Tag Archives: Rash

Straight, No Chaser: Contact Dermatitis, Diaper Rash, Poison Ivy and the Like

August 6, 2016Skin/Dermatology, Health Prevention844-SMA-TALK, Allergic contact dermatitis, Allergy, Atopic dermatitis, Behind the Curtain, Citrus, Contact dermatitis, Dermatitis, health, Irritation, Latex, Rash, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Urushiol-induced contact dermatitisJeffrey Sterling, MD

Let’s pick up where we left off. In our discussion of eczema and psoriasis, we described the common theme of underlying inflammation manifesting in rashes of different appearances. The theme continues today, with the difference being overlying inflammation. Contact dermatitis (dermatitis = skin inflammation) results from some external entity becoming a nuisance to your skin and generating a response in the form of a rash. You know this in many different forms (shown in the pictures below) – think about those old nickel coated watches, piercings gone bad (piercings also cause actual infections, which is a different consideration), clothing (below is a picture of contact dermatitis caused by flip-flop slippers), poison ivy and diaper rash. I bet the lead picture, which seems like a brand of a butterfly necklace pendant, as well as the following pictures look familiar to many of you.

These rashes are examples of allergic contact dermatitis. Your immune system is generating a response because it believes it is under attack by whatever has touched you. The way the body defends itself leads to release of various chemicals (most notably histamines) that cause the rash. The reason I picked the illustration of the diaper rash is to remind you that the rash actually is in the distribution of the diaper (not just under it), meaning that it may be the diaper that’s the culprit. In other words, don’t just zone in on feces and urine as the problem. Allergic contact dermatitis can occur from – well, anything you’re allergic to, but it’s commonly associated with latex, fruit peels (especially citrus), lotions, perfumes and other topical substances applied to the skin.
When we discussed eczema earlier, we were describing irritant contact dermatitis, which occurs because something damages the skin (remember eczema is called “the itch that rashes”). Imagine that you’ve sensitized and damaged your eczematous skin by scratching away at it and then place something irritating on it. That’s what this is. The longer the new irritant stays on the already damaged skin, the worse the inflammation is, and the more violent the rash appears.
So let’s get to the bottom line: the name of the game is avoidance (as in poison ivy, latex or other known irritants), prompt recognition and removal of irritants, and symptomatic treatment. If you come in contact with a substance that burns or rashes immediately, remove the object or get away from it, and then wash the affected area with mild soap and moderate water. Consider oral histamines (e.g. benadryl) and a mild OTC hydrocortisone ointment. If the rash isn’t better within a few days, or if you ever feel short of breath or as if your throat is closing, contact your physician or the local emergency room immediately for evaluation. Unless you have an underlying condition like eczema or psoriasis, contact dermatitis should resolve within 2-4 weeks with this approach to management.
So in closing, remember: it’s not just the more you itch, the more you scratch. It’s also the more you scratch, the more you itch. Break the cycle.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: STDs – Syphilis, The Great Mimicker

April 30, 2016Genital/Urinary, Infectious Disease, Obstetrics and GynecologyBehind the Curtain, Conditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, Syphilis, TuskegeeJeffrey Sterling, MD

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: Advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Shingles – Return of the Chickenpox

July 17, 2015Skin/Dermatology844-SMA-TALK, Behind the Curtain, Blisters, Chickenpox, health, herd immunity, Herpes, Herpes zoster, Immunocompromised, Rash, Shingles vaccine, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Varicella vaccine, Varicella zoster virus, Vesicles, ZostavaxJeffrey Sterling, MD

I wonder if any of you haven’t had chickenpox. That’s a question that never would have been asked a few decades ago. Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.). Repeat infections or reactivation of the virus that went dormant inside of you causes shingles. When I was younger, no one ever got shingles because no one got chickenpox twice. Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it. The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).

Then an odd thing happened. A chickenpox vaccine came out. Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age. Then shingles started being seen more often.

The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes. Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears. The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks). Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.

Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful. If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half. Please discuss this with your physician. If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.

Quick Tips:

If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
If you have shingles, avoid close contact with people until after the rash blisters heal.
Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.

I welcome your questions, comments or stories. For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer. Who’s this famous manager pictured here with shingles?

In the meantime, if you’d like to read Behind the Curtain ahead of its national launch, we are now shipping orders made exclusively on www.jeffreysterlingbooks.com!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: STDs – Syphilis, The Great Mimicker

November 19, 2014Genital/Urinary, Infectious Disease, Obstetrics and GynecologyConditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, Syphilis, TuskegeeJeffrey Sterling, MD

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: Advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
For a historical lesson on what happens with untreated syphilis, review this Straight, No Chaser post on The Tuskegee Experiments.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Contact Dermatitis, Diaper Rash, Poison Ivy and the Like

October 2, 2013Skin/Dermatology, Health PreventionAllergic contact dermatitis, Allergy, Atopic dermatitis, Citrus, Contact dermatitis, Dermatitis, health, Irritation, Latex, Rash, Urushiol-induced contact dermatitisJeffrey Sterling, MD

These rashes are examples of allergic contact dermatitis. Your immune system is generating a response because it believes it is under attack by whatever has touched you. The way the body defends itself leads to release of various chemicals (most notably histamines) that cause the rash. The reason I picked the illustration of the diaper rash is to remind you that the rash actually is in the distribution of the diaper (not just under it), meaning that it may be the diaper that’s the culprit. In other words, don’t just zone in on feces and urine as the problem. Allergic contact dermatitis can occur from – well, anything you’re allergic to, but it’s commonly associated with latex, fruit peels (especially citrus), lotions, perfumes and other topical substances applied to the skin.
When we discussed eczema earlier, we were describing irritant contact dermatitis, which occurs because something damages the skin (remember eczema is called “the itch that rashes”). Imagine that you’ve sensitized and damaged your eczematous skin by scratching away at it and then place something irritating on it. That’s what this is. The longer the new irritant stays on the already damaged skin, the worse the inflammation is, and the more violent the rash appears.
So let’s get to the bottom line: the name of the game is avoidance (as in poison ivy, latex or other known irritants), prompt recognition and removal of irritants, and symptomatic treatment. If you come in contact with a substance that burns or rashes immediately, remove the object or get away from it, and then wash the affected area with mild soap and moderate water. Consider oral histamines (e.g. benadryl) and a mild OTC hydrocortisone ointment. If the rash isn’t better within a few days, or if you ever feel short of breath or as if your throat is closing (as described in greater detail here), contact your physician or the local emergency room immediately for evaluation. Unless you have an underlying condition like eczema or psoriasis, contact dermatitis should resolve within 2-4 weeks with this approach to management.
So in closing, remember: it’s not just the more you itch, the more you scratch. It’s also the more you scratch, the more you itch. Break the cycle.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What's that Rash? Eczema and Psoriasis

September 30, 2013Medical Treatment, Skin/DermatologyAtopic dermatitis, Benadryl, Cutaneous condition, Eczema, health, Inflammation, Psoriasis, Rash, Skin, WordPressJeffrey Sterling, MD

Rashes are very frustrating for patients. They itch, burn, get infected, aren’t pleasant to look at and never go away rapidly enough. Another problem is no one ever seems to know what they are at first, and that causes a big problem because you’re concerned immediately (as you should be) when the rash appears. Unfortunately, in the early stages, most rashes are indistinguishable. In many cases, in order to diagnose them, you’d have to let them evolve and bloom into whatever they’re trying to become, but who has time for that? I remember in medical school, the prevailing wisdom was “If it’s wet, dry it (powder), if it’s dry, wet it (creams, lotions and ointments), and give everybody steroids.” Well, don’t try that at home without your physician’s direction because it’s not universally true, but it sure does seem like hydrocortisone has a lot to do with treating rashes.
Today, I’d like to review two common chronic conditions defined by rashes, and later I’ll do the same with acute presentations of rashes. The thing about eczema and psoriasis is we should know it when we see it, and so should you. By the way, dermatitis is the general term for skin inflammations, and eczema and psoriasis both fall under this category. As such, they have a lot in common, including basic underlying mechanisms (irritation), treatment considerations and a knack at raising frustration levels.

Eczema (aka atopic dermatitis, which is the most common form of eczema) is a red, dry itchy rash that really is just an inflammatory reaction. If you let it linger, it can become cracked, infected and develop a leather-like consistency. It’s said that you’d develop eczema just by scratching or rubbing your skin long enough, because it’s the damage to the skin that causes the inflammatory reaction that defines eczema. This is why eczema is notoriously called “the itch that rashes”. You’re more likely to have it if you have asthma, have fever or tendencies toward food allergies (or other allergies), but you can get it with pretty much any significant skin irritation. It’s not contagious, but it does run in families.

Psoriasis is another chronic skin condition that is easily recognized. As noted above, that thick scaly, silvery skin (called plaques) results from an overgrowth of skin cells. As with eczema, this condition is a result of inflammation to the skin, in this instance caused by an overreaction of your immune system speeding up the production of skin cells. Psoriatic lesions are most often seen on the elbows, knees and scalp; it can also involve the back, hand and feet (including the nails). Psoriasis tends to flare-up then go into remission, but during those flare-ups, it is very uncomfortable and unsightly.
These are both ‘dry’ rashes, so treatment involves moisturizers, changing habits to include mild soaps, loose fitting clothing, moderate temperature showers (to avoid drying the skin), and when necessary, antihistamines (like Benadryl) and topical steroid creams (like hydrocortisone). Use any medications after consultation with your physician, who may prescribe more exotic treatments such as medications to calm or suppress the body’s immune response or ultraviolet light therapy. Your job is to identify and avoid the irritants that cause the inflammatory reaction (e.g. sweating, scratching, tight-fitting clothing and anything that dries you out). It’s important for you to get these addressed early before the appearance becomes too bothersome for you.
I welcome any questions or comments.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Syphilis – The Great Mimicker

September 25, 2013Genital/Urinary, Obstetrics and GynecologyConditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, SyphilisJeffrey Sterling, MD

Today, you will learn two phrases that you may not have previously heard: The Great Mimicker and MSM. Regarding another word you definitely should know, I’ll touch on it and will save for a separate post: Tuskegee.
Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease from the Americas to Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In the first part of this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The bacteria causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
All of the pictures in this posts are typical representations of the various stages of syphilis, and I’ve seen them all. These are not meant to provide any shock value other than demonstrating what occurs with progression of the disease. Later, I will discuss treatment, risks and other considerations. I don’t think you’ll want to miss the rest of the story. That really is shocking – and horrible.
Feel free to offer comments or ask questions.
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Straight, No Chaser: Quick Tips – Rashes on Your Palms and Soles – Pay Attention!

August 11, 2013Skin/DermatologyHand foot and mouth disease, health, Infectious disease, Kawasaki, Kawasaki disease, Rash, Rickettsia Rickettsii, Rocky Mountain Spotted Fever, Rocky Mountains, SyphilisJeffrey Sterling, MD

In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles. However, there are a few of note, so here’s some Quick Tips to point you in the right direction.
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus. It’s rather benign.
hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii). If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.

If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease. This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.

Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.

And yes, secondary syphilis presents with rashes on the palms and soles. The real take home message is this. Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed. Trust me, you want to get treated before tertiary syphilis develops. Here’s what that rash looks like.

The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.

Straight, No Chaser: Can You Get Chicken Pox Twice? Emergency Room Adventures: Introducing Shingles

August 8, 2013Medical Treatment, Health PreventionBlisters, Chickenpox, health, herd immunity, Herpes, Herpes zoster, Immunocompromised, Rash, Shingles vaccine, United States, Varicella vaccine, Varicella zoster virus, Vesicles, ZostavaxJeffrey Sterling, MD

It’s another interesting night in the ER. My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is. They’re so good that they rarely get stumped, and they get excited when they are. The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster. Unknown to them, their problem with this patient is she’s African-American. Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.
I wonder if any of you haven’t had chickenpox. That’s a question that never would have been asked a few decades ago. Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.). Repeat infections or reactivation of the virus that went dormant inside of you causes shingles. When I was younger, no one ever got shingles because no one got chickenpox twice. Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it. The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).
Then an odd thing happened. A chickenpox vaccine came out. Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age. Then shingles started being seen more often.
The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes. Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears. The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks). Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.
Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful. If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half. Please discuss this with your physician. If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.
Quick Tips:

If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
If you have shingles, avoid close contact with people until after the rash blisters heal.
Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.

I welcome your questions, comments or stories. For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer? Who’s this famous manager pictured here with shingles?