Diseases & Conditions


Asthma

Asthma is a chronic disease of the airways that makes breathing difficult. With asthma, there is inflammation of the air passages that results in a temporary narrowing of the airways that carry oxygen to the lungs. This results in asthma symptoms, including coughing, wheezing, shortness of breath, and chest tightness. Some people refer to asthma as "bronchial asthma."

Even though there are seemingly miraculous treatments for asthma symptoms, asthma is still a serious -- even dangerous -- disease that affects more than 25 million Americans and causes nearly 2 million emergency room visits ever year. With proper asthma treatment, you can live well with this condition. Yet inadequate asthma treatment limits the ability to exercise and be active. Poorly controlled asthma can lead to multiple visits to the emergency room and even hospital admission, which can affect your performance at home and work.

In each of the following sections, there are in-depth articles that link to the topics. Be sure to read each health topic so you have a greater understanding of asthma and how it is diagnosed and treated.

There are three major features of asthma:

1. Airway obstruction. During normal breathing, the bands of muscle that surround the airways are relaxed, and air moves freely. But in people with asthma, allergy-causing substances and environmental triggers make the bands of muscle surrounding the airways tighten, and air cannot move freely. Less air causes a person to feel short of breath, and the air moving through the tightened airways causes a whistling sound known as wheezing.

(Fortunately, this airway narrowing is reversible, a feature that distinguishes asthma from other lung diseases such as bronchitis or emphysema.)

2. Inflammation. People with asthma have red and swollen bronchial tubes. This inflammation is thought to contribute greatly to the long-term damage that asthma can cause to the lungs. And, therefore, treating this inflammation is key tomanaging asthma in the long run.

3. Airway irritability. The airways of people with asthma are extremely sensitive. The airways tend to overreact and narrow due to even the slightest triggers such as pollen, animal dander, dust, or fumes.

Adult-Onset Asthma

Asthma may occur at any age, although it's more common in younger individuals (under age 40).

People who have a family history of asthma have an increased risk of developing the disease. Allergies and asthma often occur together. Smoking with asthma, a dangerous combination is still seen commonly.

However, anyone can develop asthma at any time, and adult-onset asthma happens frequently. If you have symptoms of asthma, talk to your doctor. If you have adult-onset asthma, your doctor will instruct you in using the asthma inhalers and other asthma medications to prevent further breathing problems.

Asthma in Children

Asthma is increasingly prevalent among children. Nearly one in 10 American children now has asthma, a sharp rise that still has scientists searching for a cause. An estimated 6.5 million children under age 18 (8.9%) are now diagnosed with the disease. The rate of childhood asthma has more than doubled since 1980, according to the CDC.

Asthma symptoms can vary from episode to episode in the same child. Signs and symptoms of asthma to look for include:

  • Frequent coughing spells, which may occur during play, at nighttime, or while laughing. It's important to know that coughing with asthma may be the only symptom present.
  • Less energy during play
  • Rapid breathing
  • Complaint of chest tightness or chest "hurting"
  • Whistling sound when breathing in or out. This whistling sound is called wheezing.
  • Seesaw motions in the chest from labored breathing. These motions are called retractions.
  • Shortness of breath, loss of breath
  • Tightened neck and chest muscles
  • Feelings of weakness or tiredness

For more information, see WebMD's Asthma in Children.

Asthma Causes and Triggers

People with asthma have very sensitive airways that react to many different things in the environment called "asthma triggers." Contact with these triggers cause asthma symptoms to start or worsen. The following are common triggers for asthma:

  • Infections such as sinusitis, colds, and flu
  • Allergens such as pollens, mold spores, pet dander, and dust mites
  • Irritants such as strong odors from perfumes or cleaning solutions, and air pollution
  • Tobacco smoke
  • Exercise, called exercise-induced asthma
  • Weather; changes in temperature and/or humidity, cold air
  • Strong emotions such as anxiety, laughter or crying, stress
  • Medications, such as aspirin-sensitive asthma

For more information, see WebMD's Causes of Asthma.
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Allergies

An allergy is an exaggerated immune response or reaction to substances that are generally not harmful.

Causes, Incidence and Risk Factors

Allergies are pretty common. Both genes and environmental factors play a role.

The immune system normally protects the body against harmful substances, such as bacteria and viruses. It also reacts to foreign substances called allergens, which are generally harmless and in most people do not cause a problem.

But in a person with allergies, the immune response is oversensitive. When it recognizes an allergen, it releases chemicals such as histamines. which fight off the allergen. This causes allergy symptoms.

Common allergens include:

  • Drugs
  • Dust
  • Food
  • Insect bites
  • Mold
  • Pet dander
  • Pollen

Some people have allergy-like reactions to hot or cold temperatures, sunlight, or other environmental triggers. Sometimes, friction (rubbing or roughly stroking the skin) will cause symptoms.

A specific allergy is not usually passed down through families (inherited). However, if both your parents have allergies, you are likely to have allergies. The chance is greater if your mother has allergies.

Allergies may make certain medical conditions such as sinus problems, eczema, and asthma worse.

Complications
  • Anaphylaxis (life-threatening allergic reaction)
  • Breathing problems and discomfort during the allergic reaction
  • Drowsiness and other side effects of medicines
Calling Your Health Care Provider

Call for an appointment with your health care provider if:

  • Severe symptoms of allergy occur
  • Treatment for allergies no longer works
Prevention

Breastfeeding children for at least 4 months or more may help prevent a cow's milk allergy and wheezing in early childhood. However, changing a mother's diet during pregnancy or while breastfeeding does not seem to help prevent allergies.

For most children, changing the diet or using special formulas does not seem to prevent allergies. If a parent, brother, sister, or other family member has a history of eczema and allergies, discuss feeding with your child's doctor. When you introduce solid foods and what foods you give your baby can help prevent some allergies.

There is also evidence that infants who are exposed to certain allergens in the air (such as dust mites and cat dander) may be less likely to develop allergies. This is called the "hygiene hypothesis." It came from the observation that infants on farms tend to have fewer allergies than those who grow up in more sterile environments. However, older children do not seem to benefit.

Once allergies have developed, treating the allergies and carefully avoiding allergy triggers can prevent reactions in the future.
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COPD

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD:

  • Chronic bronchitis, which involves a long-term cough with mucus
  • Emphysema, which involves destruction of the lungs over time

Most people with COPD have a combination of both conditions.

Causes, Incidence and Risk Factors

Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD.

In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.

Other risk factors for COPD are:

  • Exposure to certain gases or fumes in the workplace
  • Exposure to heavy amounts of secondhand smoke and pollution
  • Frequent use of cooking fire without proper ventilation
Complications
  • Irregular heartbeat (arrhythmia)
  • Need for breathing machine and oxygen therapy
  • Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease)
  • Pneumonia
  • Pneumothorax
  • Severe weight loss and malnutrition
  • Thinning of the bones (osteoporosis)
Calling Your Health Care Provider

Go to the emergency room or call the local emergency number (such as 911) if you have a rapid increase in shortness of breath.

Prevention

Not smoking prevents most COPD. Ask your doctor or health care provider about quit-smoking programs. Medicines are also available to help kick the smoking habit. The medicines are most effective if you are motivated to quit.
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Chronic Cough

Chronic cough — one lasting eight weeks or longer — is more than just an annoyance. A chronic cough can ruin your sleep and leave you feeling exhausted. Severe cases of chronic cough can result in vomiting, rib fractures and lightheadedness.

While it can sometimes be difficult to pinpoint the problem that's triggering your chronic cough, the most common causes are tobacco use, postnasal drip, asthma and acid reflux — the backflow of stomach acid, which can irritate your throat. Chronic cough typically disappears once the underlying problem is treated.
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Alpha-1 Antitrypsin Deficiency

Alpha-1 Antitrypsin Deficiency (Alpha-1) is a genetic condition that is passed on by parents to their children through their genes and can cause serious liver disease in children and liver and/or lung disease in adults.

Alpha-1 antitrypsin is a protein that is produced mostly in the liver. Its primary function is to protect the lungs from neutrophil elastase. Neutrophil elastase is an enzyme that normally serves a useful purpose in lung tissue-it digests damaged or aging cells and bacteria to promote healing. However, if left unchecked, it will also attack healthy lung tissue. Alpha-1 antitrypsin, in sufficient amounts, will trap and destroy neutrophil elastase before it has a chance to begin damaging the delicate lung tissue. Consequently, if an individual doesn't have enough alpha-1 antitrypsin, the enzyme goes unchecked and attacks the lung.

Facts about Alpha-1
  • It is estimated that Alpha-1 affects 1 out every 2,500 people in the US.
  • It takes an average of three doctors and seven years from the time lung symptoms first appear before proper diagnosis is made.
  • More than 12 million people have been diagnosed with COPD in the United States, and about 3 percent of them are predicted to have Alpha-1. (Another 12 million people with COPD don’t even know they have it, according to the National Heart, Lung & Blood Institute)
  • About 10 to 15% of all liver transplant candidates have the Alpha-1 related genetic abnormalities.
  • Alpha-1 is the most common genetic condition for which pediatric liver transplantation is done.
  • An estimated 20 million people in the United States are undetected carriers of an abnormal copy of the gene that causes Alpha-1, and may pass the copy of the gene on to their children.

Most people have two normal copies of the alpha-1 antitrypsin gene that make the protein. Some people may have one normal copy and one damaged copy of the gene; they are considered Alpha-1 Carriers. Individuals with two damaged copies of the gene have the severe deficiency of the alpha-1 antitrypsin protein and considered to have "Alpha-1" and are referred to as "Alphas."

Alpha-1 Carriers with only one abnormal copy of the gene can produce enough protein to stay healthy, especially if they do not smoke. However, people with two damaged copies of the gene can't produce enough alpha-1 antitrypsin, which can cause several conditions. They are often diagnosed with emphysema as their primary disease. Other common diagnoses include COPD (chronic obstructive pulmonary disease), asthma, chronic bronchitis, and bronchiectasis. Alphas are usually quite susceptible to lung infections. In the patient with Alpha-1, any of these conditions can cause further damage if they aren't treated right away.

Another disease that some patients with Alpha-1 develop is cirrhosis of the liver. This scarring of healthy liver tissue affects infants with Alpha-1, as well as 12% to 15% of adult Alphas. Unfortunately, there is no cure for cirrhosis of the liver, regardless of its cause. Cirrhosis can be managed as a chronic condition if caught early and protective steps are taken. Still, a liver transplant is currently the only option available for advanced disease.

Rarely, Alphas may also have a disease known as panniculitis. Panniculitis is an inflammation in the fatty tissue under the skin. It can occur in both children and adults.

Alphas and physicians regularly speak of a patient's "primary disease." This means the principal way the deficiency is manifested in a given patient, whether in the lungs, the liver, or the skin.
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Primary Immune Deficiency

Primary immunodeficiency disorders — also called primary immune disorders or primary immunodeficiency — weaken the immune system, allowing repeated infections and other health problems to occur more easily.

Many people with primary immunodeficiency are born missing some of the body's immune defenses, which leaves them more susceptible to germs that can cause infections.

Some forms of primary immunodeficiency are so mild they may go unnoticed for years.

Other types of primary immunodeficiency are severe enough that they are discovered almost as soon as an affected baby is born.

Treatments can boost the immune system for many types of primary immunodeficiency disorders. Most children with primary immunodeficiency disorders lead relatively normal lives, and are able to go to school and play with friends.

Many primary immunodeficiency disorders are inherited — passed down from one or both parents. Problems in the DNA — the genetic code that acts as a blueprint for producing the cells that make up the human body — cause many of the immune system defects in primary immunodeficiency.

There are numerous types of primary immunodeficiency disorders. They can be broadly classified into six groups based on the part of the immune system that's affected:

  • B cell (antibody) deficiencies
  • T cell deficiencies
  • Combination B and T cell deficiencies
  • Defective phagocytes
  • Complement deficiencies
  • Unknown (idiopathic)

B cell deficiencies are the most common type of primary immunodeficiency disorder.
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Sinusitis

(Acute sinusitis; Sinus infection; Sinusitis - acute; Sinusitis - chronic; Rhinosinusitis)

Sinusitis refers to inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.

Causes, Incidence and Risk Factors

The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes) that are lined with mucus membranes. Healthy sinuses contain no bacteria or other germs. Usually, mucus is able to drain out and air is able to circulate.

When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.

Sinusitis can occur from one of these conditions:

  • Small hairs (cilia) in the sinuses, which help move mucus out, do not work properly due to some medical conditions.
  • Colds and allergies may cause too much mucus to be made or block the opening of the sinuses.
  • A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

Sinusitis can be:

  • Acute -- symptoms last up to 4 weeks
  • Sub-acute -- symptoms last 4 - 12 weeks
  • Chronic -- symptoms last 3 months or longer

Acute sinusitis is usually caused by a bacterial infection in the sinuses that results from an upper respiratory tract infection. Chronic sinusitis refers to long-term swelling and inflammation of the sinuses that may be caused by bacteria or a fungus.

The following may increase your risk or your child's risk of developing sinusitis:

  • Allergic rhinitis or hay fever
  • Cystic fibrosis
  • Day care
  • Diseases that prevent the cilia from working properly, such as Kartagener syndrome and immotile cilia syndrome.
  • Changes in altitude (flying or scuba diving)
  • Large adenoids
  • Smoking
  • Tooth infections (rare)
  • Weakened immune system from HIV or chemotherapy
Complications

Although very rare, complications may include:

  • Abscess
  • Bone infection (osteomyelitis)
  • Meningitis
  • Skin infection around the eye (orbital cellulitis)
Calling Your Health Care Provider

Call your doctor if:

  • Your symptoms last longer than 10 - 14 days or you have a cold that gets worse after 7 days
  • You have a severe headache, unrelieved by over-the-counter pain medicine
  • You have a fever
  • You still have symptoms after taking all of your antibiotics properly
  • You have any changes in your vision during a sinus infection

A green or yellow discharge does not necessarily indicate a sinus infection or the need for antibiotics.

Prevention

The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

  • Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
  • Get an influenza vaccine each year.
  • Reduce stress.
  • Wash your hands often, particularly after shaking hands with others.

Other tips for preventing sinusitis:

  • Avoid smoke and pollutants.
  • Drink plenty of fluids to increase moisture in your body.
  • Take decongestants during an upper respiratory infection.
  • Treat allergies quickly and appropriately.
  • Use a humidifier to increase moisture in your nose and sinuses

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Recurring Ear Infections

An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.

Ear infections are often painful because of inflammation and buildup of fluids in the middle ear.

Because ear infections often clear up on their own, treatment often begins with managing pain and monitoring the problem. Ear infection in infants and severe cases in general require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — can cause hearing problems and other serious complications.

An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.

Role of eustachian tubes

The eustachian tubes are a pair of narrow tubes than run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:

  • Regulate air pressure in the middle ear
  • Refresh air in the ear
  • Drain normal secretions from the middle ear

Swelling, inflammation and mucus in the eustachian tubes from an upper respiratory infection or allergy can block them, causing the accumulation of fluids in the middle ear. A bacterial or viral infection of this fluid is usually what produces the symptoms of an ear infection.

Ear infections are more common in children, in part, because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.

Role of adenoids

Adenoids are two small pads of tissues high in the back of the throat believed to play a role in immune system activity. This function may make them particularly vulnerable to infection and inflammation.

Because adenoids are located near the opening of the eustachian tubes, inflammation or enlargement of the adenoids may block the tubes, thereby contributing to middle ear infection. Inflammation of adenoids is more likely to play a role in ear infections in children because children have more active and relatively larger adenoids.

Related conditions

Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include the following:

  • Otitis media with effusion is inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection. This may occur because the fluid buildup persists even after an ear infection has resolved. It may also occur because of some dysfunction or noninfectious blockage of the eustachian tubes.
  • Chronic suppurative otitis media is a persistent ear infection that results in tearing or perforation of the eardrum.

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Migraines

Headache is one of the top health complaints of Americans. We're bombarded with advertisements and we pay many millions of dollars for pain relievers. Headache also is one of the most common reasons people see physicians.

Three types of headaches may possibly be related to allergic disease - "sinus headaches" (facial pain), migraines and cluster headaches.

The connection between allergies and headaches

Years of published data and clinical experience suggest that food allergy may be a trigger of recurrent, persistent migraine headaches in a few, but by no means all patients. In such cases, only a few foods trigger migraines and, by limiting or avoiding them, you can experience complete or marked relief without medication. If you have a firm diagnosis of migraine made by a physician expert in the diganosis and treatment of migraine headaches, you may want to keep a diary of foods eaten and their relation to your headaches, and then request consultation with an allergist for evaluation and possible allergy testing. On a nonallergic basis, some migraines are provoked by food additives or naturally occurring food chemicals such as monosodium glutamate (often added to oriental food and packaged foods), tyramine (found in many cheeses), phenylethylamine (found in chocolate) or alcohol. The artificial sweetener aspartame has also been reported as a trigger migraine in some people.

When to visit your physician or allergist

Because each of us is different in how we handle pain, you must decide yourself. However, here are some conditions that might call for a visit with your physician:

  • The recent onset of frequent, moderate to severe headaches, associated with other symptoms such as nausea or vomiting.
  • Headaches that occur on a daily or weekly basis.
  • Headaches that make it impossible for you to think, do your work, go to school or enjoy life.
  • Headaches that respond only to a great deal of over-the-counter pain-relief medication.
  • Headaches with fever that last more than a day or two

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Uncontrolled Itching

Dermatitis is a general term that describes an inflammation of the skin. There are different types of dermatitis, including seborrheic dermatitis and atopic dermatitis (eczema). Although the disorder can have many causes and occur in many forms, it usually involves swollen, reddened and itchy skin.

Dermatitis is a common condition that usually isn't life-threatening or contagious. But, it can make you feel uncomfortable and self-conscious. A combination of self-care steps and medications can help you treat dermatitis.

A number of health conditions, allergies, genetic factors, physical and mental stressors, and irritants can cause dermatitis.

Contact Dermatitis. This condition results from direct contact with one of many irritants or allergens.

Common irritants include:

  • Laundry soap
  • Skin soaps or detergents
  • Cleaning products

Possible allergens include:

  • Rubber
  • Metals, such as nickel; jewelry
  • Perfume and fragrances
  • Cosmetics
  • Weeds, such as poison ivy
  • Neomycin and bacitracin, common ingredients in topical antibiotic creams

Neurodermatitis. Also known as lichen simplex chronicus, this type of dermatitis typically develops when something has created an itchy sensation in a specific area of your skin. This irritation may lead you to rub or scratch your skin repeatedly in that area. Common locations include the ankle, wrist, outer forearm or arm, and the back of your neck.

Possible underlying factors include:

  • Dry skin
  • Chronic irritation
  • Eczema

Seborrheic dermatitis. This condition causes a red rash with yellowish and somewhat "oily" scales, usually on the scalp and sometimes on the face, especially around the ears and nose. It's common in people with oily skin or hair, and it may come and go depending on the season of the year. It's likely that hereditary factors play a role in this condition.

Possible underlying factors include:

  • Physical stress
  • Neurological conditions, such as Parkinson's disease

In infants, this disorder is known as “cradle cap.”

Stasis dermatitis. Stasis dermatitis can occur when fluid accumulates in the tissues just beneath the skin — typically on your lower legs — due to a sluggish return of blood from the leg veins back to the heart. The extra fluid interferes with your blood's ability to nourish your skin and places extra pressure against your skin from underneath.

Possible underlying factors include:

  • Varicose veins
  • Obesity, often extreme
  • Other chronic conditions or recurrent infections that affect circulation in your legs, such as pregnancy or deep vein thrombosis

Atopic dermatitis. This condition often occurs with allergies and frequently runs in families in which members have asthma, hay fever or eczema. It usually begins in infancy and may vary in severity during childhood and adolescence. It tends to become less of a problem in adulthood, unless you're exposed to allergens or irritants in the workplace.

Possible underlying factors include a combination of:

  • Dry, irritable skin
  • A malfunction in the body's immune system
  • A genetic tendency for allergic conditions such as asthma, hay fever or eczema

Stress can exacerbate atopic dermatitis, but it doesn't cause it.

Perioral dermatitis. This type of dermatitis may be a form of the skin disorder rosacea, adult acne or seborrheic dermatitis, involving the skin around the mouth or nose.

Possible underlying factors include:

  • Makeup
  • Moisturizers
  • Topical corticosteroids

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Contact Dermatitis (Poison Ivy/Oak/Sumac)

Contact dermatitis is a condition in which the skin becomes red, sore, or inflamed after direct contact with a substance. There are two kinds of contact dermatitis: irritant or allergic.

Causes, Incidence and Risk Factors

Irritant dermatitis is the most common type. It's caused by contact with acids, alkaline materials such as soaps and detergents, fabric softeners, solvents, or other chemicals. The reaction usually looks like a burn.

Other irritants may include:

  • Cement
  • Hair dyes
  • Long-term exposure to wet diapers
  • Pesticides or weed killers
  • Rubber gloves
  • Shampoos

Allergic contact dermatitis is caused by exposure to a substance or material to which you have become extra sensitive or allergic.

Common allergens include:

  • Adhesives, including those used for false eyelashes or toupees
  • Antibiotics such as neomycin rubbed on the surface of the skin
  • Balsam of Peru (used in many personal products and cosmetics, as well as in many foods and drinks)
  • Fabrics and clothing
  • Fragrances in perfumes, cosmetics, soaps, and moisturizers
  • Nail polish, hair dyes, and permanent wave solutions
  • Nickel or other metals (found in jewelry, watch straps, metal zips, bra hooks, buttons, pocketknives, lipstick holders, and powder compacts)
  • Poison ivy, poison oak, poison sumac, and other plants
  • Rubber or latex gloves or shoes

Although you may not have a reaction to a substance when you are first exposed to it, regular use can eventually cause sensitivity and a reaction to the product.

Some products cause a reaction only when the skin is also exposed to sunlight (photosensitivity). These include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime. A few airborne allergens, such as ragweed or insecticide spray, can cause contact dermatitis.

Complications

Bacterial skin infections may occur.

Calling Your Health Care Provider

Call your health care provider if:

  • You have symptoms of contact dermatitis
  • It is severe
  • There is no improvement after treatment

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Skin Rashes

Skin rashes can occur from a variety of factors, including infections, heat, allergens, immune system disorders and medications.

Skin rashes may cause discomfort or pain, as well as embarrassment about the appearance of your skin. Some skin rashes, such as heat rash and swimmer's itch, clear up on their own, but others, including rosacea and shingles, may require medical treatment.

Atopic dermatitis

Atopic dermatitis (ay-TOP-ik der-muh-TI-tis), commonly referred to as eczema, is an ongoing (chronic) condition that causes itchy, inflamed skin. Most often it appears as patches on the face, neck, trunk or limbs. It tends to flare up periodically and then subside for a time.

At-home interventions, such as avoiding harsher soaps and detergents or other irritants and applying creams or lotions, can lessen symptoms or reduce the risk of flare-ups. Medicated creams or ointments also can lessen symptoms.

Christmas tree rash (pityriasis rosea)

Christmas tree rash (pityriasis rosea) is a fine, itchy, scaly rash that usually appears first as a single patch on the chest, abdomen or back. After this first appearance (herald patch), the rash may spread as small patches to other parts of the back and chest and to the limbs. The rash may form a pattern on the back that resembles the outline of a Christmas tree.

Christmas tree rash usually resolves without treatment within six to eight weeks, but it can last several months. Medicated lotions may lessen itchiness and may help hasten its disappearance, but they're often not required.

Contact dermatitis

Contact with an irritant or allergen causes this form of dermatitis. Irritant contact dermatitis (A) usually produces a dry, scaly rash with a burning itch or pain. Exposure to a chemical, such as a cleaning product or industrial chemical causes this condition. The irritant will cause a rash on anyone exposed to it, but some people's skin may be more easily affected, and the severity of a reaction may vary with duration of exposure and the amount of irritant.

Allergic contact dermatitis (B) produces a very itchy, red rash with bumps and sometimes blisters. Common allergy-causing agents (allergens) include latex rubber, nickel, costume jewelry, perfume, cosmetics, nail polish and poison ivy. Allergic contact dermatitis affects people who develop immune system sensitivity to the allergen.

Avoiding the irritant or allergen allows the rash to heal, and medications may improve symptoms.

Drug rash

A drug rash may be either a side effect of a drug or an allergic reaction to a medication. While any medication may cause a drug rash, common culprits include antibiotics, anti-seizure medications and diuretics. Some drugs are more likely to produce a rash if the skin is exposed to sunlight.

A drug rash, which usually starts within the first week of taking a new medication, often begins as discrete red spots that spread, covering large areas of the body. The rash usually resolves in days to weeks after discontinuing the medication.

A drug rash can rarely be part of a more serious, potentially life-threatening allergic reaction that affects the respiratory system and other organs. These severe reactions require emergency care.

Heat rash (miliaria)

Heat rash (miliaria) occurs when the flow of sweat is obstructed, usually due to hot, humid weather, overdressing, or tightfitting clothes.

Prickly heat (miliaria rubra) is a type of heat rash that appears as clusters of small, red bumps that produce a pricking or stinging sensation (A). Miliaria crystallina appears as clear, fluid-filled bumps that generally produce no other signs or symptoms (B).

Heat rash isn't serious and usually resolves with proper self-care methods, such as keeping the affected areas cool and dry and avoiding tight, restrictive clothes.

Intertrigo

Intertrigo (in-TUR-try-go) is inflammation caused by skin-to-skin friction, most often in warm, moist areas of the body, such as the groin, between folds of skin on the abdomen, under the breasts, under the arms or between toes. The affected skin may be sensitive or painful, and severe cases can result in oozing sores, cracked skin or bleeding.

Damage to the skin and the warm, moist environment can easily result in bacterial or fungal infections at the site.

Intertrigo usually improves with proper self-care methods, such as keeping the affected areas clean and dry, using powders, wearing loosefitting clothing, and losing weight if appropriate. Infections related to intertrigo require drug treatment.

Lichen planus

Lichen planus (LIE-kun PLAY-nus) usually appears as purplish, often itchy, flat-topped bumps (lesions), most often located on the inner forearm and near the wrists or ankles. Other common locations include the lower back, neck and legs.

The condition rarely worsens after the first couple of months, but it may persist for months or years. Mild cases may need relatively simple at-home care or no treatment. When symptoms are severe, such as pain or significant itching, drug treatment may improve symptoms.

Lichen planus may also affect mucous membranes, genitals, the scalp or nails. The lesions associated with these sites generally cause more discomfort. The symptoms are more difficult to manage, often persist for long periods and often recur after initial healing.

Psoriasis

Psoriasis (suh-RI-uh-sis) is the rapid buildup of rough, scaly skin that occurs when the life cycle of skin cells rapidly increases. The accumulation of dead skin cells results in thick, silvery scales and itchy, dry, inflamed patches that are sometimes painful.

The condition tends to flare up periodically and then subside for a time before returning again.

For some people, psoriasis is a mild nuisance. For others, it can be severely disabling because the skin loses its protective function, and the condition may coexist with arthritis. Topical medications and light therapy may help reduce signs and symptoms of the skin lesions.

Ringworm of the body (tinea corporis)

Ringworm of the body (tinea corpus) is a fungal infection that appears as itchy, red, scaly, slightly raised, expanding rings on the body. The ring grows outward as the infection spreads, and the center area becomes less actively infected.

Ringworm is contagious and spreads several ways, including skin-to-skin contact or contact with a contaminated object such as unwashed clothing. Treatment usually requires an antifungal prescription medication.

A tinea infection in the groin is called jock itch (tinea cruris), and a tinea infection of the foot is called athlete's foot (tinea pedis).

Rosacea

Rosacea (ro-ZA-she-uh) is a chronic, inflammatory skin condition of adults that looks somewhat like acne. It causes redness in the face and produces either small red bumps or pus-filled bumps.

For most people, rosacea tends to flare up periodically, lessen in intensity, and then flare up again. Certain foods, skin products, extreme temperatures and sun exposure can trigger an episode.

Although there's no cure, treatments may control or reduce the signs and symptoms.

Shingles (herpes zoster)

Shingles (herpes zoster) is a condition caused by the chickenpox virus (varicella-zoster virus). After a person has chickenpox, the virus remains dormant, or inactive, in nerve cells. If it's reactivated during adulthood, it causes shingles.

Shingles first appears as a burning or shooting pain, tingling, or itch. A rash with small blisters — similar in appearance to chickenpox — appears later. These blisters break, leaving behind ulcers that dry and form crusts.

Shingles usually resolves within a few weeks without treatment. Antiviral drugs may lessen pain or decrease the likelihood of persistent pain after the rash has healed. Vaccination is available to help prevent recurrence, and although it's not always effective, the vaccine is recommended for most people older than age 60.

Swimmer's itch

Swimmer's itch (cercarial dermatitis) is a burning or itchy rash caused by an allergic reaction to a waterborne parasite that burrows into the top layer of skin. The rash usually produces tiny bumps or blisters.

Because swimmer's itch is an allergic reaction, repeated exposure to infected water can increase a person's sensitivity and result in worse symptoms with each subsequent exposure.

Swimmer's itch isn't serious and usually resolves without medical treatment within one week. At-home remedies — soothing lotions, colloidal oatmeal baths or baking soda baths — may lessen symptoms.
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Urticaria (Hives)

Chronic hives, also known as urticaria, are batches of raised, red or white itchy welts (wheals) of various sizes that appear and disappear. While most cases of hives go away within a few weeks or less, for some people they are a long-term problem. Chronic hives are defined as hives that last more than six weeks or hives that go away, but recur frequently.

In most cases of chronic hives, a cause is never clearly identified. In some cases, chronic hives may be related to an underlying autoimmune disorder, such as thyroid disease or lupus.

While the underlying cause of chronic hives is usually not identified, treatment can help with symptoms. For many people, antihistamine medications provide the best relief.

Chronic hives are an inflammation of the skin triggered when certain cells (mast cells) release histamine and other chemicals into your bloodstream, causing small blood vessels to leak. The exact cause of chronic hives isn't well understood — and triggers can be difficult to pinpoint. Chronic hives are thought to be caused by an immune system (autoimmune) disorder and may be linked to another health problem, such as thyroid disease or lupus.

Rarely, a reaction to medication, food, food additives, insects, parasites or infection is identified as an underlying cause of chronic hives. But in most cases, the cause of chronic hives is never identified, even after testing and monitoring symptoms. Heat, cold, pressure, sunlight or other environmental stimuli may worsen chronic hives. Certain pain medications, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, Anaprox, others), also can worsen chronic hives.
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Angioedema

Angioedema is a skin reaction that causes raised, red, itchy welts (wheals, or swellings) in sizes ranging from small spots to large blotches several inches in diameter. Individual welts appear and fade as the reaction runs its course. Angioedema is a related type of swelling that affects deeper layers in your skin, often around your eyes and lips.

In most cases, hives and angioedema are harmless and don't leave any lasting marks, even without treatment. The most common treatment for hives and angioedema is antihistamine medications. Serious angioedema can be life-threatening if swelling causes your throat or tongue to block your airway and leads to loss of consciousness.

Angioedema is caused by triggers that produce a skin or tissue reaction by stimulating certain cells (mast cells) to release histamine and other chemicals into your bloodstream.

Sometimes it's not possible to pinpoint the cause of hives and angioedema, especially when these conditions become chronic or recur.

Allergic reactions are one common trigger of acute hives and angioedema. Common allergens include:

  • Foods. Many foods can trigger reactions in people with sensitivities. Shellfish, fish, peanuts, tree nuts, eggs and milk are frequent offenders.
  • Medications. Almost any medication may cause hives or angioedema. Common culprits include penicillin, aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve, others) and blood pressure medications.
  • Other allergens. Other substances that can cause hives and angioedema include pollen, animal dander, latex and insect stings.

Additional triggers include:

  • Environmental factors. In some people, environmental factors can stimulate release of histamine. Examples include heat, cold, sunlight, water, pressure on the skin, emotional stress and exercise.
  • Dermatographia (also known as dermographia). The name of this condition literally means "skin writing." Stroking or scratching the skin results in raised red lines in the same pattern as the pressure.

Angioedema also occasionally occur in response to blood transfusions, immune system disorders such as lupus, some types of cancer such as lymphoma, certain thyroid conditions, and infections with bacteria or viruses such as hepatitis, HIV, cytomegalovirus or Epstein-Barr virus.

Hereditary angioedema is a rare inherited (genetic) form of the condition. It's related to low levels or abnormal functioning of certain blood proteins (C1 inhibitors) that play a role in regulating how your immune system functions.
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Insect Allergies (Bee Sting)

Bee stings are a common outdoor nuisance. In most cases, bee stings are just annoying and home treatment is all that's necessary to ease the pain of bee stings. But if you're allergic to bee stings or you get stung numerous times, you may have a more serious reaction that requires emergency treatment. You can take several steps to avoid bee stings — as well as hornet and wasp stings — and find out how to treat them if you do get stung.

Bee sting venom contains proteins that affect skin cells and the immune system, causing pain and swelling around the sting area. In people with a bee sting allergy, bee venom can trigger a more serious immune system reaction.

Possible, though uncommon, complications of bee and other insect stings include:

  • Anaphylaxis. A severe allergic reaction is the most dangerous complication of a bee or other insect sting. A rapid fall in blood pressure can lead to loss of consciousness, and can sometimes be fatal. Anaphylaxis requires an emergency shot of epinephrine and a trip to the emergency room.
  • Toxic reaction to multiple stings can be dangerous, especially in children. Because children are smaller than adults, fewer stings can create high levels of venom in the bloodstream. Complications of massive poisoning by venom (envenomation) include heart problems, rapid muscle tissue damage (rhabdomyolysis) and kidney failure.
  • Infection at the site of a sting. As with other cases when the skin is broken, a sting site may become infected. Scratching a sting site can increase your risk of infection.

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