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Skin rash: possible causes and when to worry

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • Swelling of the face, lips or tongue, a tight throat or shortness of breath
  • Fever with purple or bruise-like spots that do not fade when pressed
  • Widespread blisters or peeling skin
  • A rash with fever and dengue warning signs
  • Shingles on the face or near an eye

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Warning signs: when to go to the ER

A skin rash usually comes from something that touched your skin, an allergy, eczema or an infection such as shingles. In Puerto Rico, a rash with fever can also be dengue. Most rashes get better with simple care. Call 911 if your face swells, your throat feels tight or you are short of breath, and go to the ER for a fever with purple spots.

  • Contact dermatitis or eczema — red, itchy skin where something touched it, or that flares and settles
  • Allergies and hives — raised itchy welts that move around
  • Shingles — painful blisters in a stripe on one side
  • Dengue — rash with fever and eye or bone pain
  • Impetigo — oozing sores with a honey-colored crust
  • Bites or a medicine reaction — appears after a bite or after starting a new medicine

Common causes of a skin rash

The causes table on this page lists the usual ones. How the rash looks and where it appears are useful clues:

  • Contact dermatitis: redness and itching where skin touched something, such as soaps, detergents, cosmetics, clothing dyes, latex or plants. See dermatitis.
  • Eczema: red, dry, scaly, itchy skin that flares and settles.
  • Hives: raised, itchy welts that move around; they can come from an allergy, a medicine or an infection.
  • Shingles: pain, itching or tingling, then blisters in a stripe on one side of the body or face. See shingles.
  • Impetigo: red sores that blister, ooze and form a honey-colored crust.
  • Insect bites and reactions to a new medicine.

Rash and fever in Puerto Rico: think about dengue

Dengue can cause a fever with a rash, pain behind the eyes and bone or joint pain. If you have a rash with a fever, read our dengue warning signs guide and watch closely as the fever starts to fall. If dengue is possible, the CDC advises acetaminophen and no aspirin or ibuprofen. Visitors are at risk too.

Home care for a rash

If the rash is mild and you have no warning signs:

  • Wash with warm, not hot, water and a gentle cleanser. Do not scrub; pat dry.
  • Leave the area open to the air as much as you can.
  • Avoid whatever may have set it off: a new soap, fragrance, cream or plant.
  • Calamine lotion can soothe contact dermatitis, and over-the-counter hydrocortisone cream can help many rashes.
  • Try not to scratch; keep nails short.

When can a telehealth visit help with a rash?

Many rashes can be assessed well by video, with good natural light and the camera close to the skin. An online doctor visit can help with dermatitis, eczema, hives without other symptoms, early shingles, or a rash that is not improving with home care. The doctor will assess what she sees and what you tell her. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances.

Show your skin only during the video visit; do not send skin photos by WhatsApp or email. The doctor will assess whether a rash needs to be touched, biopsied or seen by a specialist.

Shingles: do not wait

If you feel pain, burning or tingling on one side of your body and then blisters appear in a stripe, get checked promptly: antiviral treatment works best when started early. If shingles is on your face or near an eye, get care the same day, because it can affect your vision.

When do you need the ER or an in-person visit?

Call 911 if you are short of breath, your throat feels tight or your face is swelling. Go to the ER for a fever with purple or bruise-like spots that do not fade when you press a glass on them, or widespread blisters with peeling skin. Get seen soon if the rash comes with fever, joint pain or a sore throat; if there are red streaks, swelling or very tender areas; if it started with a new medicine; if it may be from a tick bite; or if it keeps getting worse. See when to go to the ER.

Rashes in children

Children get different rashes: viral rashes, hand, foot and mouth disease, chickenpox, diaper rash or impetigo. Read rashes in children.

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Frequently asked questions

When is a skin rash dangerous?
It is an emergency if it comes with facial swelling, a tight throat or shortness of breath, or with a fever and purple spots that do not fade when pressed. Also get seen soon for a rash with fever, widespread blisters, or one that started with a new medicine.
Can a rash be assessed over video?
Often, yes. With good light and the camera close up, the doctor can see the rash and ask the right questions. If the skin needs to be touched, tested or seen by a dermatology specialist, she will tell you.
What can I put on an itchy rash?
For many mild rashes, over-the-counter calamine lotion or hydrocortisone cream helps, along with washing in warm water and not scratching. If it does not improve or gets worse, get it checked.

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