[5 min read] How to manage skin rashes in primary care

Doctors in primary care can contribute to the shortening of waiting times for specialist appointments by becoming proficient in identifying and treating various skin conditions. With adequate training in general dermatology, they can learn to differentiate between the types and causes of common skin rashes and prescribe treatment.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in General Dermatology.

Common skin rashes in primary care

Skin rashes tend to display similar symptoms. That can confuse untrained professionals and lead them to a wrong diagnosis. The cost for the patients is additional suffering, unnecessary doctor’s visits, time, and money.

The origins of the skin rash may be inflammatory (allergic dermatitis), viral (herpes), bacterial (acne), fungal (ringworm), immunological (psoriasis), and many others (melasma, scabies, etc.). Therefore, the lack of proper treatment can affect general health differently.

In rare cases, misdiagnosing a patient with the wrong disease and prescribing ineffective treatment can lead to severe complications or fatalities. That’s why it is essential for primary care physicians to strictly follow the diagnostic guidelines and focus on recognising the cause of the symptoms.

Here’s a short overview of common skin rashes, their symptoms, and treatment options in a primary care setting:

Eczema (dermatitis)

There are several types of eczema. Atopic dermatitis is the most common one. It presents as red, inflamed, itchy, and sometimes blistered or scaly patches of skin. The usual locations on the body are the hands, backs of knees, and elbow flexures.

The treatment usually consists of identifying and avoiding the triggers of flare-ups and a mix of antihistamines and topical steroids during the acute phase.

Other types, such as allergic contact dermatitis, may have similar symptoms and respond well to the same treatment.

Urticaria

There are two types, acute and chronic urticaria. The latter prevails in adults. The causes of the two differ. Acute urticaria is a response to external triggers. Chronic urticaria is most likely related to genetic predisposition.

The symptoms include red and raised patches of skin that are sometimes itchy. The treatment involves antihistamines and oral corticosteroids, but it is not always necessary.

Stasis dermatitis

Stasis dermatitis is a skin inflammation that usually affects the lower leg area. Hyperpigmentation, scaling, and itching are common symptoms. Ulcers may also appear.

The likely cause is chronic edema. Treatment should focus on the potential causes of oedema, such as:

  • Right heart failure,
  • Lymphedema, and
  • Chronic venous insufficiency

All of these are beyond the reach of primary care medicine.

Psoriasis

Psoriasis is a chronic auto-immune disease. There are several types. Doctors in primary care usually deal with mild cases of psoriasis. These present as scaly lesions that differ from the color of the surrounding skin. Topical corticosteroids and vitamin D analogs are the first-line treatment.

Scabies

Mites that cause scabies burrow and lay eggs in the epidermis triggering an immune system reaction. The consequence is an itchy rash that gets worse at night.

The treatment includes the application of Permethrin (5%) cream all over the body and sometimes a single dose of ivermectin (200 µg/kg). Repeating the topical treatment after seven days is recommended.

Washing and drying all the clothes, towels, and bed linen of the infected person at a high temperature (˃60°C) is essential.

Ringworm (dermatophytosis)

A fungal infection that spreads from person to person. Several types affect different sites on the body (skin and mucosa). The recognisable symptom is a ring-shaped rash with raised edges and lighter color in the middle.

There are topical and oral treatment options. The most popular anti-fungal creams for ringworm treatment include:

  • Clotrimazole,
  • Miconazole,
  • Terbinafine,
  • Canesten, and
  • Daktacort

Lichen planus

Lichen planus presents as itchy papules on the skin, or white streaks on the oral mucosa (oral lichen planus). The latter causes more discomfort.

Topical and oral steroids and sedating antihistamines are necessary when flare-ups fail to resolve and when severe itchiness is present.

*Skin rashes caused by scarlet fever, chickenpox, and measles are more common in children. Pediatricians working in primary care usually have sufficient experience to diagnose these conditions.

– Dr Rosmy De Barros

Read another article like this one: Common benign skin lesions seen in primary care


References:

  • Silvestre Salvador JF, Romero-Pérez D, Encabo-Durán B. Atopic Dermatitis in Adults: A Diagnostic Challenge. J Investig Allergol Clin Immunol. 2017;27(2):78-88. doi:10.18176/jiaci.0138
  • Antia C, Baquerizo K, Korman A, Bernstein JA, Alikhan A. Urticaria: A comprehensive review: Epidemiology, diagnosis, and work-up. J Am Acad Dermatol. 2018;79(4):599-614. doi:10.1016/j.jaad.2018.01.020
  • Agnihothri R, Shinkai K. Stasis Dermatitis. JAMA Dermatol. 2021;157(12):1524. doi:10.1001/jamadermatol.2021.3475
  • Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet. 2021;397(10281):1301-1315. doi:10.1016/S0140-6736(20)32549-6

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