Home' Australian Pharmacist : Australian Pharmacist August 2016 Contents Australian Pharmacist August 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
Patients with folliculitis usually
experience a red spotty rash, where
spots are usually tender, with a surface
The rash has an acute
onset and is associated with itch and
In persistent cases of
folliculitis, the patient may experience
scarring and/or permanent hair loss.
Neil assures you that his rash is not
red and spotty in nature (he reminds
you they are more like raised, red bumps).
He also has no associated pustules or
tenderness. Although folliculitis can
present as a sudden red and itchy rash, it
does not appear likely that Neil has
folliculitis at this time.
Allergic and irritant contact dermatitis
are potential causes of a red and itchy
skin rash. Allergic contact dermatitis
is caused by an allergic reaction to
chemicals such as nickel, preservatives,
dyes or fragrances.
occur within hours after exposure to
the offending allergen, and include
redness, swelling, dryness and blistering
of the affected area.
12,13 Irritant contact
dermatitis occurs when chemicals or
physical agents (such as detergents)
damage the skin’s surface, remove
moisture and oils, and penetrate the
skin, resulting in an inflammatory
Common symptoms of
irritant contact dermatitis include a
well-demarcated red and patchy rash,
with a glazed surface.
can include itch, swelling, blistering and
Neil has an itchy, red and inflamed rash
that appeared suddenly. There are several
potential causes of his current symptoms.
When considering the potential cause of
Neil’s symptoms, it is important to note
that in some cases the pharmacist should
refer patients with a skin rash to a general
practitioner (see Box 1).
Insect bites or stings may cause a
localised red, itchy and inflamed rash or
lump.5,6 In some cases, there may also be
a visible hole in the skin at the location
where the bite occurred, or the sting may
Other symptoms can include
fluid-filled blisters, hives or wheals (area
around the bite fills with fluid).
occasions, the symptoms associated
with an insect bite will resolve within a
few hours to days.5,6 However, in some
instances patients may develop a severe
allergic reaction to the bite or sting (most
typically associated with bites or stings
due to bees, wasps or the Australian jack
jumper ant). This results in a widespread
rash, swelling of the tongue or throat,
difficulty breathing, abdominal pain,
diarrhoea, vomiting, or a sudden drop in
You speak with Neil to see if he may
have been bitten or stung by an
insect. Neil does not believe he has been
bitten or stung recently. He was stung by a
bee a few years ago, and he recalled that
the area was sore and inflamed for a few
hours, then disappeared. As Neil does not
recall an insect bite, and his rash is quite
widespread, it appears unlikely that an
insect bite or sting is the cause of his
Heat rash (also called prickly heat rash,
sweat rash or miliaria) is a common
condition in Australia, which usually
occurs during periods of hot or humid
The rash develops when
sweat ducts (or pores) become blocked
and inflamed causing perspiration to
be trapped underneath the skin.
then causes the symptoms of itching
7,9 A typical heat rash will
appear as small red spots which develop
in the skin folds, and areas which are
subject to friction.
of heat rash can include itchiness,
irritation, a prickling sensation on the
skin, redness, and mild swelling.
Cases of heat rash can last for 5–6 weeks,
and may cause significant discomfort for
Upon further questioning, you
discover that Neil has not been
spending time in hot or humid weather.
He also spends most of his days indoors, in
an air-conditioned office or house, so is
not overly affected by the heat, even
during summer. Neil also confirms that he
does not have small red spots on the skin
(they are more like raised, red bumps), and
there are no lesions in his skin folds. As a
result, it seems that Neil is not suffering
from heat rash on this occasion.
Folliculitis is a skin condition which
occurs due to inflamed hair follicles.
Folliculitis is caused by an infection
(bacterial, viral, parasitic or fungal),
follicular trauma or irritation (e.g. after
shaving, waxing, electrolysis or plucking
hairs), inflammation, occlusion/blockage
(including from some moisturisers and
paraffin-based ointments) or certain
skin diseases (e.g. acne and rosacea).
Skin rash does not respond to
treatment as expected or recurs
Symptoms are getting worse and/or
rash is spreading
Any associated signs of wheeze,
tightness of the chest, difficulty
breathing or swallowing, swelling
of the face, eyes, lips, throat
and tongue or angioedema (i.e.
suspected widespread allergic
response or anaphylaxis)
Associated high fever, muscular
pains, diarrhoea, vomiting or
arthralgia (e.g. suspected Stevens-
Suspected infection, e.g. yellow
crusting, oozing or pain, high
temperature, swollen and sore skin
Skin rash that develops after an
upper respiratory tract infection
(suspected meningococcal disease)
Box 1. Skin rash: when to refer1–4
Common symptoms of
irritant contact dermatitis
include a well-demarcated
red and patchy rash, with
a glazed surface.
symptoms can include
itch, swelling, blistering
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