodes or deep pustules open. An ulcer has a bottom and edges that can be soft (tuberculosis) or hard (skin cancer). The bottom can be smooth (chancroid) or uneven (chronic ulcerative pyoderma), covered with a variety of discharge and granulations. The edges are undermined, vertical, saucer-shaped. After ulcers heal, scars always remain.

Flake - represents detached horny plates that form peeling. Physiological peeling occurs constantly and is usually unnoticeable. In pathological processes (hyperkeratosis, parakeratosis), peeling becomes much more pronounced. Depending on the size of the scales, peeling can be pityriasis-like (the scales are small, delicate, as if they powder the skin), lamellar (the scales are larger) and large-lamellar (the stratum corneum is torn off in layers). Pityriasis-like peeling is observed with pityriasis versicolor, rubrophytosis, lamellar - with psoriasis, large-lamellar - with erythroderma. The scales are loosely arranged, easily removed (with psoriasis) or tightly seated and removed with great difficulty (with lupus erythematosus). Silvery-white scales are characteristic of psoriasis, yellowish - for seborrhea, dark - for some types of ichthyosis. In some cases, impregnation of the scales with exudate and the formation of scaly crusts are observed (with exudative psoriasis).

Crust - occurs when the contents of vesicles, blisters, and pustules dry out. Depending on the type of exudate, crusts can be serous, hemorrhagic, purulent or mixed. The shape of the crusts is often irregular, although it corresponds to the contours of the primary rash. Massive, multi-layered, conical, purulent-hemorrhagic crusts are called Rs.

Scar - occurs during the healing of ulcers, tubercles, nodes, deep pustules. It is a newly formed coarse fibrous connective tissue (collagen fibers). Scars can be superficial or deep, atrophic or hypertrophic. Within their boundaries there are no skin appendages (stripes, sweat and sebaceous glands), the epidermis is smooth, shiny, sometimes has the appearance of tissue paper. The color of fresh scars is red, then pigmented, and eventually white. In place of lesions that do not ulcerate, but resolve “dryly”, the formation of cicatricial atrophy is possible: the skin is thinned, lacks a normal pattern, and often sinks in comparison with the surrounding unchanged areas. Similar changes are observed in lupus erythematosus and scleroderma.

Lichenification (syn. lichenization) - characterized by thickening, hardening of the skin due to papular infiltration, and increased skin pattern. The skin within the foci of lichenification resembles shagreen. Such changes often form with persistent itchy dermatoses, manifested by papular efflorescence (atopic dermatitis, neurodermatitis, chronic eczema).

Vegetation - characterized by the growth of the papillary layer of the dermis, has a villous appearance, reminiscent of cauliflower or cockscombs. Vegetations often occur at the bottom of erosive and ulcerative defects (wet vegetations) with pemphigus vegetans, on the surface of primary papular rashes (dry vegetations) with genital warts.

Clinical picture diseases(symptoms and syndromes)

The rash can be a manifestation of both acute (measles, scarlet fever, chickenpox, etc.) and chronic (syphilis, tuberculosis, etc.) infectious diseases. Thus, with some infectious diseases (measles, chicken pox, scarlet fever) rashes always appear, with others (rubella, typhoid-paratyphoid diseases) they occur frequently (50-70%), with others (infectious mononucleosis, leptospirosis, viral hepatitis) they are rarely observed . An essential component of the characteristics of a rash is the presence or absence of fresh lesions, itching or other subjective sensations in the areas of the rash. It is necessary to take into account the duration and evolution of the rash: with typhoid fever and paratyphoid fever, unlike other diseases, roseola persists for 2-4 days and then disappears without a trace. Vesicles on the mucous membranes of the mouth, lips, and genitals are observed with chickenpox, herpes simplex and herpes zoster, and foot-and-mouth disease; on the tonsils, mucous membrane of the posterior wall of the pharynx, uvula, anterior arches - with enterovirus infection (herpangina). In cases of some childhood infectious diseases, the rash is so characteristic that it makes it possible to accurately determine the cause of the disease only on the basis of the patient’s appearance. In other cases, the nature of the rash is less specific, which makes it necessary to use additional diagnostic methods to determine the cause of the disease. On the other hand, in adults the picture of “childhood” infections may be “atypical”».

Chickenpox (chickenpox) is an acute viral disease caused by the herpes zoster virus (human herpes virus type 3). Chickenpox is the acute phase of the initial penetration of the virus into the body, and herpes zoster (shingles) is the result of reactivation of the virus. Chickenpox is highly contagious. The disease is transmitted by airborne droplets. The patient begins to be contagious 48 hours before the first rash appears, and contagiousness persists until the last rash covers with scabs (crusts). However, the most contagious are patients in the initial (prodromal) period of the disease and at the time of the appearance of rashes. Chickenpox epidemics usually occur in winter and early spring. In adults who did not have chickenpox in childhood, and in children with weak immune systems, the infection can be severe. Approximately 10-15 days after contact with the source of infection, 24-36 hours before the rash appears, a headache appears, a low temperature and general malaise are observed. Against the background of general malaise, 1-2 days after the onset of the disease, rashes appear on the skin and mucous membranes. Primary rashes, in the form of spots, may be accompanied by short-term redness of the skin. Over the course of several hours, the spots develop into papules (nodules) and then into characteristic vesicles (bubbles) with a red base, filled with clear liquid, which usually cause severe itching. The rash first appears on the face and torso. The rash can cover large areas of skin (in more severe cases) or limited areas, but almost always affects the upper torso. Ulcers may appear on the mucous membranes, including the oropharynx and upper respiratory tract, the mucous membrane of the eyes, genitals, and rectum. In the mouth, the blisters burst immediately and are no different from the blisters with herpetic stomatitis. These ulcers cause pain when swallowing. By about the 5th day of illness, the appearance of new rashes stops, and by the 6th day of chickenpox, most of the rashes are already covered with crusts. Most of the crusts fall off before the 20th day from the onset of the disease. The contents of the vesicles may undergo bacterial infection (usually streptococcal or staphylococcal), which results in pyoderma (rarely, streptococcal toxic shock). In adults, newborns, and immunocompromised patients, chickenpox can be complicated by pneumonia. Complications such as myocarditis, transient arthritis or hepatitis, and internal bleeding also occur. Very rarely, usually towards the end of the illness or within 2 weeks after recovery, encephalopathy may develop. Chickenpox is suspected in patients with a characteristic rash and course of the disease. Chickenpox rashes may be confused with rashes caused by other viral diseases. If the diagnosis of chickenpox is doubtful, laboratory tests can be performed to establish the virus. The analysis is taken by scraping the affected areas of the skin. Severe or even fatal forms of the disease occur in adults, in immunocompromised patients, and in patients being treated with chemotherapy or corticosteroids. Once contracted, the disease usually leaves lifelong immunity. However, in an adult, reactivation of the virus and development of herpes zoster is possible. All healthy children and susceptible adults, especially women of childbearing age and those with chronic diseases, should be vaccinated. The chickenpox vaccination contains live, weakened viruses and rarely leads to the development of the disease, which is mild - no more than 10 papules or blisters and mild general symptoms of malaise.

Measles is a contagious viral disease, the main symptoms of which are fever (increased temperature), cough, conjunctivitis, and a characteristic rash. Measles most often occurs in children, but adults who did not have measles in childhood can also get it. Measles is so contagious that even minor contact between a susceptible person and a sick person can lead to infection and development of the disease. After an incubation period of approximately 10 days, the patient develops a fever, the eyes become red and watery, there is profuse discharge from the nose and redness of the throat. Because of these symptoms, measles is often mistaken for a bad cold. After 48-96 hours from the onset of the disease, a spotty rash appears, and the temperature rises to 40°C. 36 hours before the appearance of the rash, typical spots appear on the oral mucosa, called Filatov-Koplik spots - whitish specks surrounded by a bright red spot with a diameter of up to 0.75 mm. After 1-2 days, the rash darkens and then gradually becomes discolored, the temperature drops sharply, and the runny nose disappears. Measles should be distinguished from other diseases that cause a rash. If there are no complications, measles lasts about 10 days. Complications from measles are quite common (otitis media, pneumonia). In rare cases, encephalitis may develop. The measles virus can attack various body systems and cause hepatitis, appendicitis and even gangrene of the extremities. By treating complications of measles with antibiotics and sulfonamides, mortality due to measles decreased significantly in the 20th century. By the end of the 60s, active vaccination began around the world, but, contrary to expectations, the incidence of measles is still high throughout the world. As a rule, once contracted measles leaves immunity for life. Children under 4-5 months of age are immune against measles if their mother has immunity against the disease.

Rubella- pale, patchy erythema (redness of the skin), especially on the face. On the second day, the rashes are more reminiscent of those with scarlet fever - small red dots on a reddish background. The rash lasts from 3 to 5 days. In children with rubella, the most common symptoms of the disease may be mild malaise and joint pain. In adults with rubella, general signs of intoxication of the disease are more common than in children and include fever, severe malaise, headache, limited joint mobility, transient arthritis and mild runny nose. The temperature usually returns to normal on the second day after the rash appears. Serious complications of rubella include encephalitis, thrombocytopenic purpura, and otitis media (inflammation of the middle ear). Fortunately, such complications are extremely rare. Rubella is suspected in patients with a characteristic rash and lymphadenitis. Laboratory tests are carried out only in pregnant women, patients with encephalitis and in newborns, since rubella is especially dangerous in such cases. Rubella must be distinguished from measles, scarlet fever, secondary syphilis, drug rash, erythema infectiosum, and infectious mononucleosis. Rubella differs from measles by a less pronounced and shorter-lasting rash, less pronounced and shorter-lasting general signs of the disease, and the absence of Koplik's spots and cough. Scarlet fever is distinguished by more severe general signs of intoxication and more severe pharyngitis, which occurs on the very first day of the disease. With secondary syphilis, the enlarged lymph nodes are not painful, and the rash is more pronounced on the palms and soles. With mononucleosis, a sore throat often develops and an increase in all groups of lymph nodes is observed. There is no specific treatment. The main measures are aimed at combating the symptoms of the disease (symptomatic treatment) - antipyretic and antihistamine drugs. In more than 95% of vaccination cases, the rubella vaccine provides lasting immunity for more than 15 years. A vaccinated person is not contagious and does not pose a threat to others.The rubella vaccine is given to children and all susceptible older adults, especially students, military recruits, medical personnel and those who work with young children. After the vaccine, children rarely develop a fever, a rash, enlarged lymph nodes, or temporary arthritis. In adults, especially women, painful joint swelling may occur.

Rubella and pregnancy . Vaccination against rubella is contraindicated in persons with weakened immune systems, as well as pregnant women. Women who have received the rubella vaccine are advised not to conceive a child for at least 28 days after the vaccine. Intrauterine fetal rubella can have an extremely negative impact on the development of pregnancy, including its termination or the occurrence of fetal malformations.

Scarlet fever- an acute infectious disease caused by hemolytic streptococcus, most often Streptococcus pyogenes. Scarlet fever can affect both adults and children, but the disease is more common in children.Before the advent of antibiotics, scarlet fever was considered a very dangerous, even fatal disease, with serious complications. Fortunately, today scarlet fever occurs less frequently and in less severe forms.
With timely treatment with antibiotics, a quick and complete recovery occurs. Most of the possible complications of scarlet fever can be prevented with an adequate course of treatment. This disease most often occurs in children over two years of age, and the peak incidence of scarlet fever occurs between 6 and 12 years. Scarlet fever is more common in temperate climates. The disease is transmitted by airborne droplets from sneezing and coughing. It can also be transmitted through contaminated objects or dirty hands. The source of scarlet fever pathogens are sick children or carriers of infection. The incubation period for scarlet fever lasts 1-7 days. Typically, the disease begins with a sharp rise in temperature, vomiting and severe sore throat (sore throat). The patient also develops headache, chills and weakness. Between 12 and 24 hours after the fever rises, a characteristic bright red rash appears. Sometimes patients complain of severe abdominal pain. In typical cases of scarlet fever, the temperature rises to 39.5 °C or higher. There is redness of the throat, the tonsils are enlarged, red and covered with purulent discharge. The submandibular salivary glands are inflamed and painful. At the beginning of the disease, the tip and edges of the tongue are red, and the remaining parts are white. On the third or fourth day of illness, the white coating disappears, and the entire tongue takes on a bright crimson color. The bright red rash that appears soon after the fever rises is described as a "sunburn with goosebumps." The skin is covered with small red dots that disappear when pressed and the surface is rough to the touch. The rash usually covers the entire body except the area around the mouth. The rash with scarlet fever is characterized by desquamation (peeling), which occurs by the end of the first week of the disease. The skin peels off in the form of small flakes, similar to bran. As a rule, the skin on the palms and heels peels off last (not earlier than the second or third week of illness). Peeling skin is caused by a special streptococcus toxin, which causes the death of the skin epithelium. Early complications of scarlet fever usually occur in the first week of illness. The infection can spread from the tonsils, causing inflammation of the middle ear (otitis media), inflammation of the sinuses (sinusitis), or inflammation of the lymph nodes in the neck (lymphadenitis). A rare complication is bronchopneumonia. Even less common are osteomyelitis (inflammation of the bone), mastoiditis (inflammation of the bone area behind the ear), and sepsis (blood poisoning). With timely, proper treatment, these complications occur extremely rarely. The most dangerous late complications of scarlet fever are: rheumatism, glomerulonephritis (inflammation of the urinary tissues of the kidneys), chorea. Prevention of scarlet fever consists of timely identification and isolation of patients with scarlet fever (especially from other children). Persons in contact with a person with scarlet fever are advised to wear sterile gauze masks and strictly observe personal hygiene.

Rosacea- This is a fairly common papulopustular disease of the follicles of the sebaceous glands, but not accompanied by comedones. It is localized mainly in the center of the face, but can occasionally spread to the forehead and scalp. In most cases, on an erythematous base with telangiectasia (stage I: erythematous rosacea), inflamed, hyperemic nodules of various sizes develop, in the center of which a pustule may be noted (stage II: papular or pustular rosacea. Diffuse tissue hyperplasia, especially in the nasal area, can lead to to the development of rhinophyma. Etiology is unknown.

Shingles characterized by a segmental and, as a rule, unilateral arrangement of groups of vesicles that develop on an erythematous base. After the rash resolves, scars and areas of depigmentation may remain. At the eruptive stage, groups of vesicles develop sequentially, one after another, so the degree of development of vesicles within one group is approximately the same, but may differ from group to group. Fully developed bubbles have a slight depression at the top. Shingles is caused by the same virus as chickenpox - the Varizella-Zoster virus from the herpesvirus group. Both diseases represent different clinical forms of a single infectious process. A neurotropic viral disease develops either as a result of reinfection of the virus with reduced immunity (incubation period 7-14 days), or with a decrease in the body's resistance or immunosuppression, it occurs in the form of zoster symptomaticus as a result of reactivation of the virus that persists in the glial cells of the spinal ganglia. The disease begins acutely with a feeling of malaise and mild fever (prodromal stage). Bubbles arise in the zone of innervation of one or more sensory spinal ganglia (zoster segmentalis or zoster multiplex) and in the corresponding area of ​​the head. The pain is severe, burning and may also precede the appearance of exanthema. The disease can be localized not only in the belt area, as indicated by the term “herpes zoster,” but also in other areas (there is a known case of trigeminal herpes zoster). When shingles spreads to the area of ​​the 1st branch of the trigeminal nerve, the eye (zoster opticus or ophthalmicus) may also be affected. In such cases, urgent consultation with an ophthalmologist and joint management of the patient is indicated, especially if there is a risk of corneal damage. Eye damage caused by the herpes simplex virus generally corresponds to the symptoms of keratitis. Keratitis is sometimes accompanied by uveitis, which can lead to severe and long-term persistent secondary glaucoma. In addition, follicular conjunctivitis and episcleritis may develop in the anterior part of the eye. When the facial nerve is damaged, symptoms of paralysis and neuralgia are observed. Other complications include zoster meningitis and encephalitis (meningoencephalitis). If no complications arise in the form of hemorrhage, ulceration or necrosis, the disease resolves within 2-3 weeks without leaving scars. Relapses do occur, and immunity usually lasts for life. Sometimes segmental localization is disrupted, and the rash spreads to neighboring or more distant areas or even spreads to all skin in the form of generalized shingles. Herpes zoster can occur as a concomitant disease, for example, with leukemia, Hodgkin's and non-Hodgkin's lymphomas. From the point of view of differential diagnosis, erysipelas, herpes simplex, and in case of generalized herpes zoster - chicken pox are considered.

Herpes simplex, which is also called herpes labialis or genital herpes depending on its location, is a reactivated latent infection of one of two types of virus: HSV-1 (the so-called oral strain) or HSV-2 (the so-called genital strain). After a primary infection in childhood, the virus persists in the affected ganglion cells, spreading from them to colonize the epithelial cells of the skin, where it multiplies. Reactivation of the virus depends on irritation of the infected neuron, which can be caused by infections with fever, strong ultraviolet radiation (ultraviolet burn in high altitude areas), gastrointestinal dysfunction, and a weakened immune system due to carcinoma, leukemia, or cytotoxic therapy. The blisters appear on an erythematous base, their occurrence is preceded by itching, a feeling of skin tension and local burning. After opening the blisters, weeping rashes form, which crust over within a few days, and a painful enlargement of the regional lymph nodes is often observed. The segmental arrangement of rashes is not typical for herpes simplex.

1. It is necessary to find out exactly whether there is a connection between the appearance of a rash and the underlying disease. Most often, a rash as a secondary phenomenon in hospitalized patients is associated with an allergic reaction to drugs; a reaction to antibiotics is most likely. The timing of the rash may coincide with the onset of the disease; In addition, in hospitalized patients, any of the disorders listed in paragraphs 2-5 may occur as a secondary disease. Drug rash most often appears as an erythematous macular rash localized to the trunk and extremities, but not affecting the palms and soles of the feet, or as classic urticarial allergic manifestations. Stevens-Johnson syndrome is a life-threatening condition in which a rash appears on the mucous membranes; a beneficial effect can be obtained with the use of glucocorticoids.

Toxic shock syndrome- a life-threatening disease characterized by acute damage to multiple body systems. The cause of the disease is toxins produced by Staphylococcus aureus (S aureus) or streptococcus. When the disease is caused by streptococcus, it is called streptococcal toxic shock syndrome.The greatest risk of developing toxic shock is observed in young girls and women who use vaginal tampons during menstruation.Toxic shock syndrome is an extremely serious illness and can lead to death even with adequate intensive care. The illness comes on suddenly and is characterized by high fever, chills, pharyngitis and, in some cases, diarrhea and vomiting. The patient may also have low blood pressure (shock), disorientation, lightheadedness, severe drowsiness and weakness. The rash from toxic shock syndrome resembles a sunburn. If you suspect that a person may have toxic shock syndrome, call 911 immediately.

Hemorrhagic rash. There is another type of rash that requires immediate medical attention. This type of rash is called petechial hemorrhage or hemorrhagic rash (purpura). This rash is caused by ruptured blood vessels under the skin. Petechiae look like small, red, flat dots (as if someone drew them with a red fine-point pen). Purpura is characterized by large patches that may have a darker (purple or blue) hue. There are two most important signs of this rash: firstly, it does not disappear and does not turn pale when pressed. secondly, they are absolutely flat and cannot be felt with your fingers. If you suspect that a patient has a hemorrhagic rash, immediately consult a doctor, call an ambulance, or take the patient to the emergency department. It is important to take the necessary measures within a few hours after the rash appears.

Allergic rash observed in serum sickness, food and drug allergies. For serum sickness against the background of an underlying disease, for example, diphtheria, botulism, tetanus, etc., a week after the administration of heterologous serum, the patient develops a rash. The nature of the rash can be varied: spotted, maculopapular, medium and large in size. A urticarial rash is very characteristic. The rash is necessarily accompanied by itching. The rash is located everywhere: on the face, torso, limbs, but most of all around the joints and at the site of injection of the serum. Food and drug allergies most often it occurs due to sulfonamide drugs, ampicillin, vitamins, etc. The rash is varied, of various sizes, itchy. The addition of elements is typical if exposure to the allergen continues. When the drug or food product is discontinued, as well as after the administration of antihistamines and glucocorticosteroids, the rash quickly disappears. Usually leaving no trace, but rapid pigmentation may occur.

Exudative erythema multiforme. This erythema, like nodular erythema, is of an infectious-allergic nature. It is characterized by a rash: macular or papular; round shape; diameter 3 - 15 mm; sharp boundaries; pink or bright red color; centrifugal growth with retraction and lighter color of the central part; sometimes individual spots merge, forming figures in the form of garlands. The skin is affected symmetrically and quite widely. The rash is localized primarily on the extensor surfaces of the extremities, most often the forearms, less often the legs, dorsum of the feet, face, and neck. Erythema is often preceded by fever, pain in the throat, joints, etc. Syndrome Stevens-Johnson refers to variants of the course of exudative erythema multiforme. The mechanism of development of the syndrome is associated with immediate allergic reactions occurring according to the Arthus phenomenon type. Most often it develops with allergic reactions to taking medications: sulfonamide drugs, pyrazolone derivatives, antibiotics, etc. The onset of the disease is acute, violent, with fever lasting from several days to 2 - 3 weeks. There is a sore throat, increased blood circulation in the mucous membranes, runny nose, conjunctivitis, hypersalivation, and joint pain. From the very first hours, progressive damage to the skin and mucous membranes is observed in the form of painless dark red spots on the neck, face, chest, limbs, even palms and soles. Along with this, papules, vesicles, and blisters appear. Quite rarely, large blisters with serous-bloody contents can form. The rashes tend to merge. Lyell's syndrome or toxic epidermal necrolysis is an allergic reaction to: infectious, predominantly staphylococcal, process; taking medications (antibiotics, sulfonamides, analgesics); blood transfusion and its components. In the appearance and development of the disease, the “explosive” release of lysosomal (degrading) enzymes in the skin is of primary importance. The disease begins acutely with chills, fever, pain in the throat, lower back, joints, as well as burning and soreness of the skin. Then large erythematous spots of varying sizes quickly appear, often merging, and within a few hours spread throughout the body. In some areas of the skin, vesicles, papules, blisters appear in place of the spots, and then large, flat, flabby blisters. On other areas of the skin there are hemorrhages. In areas of the skin exposed to friction by clothing, the surface layers of the skin peel off, regardless of the presence or absence of blisters. Nikolsky's sign (peeling of the epidermis when pressed) is positive. The patient looks like he has a second degree burn. This syndrome may also affect the mucous membranes of the mouth and eyes. During the course of the disease, toxicosis is pronounced, myocarditis, nephritis, and hepatitis often develop. I'm hives It is one of the most common allergic skin lesions. In children, allergens are most often food substances. A few minutes or hours after eating allergens, the patient feels tingling of the tongue, lips, palate, swelling in these places, and often sharp pain in the abdomen. Erythema appears on the skin of the face, which subsequently spreads to other parts of the body. At the site of erythema, urticarial, severely itchy elements appear. The rashes have a varied character: nodules, blisters of various sizes and bizarre shapes. Often conjunctivitis is simultaneously observed, less often difficulty breathing due to swelling of the larynx, etc. There are immune and non-immune forms of urticaria. Angioedema or giant urticaria, Quincke's edema one of the most common allergic skin lesions. With angioedema, significant, clearly limited swelling is detected. Such swelling can occur in any part of the body, but most often occurs in the lips, tongue, eyes, arms, legs, and genitals. Swelling may migrate. With angioedema, general symptoms are possible: fever, agitation, arthralgia, collapse. Hill's erythroderma. This is one of the most severe variants of the course of neurodermatitis. The skin of the entire body becomes red, resembles goose skin, becomes lichenized in many places, and peels off with pityriasis scales. Characterized by excruciating itching. There is no tendency to vesiculation or weeping. Severe eosinophilia is detected in the blood.

Erythema nodosum is an allergic inflammation of the walls of small blood vessels. The causes of the development of erythema nodosum are varied and can be infectious (diseases caused by β-hemolytic streptococcus group A, tuberculosis, yersiniosis, chlamydia, coccidioidomycosis, histoplasmosis, psittacosis, lymphogranuloma venereum, ornithosis, measles, disease cat scratches, protozoal infections), and non-infectious (sarcoidosis, ulcerative colitis, regional ileitis, Hodgkin's disease, lymphosarcoma, leukemia, Reiter's disease, Behçet's syndrome, due to taking medications: sulfonamides, bromides). Diseases accompanied by the development of erythema nodosum are usually passes sharply. There are relapses at intervals of several months and even years. Chronic forms of the disease, in which nodules persist for several years, are rare. Some patients, even despite widespread skin manifestations, feel quite well. Others experience general malaise, fever, chills, anorexia, and weight loss. Body temperature most often increases slightly, but can reach 40.5 °C. Sometimes fever lasts more than 2 weeks. Skin rashes usually appear suddenly, in the form of erythematous, painful, slightly raised nodules above the surface of the skin. The diameter of each nodule ranges from 0.5 to 5 cm. The skin over the nodule is reddish, smooth, and shiny. Individual nodules coalesce to form lumps that can cause significant swelling. There is no itching. Usually within 1 - 3 weeks the color of the nodules changes: first they are bright red, then blue, green, yellow and finally dark red or purple. The change in skin color adjacent to the nodules is similar to that seen when a bruise develops. After 1 to 3 weeks, the nodules resolve spontaneously without ulceration, scarring, or permanent pigmentation. Erythema nodosum is characterized by a certain dynamics of the process: the spread of nodules goes from the central element to the periphery, and the disappearance also begins from the central part. Skin elements can be located in all places where there is subcutaneous fatty tissue, including on the calves, thighs, buttocks , as well as in inconspicuous areas, for example, the episclera of the eyeball. Favorite localization is on the anterior surfaces of both legs. Less commonly on the extensor surface of the forearms. Most often, the rashes are single and located only on one side. However, the described clinical features of the course of the disease are not constant, i.e. Because there are other variants of the clinical course of erythema nodosum. A characteristic sign of erythema nodosum is adenopathy of the roots of the lungs on one or both sides. It is usually asymptomatic, detected on a chest x-ray, and can persist for months. Every third patient has signs of arthritis. Usually large joints of the extremities (knees, elbows, joints of the wrists and tarsus), and less often small joints of the hands and feet are affected symmetrically. Most children experience arthralgia that accompanies the febrile period of the disease, or precedes it for several weeks. Joint syndrome can last for several months, but joint deformation does not occur.

Rash due to diseases of connective tissue, blood, blood vessels

For skin damage dermatomyositis Characteristic is the presence of purple erythema. Predominant localization: around the eyes, on the neck, torso, outer surface of the limbs. Capillaritis, bluish discoloration of the feet and hands, excessive sweating, and coldness of the extremities are also observed. Edema can be focal and widespread, soft and dense. In severe cases, tissue nutrition is disrupted with the formation of superficial or deep necrosis. All patients have damage to the mucous membranes - petechiae, ulcers, atrophy of the papillae of the tongue, erosive-ulcerative stomatitis, rhinitis, conjunctivitis. Muscles are involved in the process symmetrically. Muscle weakness, muscle pain, and progressive weight loss are noted. A critical situation is created by damage to the respiratory and pharyngeal muscles. A characteristic and common symptom of dermatomyositis is a decrease in calcium content in the muscles. Damage to internal organs is represented by diseases of the lungs (pneumonia, atelectasis), heart (myocarditis, myocardial dystrophy), and gastrointestinal tract (ulcerative esophagitis, enteritis). Damage to the nervous system is characterized by a wide variety of clinical symptoms: encephalitis, paresis, paralysis, neuritis, psychosis. In the diagnosis of the disease, special importance is attached to: increasing the activity of enzymes: creatine phosphokinase, lactate dehydrogenase, aspartate and alanine aminotransferase; electromyography data, which determines low-amplitude electrical activity; muscle biopsy, which is most often performed in the shoulder or thigh area, and which reveals the dissolution of necrotic muscle fibers, inflammation of the walls of blood vessels, and lumpy breakdown of nerve fibers.

Systemic scleroderma (SD). Characterized by progressive vasomotor disorders of the Raynaud's syndrome type, trophic disorders with gradually developing thickening of the skin and periarticular tissues, the formation of contractures, osteolysis, and slowly developing sclerotic changes in internal organs (lungs, heart, esophagus). The skin on the affected areas is initially somewhat swollen, reddish, then thickens, acquires an ivory color, followed by atrophy. Subsequently, new areas of the skin are involved in the process. A reliable early diagnostic criterion for diabetes is a triad of signs: Raynaud's syndrome, articular syndrome and dense swelling of the skin; sometimes this triad can be combined with one of the visceral manifestations.

Systemic scleroderma is characterized by: progressive narrowing of blood vessels like Raynaud's syndrome; disorders of the regulatory influence of the nervous system; gradually developing compactions of the skin, muscles, tendons, connective tissue membranes of the muscles; formation of persistent spasms; resorption of bone tissue; slowly developing compactions in the lungs, heart, esophagus. The skin on the affected areas is initially somewhat swollen, reddish, then thickens and acquires an ivory color. Then comes atrophy. Subsequently, new areas of the skin are involved in the process.

A reliable early diagnostic criterion for systemic scleroderma is a triad of signs: Raynaud's syndrome; articular syndrome; dense swelling of the skin. Sometimes this triad can be combined with one of the internal manifestations.

Systemic lupus erythematosus (SLE). For systemic lupus erythematosus, skin syndrome is very typical. The picture of the disease consists of characteristic symptoms: erythematous rashes on the face in the form of a butterfly, located on the bridge of the nose and both cheeks; migratory polyarthritis; inflammation of any structures of the heart; kidney damage, most often nephrotic syndrome; damage walls of the alveoli in the lungs; cerebral vascular damage; fever; weight loss; increased ESR; increased levels of immunoglobulins in the blood. The presence of LE cells, antinuclear factor (ANF), decreased complement titer, cytopenia confirm the diagnosis.

Particularly typical for systemic lupus erythematosus is damage to the skin of the face in the form of diffuse edematous erythema with sharp boundaries, reminiscent of erysipelas. The rash may spread to the trunk and limbs. The rash consists of blisters and necrotic ulcers. The elements leave behind atrophic superficial scars and nested pigmentation. Urticaria and a measles-like rash may also occur. Diagnostic criteria for SLE are as follows: erythema on the face (“butterfly”); discoid lupus; Raynaud's syndrome (arterial spasms provoked by low temperature); alopecia; increased sensitivity of the body to ultraviolet radiation; ulcerations in the mouth or nasopharynx; arthritis without deformity;

LE cells (lupus erythematosus cells); false-positive Wasserman reaction;

proteinuria (more than 3.5 g of protein in urine per day); cylindruria; pleurisy, pericarditis; psychosis, seizures; hemolytic anemia, leukopenia, thrombocytopenia; presence of ANF. The combination of any 4 of the above criteria allows us to diagnose systemic lupus erythematosus with some certainty. The reliability of the diagnosis increases significantly if one of the four criteria is “butterfly”, LE cells, high titer antinuclear factor, and the presence of hematoxylin bodies.

Thrombocytopenic purpura. Hemorrhages with thrombocytopenia are observed in all organs. They are most dangerous in relation to the central nervous system, as they can often lead to sudden death. In contrast to coagulopathy, with thrombocytopenia, bleeding develops immediately after the appearance of the rash. Spontaneous bleeding occurs most often when the platelet count decreases to less than 30,000/μl. Tiny petechial bleeding in acute idiopathic thrombocytopenic purpura (acute ITP) is barely noticeable. Acute ITP develops primarily in childhood, but also occurs in adolescents and adults. The platelet count falls within a few weeks below 20,000/mcL. This syndrome has a significant tendency toward spontaneous remission (>80%). The number of platelets in peripheral blood in chronic thrombocytopenic purpura and Werlhof's disease ranges between 10,000 and 70,000/μl. The predominant location of purpura is the lower legs. Werlhof's disease develops more often in women and usually begins unnoticed before the age of 20. A clear relationship between acquired disorders of thrombocytopoiesis and infections, medications, or exposure to allergens has not been established. The tendency towards spontaneous remission is insignificant (10-20%). From the point of view of differential diagnosis, one should exclude, in particular, thrombocytopenia in another primary disease, such as systemic lupus erythematosus. Microscopy reveals giant and fragmented forms of platelets; the number of megakaryocytes in the bone marrow increases greatly with a shift to the left. In many cases, platelet antibodies are present. Rare syndromes with thrombocytopenia include thrombotic thrombocytopenic purpura (Moschkowitz syndrome) and hemolytic uremic syndrome (Gasser syndrome). In a number of hereditary and acquired diseases, platelet dysfunction (thrombocytopathy) can lead to an increased tendency to bleed. Such diseases include dysproteinemia, Glyantzmann-Naegeli thrombasthenia and Wiskott-Aldrich syndrome.

In case Henoch-Schönlein purpura, primary systemic necrotizing leukocytoclastic immune complex vasculitis of small vessels, there is palpable purpura of the skin and damage to the joints, intestines and kidneys. Henoch-Schönlein purpura occurs in children and adolescents, but is increasingly common in adults (male: female = 2:1). In 60% of patients, the disease is preceded by bacterial or viral infections. Skin vasculitis manifests itself in the form of a symmetrical exanthema localized on the extensor surfaces of the legs, as well as in the buttocks and sometimes in other parts of the body. The Rumpel-Leede test is positive. From a clinical and morphological point of view, the more common hemorrhagic, necrotic-ulcerative and mixed forms are distinguished. When pressed with a glass spatula, the main rashes do not turn pale. Without taking into account relapses, the disease usually lasts 4-6 weeks (mortality: 3-10%).

CAUSES OF LONG-TERM RASHES: Eczema- a fairly common disease. It is essentially an inflammation of the skin accompanied by severe itching. The skin turns red, becomes dry and peels. In areas affected by eczema, the skin thickens, cracks, and becomes chronically infected. The scratched areas tend to bleed and become wet. Eczema begins with a rash of pink bumps just under the top layer of skin that cause intense itching. There are several types of eczema, and each requires individual treatment. The most common eczemas in children are atopic eczema (also known as infantile eczema) and seborrheic eczema, for which treatment varies. Atopic eczema, which affects 12% of children, has one distinctive feature: many children outgrow it by age three, and 90% are free of it forever by age eight. There are two more types of fairly common eczema - contact eczema (contact dermatitis) and blistering eczema. Contact eczema occurs as a result of exposure of the skin to chemical irritants that cause local irritation of the skin. Such irritants can be certain creams, washing powders, metals from which jewelry is made, and some plants. Blistering eczema usually appears on the fingers and toes during the warmer months. Both types of eczema also affect adults. Almost always the cause is a hereditary factor. If anyone in the family: parents, sisters or brothers were susceptible to the same eczema, in 50% of cases the newborn may develop atopic eczema. It is associated with hay fever, asthma, ear infections, and migraines. Factors that cause eczema: wool, laundry detergents with bio-additives, detergents, fluff and dander from pets and birds, parental smoking, emotional factors, house dust mites, food products, food additives and dyes.

Seborrheic eczema It occurs in adolescents and adults, as well as in infants. It affects areas of the skin where oil glands are concentrated, forming a thick yellow crust on the skin. Eczema of the head in an infant is a prime example of this disease. Most newborns develop scabs on their heads in the first weeks of life. Then the skin naturally clears itself of them. Such crusts often appear on the cheeks, neck and along the hairline on the head, especially behind the ears. Scabs may appear on the eyelids and on the outer part of the external auditory canal. On the face, seborrheic eczema is located in places where the sebaceous glands are concentrated, for example, around the nostrils. Rashes also occur in the groin. Seborrheic eczema is not itchy like atopic eczema and is easy to treat.

At psoriasis a rash appears, which is often mistaken for eczema. But the location of the rash in psoriasis, its cause and treatment are completely different from those in eczema. Unlike eczema, psoriasis rarely affects children under two years of age and is more common at older ages. About 1% of the adult population of various ages suffer from psoriasis.
As a rule, this is a hereditary disease; any common infection can trigger it, for example, just a cold in the throat. In children, the disease begins with an extensive rash in the form of small dry plaques on the skin, round or oval in shape, red-pink in color. On top of the redness, a characteristic silvery peeling is clearly visible, which constantly crumbles. The distribution of the rash on the body is characteristic only of psoriasis - mainly on the elbows, knees and head. But often rashes occur on the ears, chest and upper part of the fold between the buttocks. In infants, psoriasis sometimes causes a continuous and extensive diaper rash (diaper psoriasis). Fortunately, psoriasis rashes are not as itchy as eczema rashes. The apparent cause of psoriasis is accelerated growth of skin cells. But why this happens is still unknown. The patchy, guttate form of psoriasis that occurs in infants usually lasts three months and then goes away suddenly. However, it may return in the next five years and then in adulthood.

Skin mycoses(fungal infections). Appearing at first as a separate spot, the fungal infection gradually becomes a widespread rash on moist areas of the body - in the groin, between the fingers, under the arms and on the face. Often oval spots appear on the legs. On the head, spots are located in areas of baldness. Between the toes, the infection forms a wet, white swelling known as athlete's foot. A fungal infection can be transmitted by just touching. It can be obtained in the bathroom, in the shower, in any constant damp environment.

Pityriasis versicolor, synonym - lichen versicolor, common name - solar fungus. The cause of the disease is a fungus belonging to the group of keratomycosis. Today, microscopy identifies three forms of one pathogen: round, oval, mycelial, capable of transforming into each other. The incubation period ranges from two weeks to months. The fungus can live on the skin for a long time without causing external manifestations of the disease. Concomitant and predisposing factors for the disease are endocrine pathologies, sweating, a weakened immune system, stressful situations for the skin (solarium, excessive tanning, frequent use of antibacterial soaps and shower gels, etc.) that disrupt the natural protective function of the skin. The external manifestations of the disease become especially noticeable in the summer, when lighter (hypopigmented) spots clearly stand out against the background of tanned skin. The shape of the spots is round, with clear boundaries. Diameter 0.5-2.0 cm. Lesions tend to merge into large areas. Typical localization is the back, chest, and shoulders. The reason for their appearance is as follows. By multiplying in the epidermis (the upper layer of the skin), the fungus causes disruption in the functioning of melanocytes (the cells responsible for the production of the melanin pigment). It is thanks to melanin that the body acquires a tan when exposed to sunlight. Dicarboxylic acid produced by the fungus reduces the ability of melanocytes to synthesize pigment, resulting in hypopigmented areas. A similar clinical picture in connection with the predominantly pronounced external manifestation under the influence of the sun’s rays gave rise to another common name that can be found at resorts - “sun fungus”. There is another, externally opposite manifestation of pityriasis versicolor. More often in cold seasons you can see spots with a brownish or yellowish-pink tint, round in shape, with slight peeling. The localization of lesions is similar to those described above. The difference in the color of the spots in different people, which can occur in the same person, explains the synonym for the name pityriasis versicolor - pityriasis versicolor. Unlike most fungal diseases, the risk of transmitting pityriasis versicolor from one person to another, even through close contact, is relatively low. However, its course in affected people is quite persistent and can last for years. Diagnosis is carried out using the following methods: Visual inspection using specific samples. As a result of the proliferation of the fungus, the cells of the epidermis become loosened. Based on this phenomenon, the so-called Balzer test is used in diagnosis. The spots and nearby healthy skin are smeared with a dye solution (usually 3%-5% iodine tincture is used). As a result, the loose affected area of ​​skin absorbs the dye to a greater extent. Its color becomes darker in relation to the unaffected one.
Wood's lamp examination, in which the foci give a characteristic glow.
Apply microscopy skin scraping, in which short threads of fungus with spores are found. Pityriasis versicolor responds well to treatment. Despite this, a long-term process with periodic exacerbations is often encountered. The cause of relapses is non-compliance with therapeutic recommendations and preventive measures or the use of ineffective drugs. The disease should be differentiated from vitiligo, Zhiber's pityriasis rosea, and syphilitic roseola.