What's That Rash?

When cold weather ushers in dry, red, itchy skin, you probably feel like an unlucky contestant on a rash-guessing quiz show: Is it dry skin...or some exotic flesh-eating bacteria you heard about on the news? The bacteria's a long shot, but what you might mistake for simple dryness could be a skin disease that gets worse in the winter and needs targeted treatment to heal.

"The skin is the largest organ in the body, and you need to moisturize it in the winter," advises Neera Agarwal-Antal, MD, a dermatologist in private practice at Hudson Dermatology in Hudson, Ohio. It's no fun to play "What's That Rash?" but your fabulous prize can be finally finding relief.

Warning: Graphic images ahead

Looks:

Red and irritated, eventually taking on a brown, leathery appearance after too much scratching.
Caused by: Doctor's don't know exactly, but it begins when something irritates the skin, and the more you scratch it, the more it itches.
Feels: Itchy, itchy, itchy.
Contagious: No.
Where: Ankles, wrists, neck, rectum, arms, legs, back of the knee, inner elbow.
Treatment: Stop scratching! We know that's easier said than done. You may need help from an anti-itching cream, such as hydrocortisone, as well as antihistamines or even tranquilizers prescribed by your doctor. Salicylic acid medications may be used on thickened lesions.
See a doctor if: The itching worsens, or your skin starts to get infected (you experience pain or fluid leaks from the lesion).

Looks like:

Red, scaly patches with distinct edges that can resemble a ring. Sometimes the patches blister and ooze.
Caused by: Not a worm, despite the name. The culprit is a tenacious little fungus called tinea that thrives in warm, moist areas.
Feels: Very itchy.
Where: Anywhere, but often in warm, cozy areas like skin folds or on the scalp.
Contagious: Yes, it's spread though through direct skin-to-skin contact or with personal items such as towels, and on locker room and pool surfaces. You can also catch it from pets.
Treatment: Over-the-counter antifungal creams that contain miconazole or clotrimazole. Continue to use them for one to two weeks after the rash has cleared to prevent reinfection, and wash sheets every day.
See a doctor if: The infection won’t clear up. Your doctor may give you a prescription topical lotion or antifungal pills.

Looks like:

Thick, red patches of skin covered by flaky, white scales (this describes the most common kind, plaque psoriasis). Other types are guttate (small, red spots), pustular (white pustules surrounded by red skin), inverse (lesions in skin folds), and erythrodermic (widespread redness, itching, and pain).
Caused by: An immune system dysfunction that causes overproduction of skin cells. Though a chronic condition, psoriasis can be triggered by dry skin; minor skin injuries; stress; sunburn or UV deprivation; and some infections, like strep throat.
Feels: Sometimes painful and can be very embarrassing.
Where: Elbows, knees, or torso, but can appear anywhere.
Contagious: No.
Treatment: Keep skin lubricated. Depending on severity and location, treatment may include OTC cortisone creams, coal tar ointments, salicylic acid products, or dandruff shampoos. Exposure to sunlight can help clear skin (but avoid burning).
See a doctor if: Your skin doesn't clear with OTC treatment. Doctors can prescribe prescription topicals, phototherapy (light therapy), systemic medications, or newer drugs called biologics, which target the body’s immune response.

Looks like:

Anything from scaly, dry patches to gooey blisters and dry, leathery areas.
Caused by: There is no proven cause, but European scientists have found that people are genetically susceptible to it, and triggers can include certain fabrics, warm clothing, deodorant, soaps, excessive bathing or perspiration, and stress.
Feels: Intensely itchy.
Where: Often on the inside of knees and elbows, face, and neck, but can crop up anywhere.
Contagious: No.
Treatment: Keep skin moist. Take brief showers with warm (not hot) water. Apply moisturizer immediately after bathing when skin is still damp. Slap on the heaviest ointment you can manage. Over-the-counter anti-itch lotions and topical corticosteroids can soothe skin.
See a doctor if: It doesn’t clear up after vigilant moisturizing efforts, or skin is cracked and painful.

Looks:

Red, chapped, scaly, or cracked, and makes you look older than you feel.
Caused by: Dry winter air, harsh soaps, chemicals.
Feels: Dry and itchy.
Where: Mostly lower legs and arms, but possible anywhere.
Contagious: No.
Treatment: Wear gloves outside. Keep showers brief and use warm (not hot) water. Try a mild soap such as Cetaphil or Dove and don't soap up driest areas. Apply moisturizer immediately after bathing while skin is still damp. Slather on the heaviest, greasiest product you can tolerate.
See a doctor if: The itching prevents you from sleeping or you suspect it is something other than dry skin.

Looks like:

Snowflakes on your shoulders or a less poetic accumulation of yellowish scales on your scalp. Scalp can also be red and irritated.
Caused by: Oily skin getting cozy with a yeast called malessizia.
Feels: Itchy (and embarrassing).
Where: Usually the scalp but sometimes on eyebrows, eyelids, behind the ears, or in skin folds.
Contagious: No.
Treatment: Over-the-counter medicated dandruff shampoos with active ingredients such as salicylic acid, coal tar, zinc, resorcin, ketoconazole, or selenium. Shampoo daily, using fingertips to massage scalp and loosen scales.
See a doctor if: It doesn’t respond. Your doctor can prescribe stronger shampoos and medicated lotions containing selenium, ketoconazole, or corticosteroids.

Looks like:

Cracked, flaky, red skin, sometimes with weeping blisters.
Caused by: A workaholic fungus called tinea pedis that loves to live it up in humid areas.
Feels like: Burning and stinging.
Where: Between the toes, anywhere on the foot or hands.
Contagious: Yes, it can be passed through direct personal contact, in showers and pools, or by contact with someone else’s shoes and socks.
Treatment: Over-the-counter antifungal powders or creams that contain miconazole, clotrimazole, or tolnaftate. Continue to use them for one to two weeks after athlete’s foot has cleared to prevent reinfection.
See a doctor if: The rash doesn’t clear after two to four weeks of using OTC products. Your physician can prescribe stronger, prescription antifungals.

Looks like:

Red patches with sharply defined edges that may blister and ooze.
Caused by: That overzealous tinea cruris fungus strikes again.
Feels: Itchy.
Where: In the groin, anus, or the creases of the upper thighs.
Contagious: Yes, you can get it through skin-to-skin contact or contact with unwashed clothing.
Treatment: Keep area clean and dry, wear loose-fitting clothes that won’t irritate the affected area, and apply an over-the-counter antifungal that contains miconazole, clotrimazole, or tolnaftate.
See a doctor if: It lingers for more than two weeks. Your doctor can prescribe stronger medications, including oral antifungals.