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Red Patches on the Skin by G.Bertelli

Generality

Red spots on the skin are a symptom that can be caused by many factors.

The redness can be localized (ie limited to certain regions of the body, such as the face or trunk) or widespread (when the rash occurs on large areas). Red spots may develop on the surface of the skin, but may also be associated with reactions that originate in the deep subcutaneous tissue or involve the organism systemically .

Depending on the aetiology, red spots on the skin can be accompanied by other ailments, such as itching, a sense of heat and swelling. Sometimes, papules, vesicles, blisters and flaking can also be found.

The appearance of red spots on the skin (number, size and distribution of skin lesions), the affected sites, the evolution over time and the appearance in relation to other symptoms are important aspects for the differential diagnosis.

Therefore, when this manifestation occurs, it is important to contact the reference dermatologist who, on the basis of the triggering factor, will establish the most appropriate treatment.

What are

Red spots on the skin are the direct expression of a pathological process that affects the skin surface or the entire body. These single or multiple lesions are characterized by a more or less regular redness and variable dimensions. Even the coloring is not always uniform: it goes from pale red (near pink) to darker purple.

Causes and Risk Factors

There are many conditions within which the appearance of red spots on the skin is one of the main characteristics.

The causes include various forms of dermatitis, skin inflammation manifested by redness of the epidermis, itching and sometimes dryness and cracking. The skin can react with the formation of red spots on the skin even after contact with irritating substances or allergens (irritative contact dermatitis or allergies). Similar injuries can occur in the skin even in the case of insect bites or adverse reactions to drugs or personal hygiene products.

The appearance of red spots on the skin can also occur in patients suffering from acne and infectious diseases (including chickenpox, shingles and measles). Other causes are physical (mechanical or thermal; eg severe burns, intense friction and rubbing), chemical, hormonal and psycho-emotional.

Those listed below are the main causes of the appearance of red spots on the skin.

Erythema

Erythema is a redness of the skin that has the peculiarity of disappearing under the pressure of the fingers, only to reappear with the cessation of the same.

This type of red spot on the skin is associated with numerous dermatological conditions, but may also depend on systemic diseases .

In reality, these signs can take on different chromatic shades, therefore they are distinguished:

  • "Active" forms of erythema ( bright red spots ): the redness is due to the arteriolar dilation and to the increase of the local temperature; it can be circumscribed (eg reaction to physico-chemical agents and rosacea ) or widespread (as in the case of infantile exanthematic diseases ; eg measles, scarlet fever or roseola). One of the most common forms of active erythema is solar .
  • "Passive" forms of erythema ( bluish-red spots ): it is associated, instead, to phenomena of venous stasis ; it presents with cyanosis and lowering of the local temperature. The main forms of passive erythema include: acrocyanosis, chilblains, reticular livedo, cutis marmorata and Raynaud's syndrome.

Physical and chemical factors

  • Severe burns and / or burns - Exposure to flames, steam or contact with a very hot surface can cause red spots to appear on the skin, as well as radiation.
  • Exposure to extreme cold - Rarely, red spots on the skin can form due to tissue damage sustained by freezing . Usually, this manifestation involves hands and feet, ie the body parts most easily exposed to the external environment.
  • Friction or rubbing - Red spots on the skin can develop following friction (or continuous pressure ) exerted against a particularly sensitive portion of skin exposed to external aggression.

Urticaria

Urticaria is a rash characterized by the appearance of wheals (small red skin bumps), usually accompanied by intense itching . This condition can be on an allergic basis, so the red spots on the skin are determined by a reaction of the immune system against certain foods (such as kiwi, milk, eggs), drugs (including aspirin and antibiotics), pollen or cosmetics for daily body care.

However, the triggering causes can be multiple and include the use of synthetic clothing, contact with irritating plants and prolonged stress.

The non-allergic causes of hives also include:

  • Viral, bacterial or parasitic infections, including viral hepatitis, mononucleosis and candida;
  • Alteration of cholinergic pathways (excessive sweating);
  • External physical stimuli, such as friction or pressure on the skin, water, temperature change or sunlight.

The red spots on the skin, localized or widespread, develop on the surface, but may be associated with oedematous reactions in the deep subcutaneous tissue (angioedema). Most episodes last less than six weeks (acute urticaria), while an eruption that lasts for a longer time characterizes the chronic form.

Allergies and reaction to irritants

The skin can react with the formation of red spots when it comes into contact with irritating, stinging or allergenic substances (pollens, insect bites, dust mites, spider bites etc.). This condition is known as contact dermatitis, an inflammation that occurs most commonly in the hands and face. Red spots on the skin can also develop as an adverse effect induced by some medicines.

In addition to red spots on the skin, contact dermatitis is manifested by symptoms such as itching, burning, scaly lesions and blisters.

Angioma

Angiomas are a disease that results from a defect in blood vessels present since birth; in many cases, these lesions tend to disappear spontaneously.

Angiomas appear as red spots on the skin.

In particular, depending on the shape and color, we can distinguish:

  • Flat angioma : commonly called "strawberry wish", it is a bright red spot, which appears above all on the head and on the neck. The diameter varies from 3 millimeters to 10 centimeters. It usually occurs in the first weeks of life;
  • Ruby or senile angioma : it occurs in old age, with very small spots, of about 3 millimeters, bright red or cherry, characterized by the presence of many capillaries under the skin. Over time, the stains can turn into small solid circular reliefs - called papules - similar to red gods. The ruby ​​angioma does not cause itching or pain and can be eliminated, for aesthetic reasons, with laser or cryotherapy;
  • Stellar angioma : it consists of a red spot on branched skin (similar to a small spider), which appears on the face, legs or trunk.

Atopic dermatitis (atopic eczema)

Red spots on the skin can also be one of the symptoms of atopic dermatitis, a chronic, non-contagious inflammatory disease characterized by the appearance of erythematous and itchy lesions. The causes that trigger the disease have not yet been completely clarified, but genetic, immune and environmental factors seem to be involved, which contribute to altering the skin barrier, modifying the metabolism of the lipids found in the epidermis. In practice, people who suffer from atopic dermatitis have excessively reactive skin against various stimuli, such as: dry skin, abrupt temperature changes, wool or synthetic fabrics, dust, body care products, some foods, sweating and emotional stress.

As a result, the skin of the face and body becomes reddened, dry, rough, itchy and irritable.

Rosacea

Rosacea is a chronic disease of the skin that usually occurs with red spots on the skin of the face - in particular, on the nose, cheeks and chin - sensation of heat, swelling, dilated capillaries and, sometimes, pustules. In the most serious cases, this condition can lead to hyperkeratosis, or thickening of the stratum corneum of the skin.

petechiae

The petechiae are small red spots on the skin, not itchy, of circular shape and usually not exceeding 3 mm. These lesions are caused by the leakage of blood from the capillaries and, in most cases, appear as red spots on the skin of arms and legs, but can also emerge on the face.

At the face level, petechiae can be caused by trauma (severe coughing or vomiting). The red spots on the skin of the body can derive, instead, from diseases that alter the coagulative capacity of the blood such as amyloidosis, hemophilia, lupus erythematosus and leukemia. In some cases, petechiae depend on a vitamin K deficiency.

Normally, petechiae tend to reabsorb on their own within a few days.

Pityriasis rosea

Pityriasis rosea is an inflammatory skin disorder. This is manifested by red spots on the chest and trunk skin, oval and slightly raised, which can reach up to 8 cm in size. The eruption tends to reabsorb spontaneously in a few weeks. Pityriasis rosea mainly affects young subjects (between 10 and 35 years) and reaches the peak of incidence in the spring and autumn months.

The cause is unknown, but a bacterial and / or viral origin has been hypothesized (in particular, the reactivation of human herpes viruses 6 and 7 seems to be implicated).

Other pathological conditions

Red spots on the skin are a common symptom that characterizes many infectious diseases and a number of other diseases of different origins, such as:

  • Measles : infectious infectious disease that occurs frequently in childhood, but can also be contracted by adults. Red spots on the skin appear on the stomach, chest, arms and other parts of the body. These signs are strongly itchy and, when rubbed, turn into crusts.
  • Schamberg syndrome : is a progressive pigmentary dermatosis that causes the appearance of small purple-colored roundish spots. Usually, it appears on the legs, but it can also extend to the arms and, more rarely, to the face.
  • Systemic Lupus Erythematosus : chronic autoimmune disease that can manifest itself with red spots on the skin (on the face, these take the form of a butterfly).
  • Acne : is a dermatological disease characterized by the appearance of small red spots on the skin, which evolve into pimples and pustules. This pathology is due to the hyperactivity of the sebaceous glands, the obstruction of the pores of the skin and their inflammation.

Other diseases that can occur with the appearance of red spots on the skin are:

  • Scarlet fever;
  • Chickenpox;
  • Rubella;
  • Herpes simplex (herpetic infection that occurs most frequently around the lips);
  • Shingles (shingles);
  • Ringworm (or tinea corporis);
  • Intertrigo;
  • Skin cancer;
  • Typhus;
  • Syphilis.

Symptoms and Complications

The red spots on the skin appear as a reddening of various shapes (round or irregular, flat or raised on the skin surface, etc.) and dimensions (from a few millimeters to several centimeters in diameter).

As for the extension, this event can appear anywhere. Red spots on the skin may be limited to a specific area or spread to multiple areas of the body or over large areas.

Local or general redness

Red spots on the skin can occur due to a localized problem or a systematic disease, involving one or more organs, or systems of the human body.

Given the wide spectrum of dermatological conditions and not which they can be associated with, these lesions may be accompanied by numerous other signs and disorders.

In particular, red spots on the skin can manifest themselves in association with:

  • Ache;
  • Edema;
  • Itch;
  • Burning sensation or tingling;
  • Numbness or tingling;
  • Hypersensitivity;
  • exudation;
  • flaking;
  • Scab formation;
  • Vesicles (sometimes).

The systemic manifestations associated with the appearance of red spots on the skin are very variable. Depending on the cause causing it, for example, fever, abdominal pain, weight loss, sweating, weakness, palpitations and headaches may occur.

The clinical features of the red spots on the skin (number, size and distribution of skin lesions), the affected sites, the evolution over time and the appearance in relation to other symptoms are important aspects for the differential diagnosis.

Diagnosis

The diagnosis of red spots on the skin is initially established by a dermatologist.

The procedure for establishing the exact trigger causes the anamnesis and the physical examination . Only a few red spots on the skin require a biopsy or other investigation.

history

The most important information to be investigated during the collection of anamnestic data includes:

  • Personal or family history of atopy (to be evaluated in case of atopic dermatitis) or other cutaneous manifestations of significant clinical significance;
  • Exposure to plants, animals or chemicals (contact dermatitis);
  • Prolonged exposure to sunlight or other types of radiation (benign and malignant skin tumors);
  • Systemic diseases (eg diabetes and candida or ringworm);
  • Sexual habits (syphilis and gonorrhea);
  • Known reactions to systemic and topical drugs;
  • Recent trips to endemic areas (Lyme disease, skin infections etc.);
  • Any factors that alleviate or aggravate the red spots on the skin.

In addition to those listed, the patient should report all possible triggers that may have contributed to the appearance of red spots on the skin.

The anamnesis is important both to confirm, that to exclude a suspected pathology, therefore it must be conducted in a very accurate way.

Physical examination

Visual inspection is a fundamental tool for evaluating red spots on the skin; various dermatological diseases are diagnosed, in fact, based on the appearance or morphology typical of the lesion itself.

During the examination of the skin, the doctor will evaluate the following aspects:

  • Characteristics and methods of presentation of red spots on the skin: evaluation of their location and onset; morphology, size, extension and distribution of lesions (local or general); any changes, duration, etc .;
  • Analysis of local and / or general signs and symptoms associated with the appearance of red spots on the skin;
  • Presence of signs of secondary infections (such as swelling, heat and formation of yellow or honey-colored crusts), lymphadenopathy, organomegaly, tenderness or numbness.

Any associated exams

Dermatological diseases are usually diagnosed clinically. However, when the red spots on the skin are accompanied by other manifestations of significant importance (eg fever, dyspnea, headache, etc.) and uncertain etiology, a skin biopsy may be appropriate.

Based on the clinical suspicion, the dermatologist can also decide to proceed with the execution of allergic tests - on skin or blood - to highlight whether the red spots could be caused by an allergic reaction. In other cases, it is advisable to take microbiological samples using a swab ( culture test ); this makes it possible to establish an infectious etiology.

Other investigations may be useful to confirm or exclude an underlying systemic pathology.

These investigations aimed at establishing the causes of red spots on the skin generally include:

  • Complete blood count : identifies quantitative changes in blood cells and possible eosinophilia caused by allergy or infection;
  • Erythrocyte sedimentation rate (ESR), PCR and other inflammation rates : can help identify possible autoimmune conditions;
  • Examination of a stool sample : it can highlight the presence of intestinal parasites;
  • Thyroid, hepatic and renal function tests ;
  • Dosage of tumor markers to verify the presence of a neoplasm.

Treatment

The management of red spots on the skin varies depending on the cause that triggered the disorder.

  • In the event that the red spots on the skin are caused by a temporary disorder, in principle, it is not necessary to undertake any kind of treatment, since the eruption will gradually resolve within a few days.
  • In the event that the red spots on the skin are caused by basic pathologies, the treatment of the latter can induce the resolution of the symptomatology. Unfortunately, this does not always occur and, in some cases, these signs remain even if the illness that triggered them has been adequately treated.

To alleviate the disorder, the doctor may prescribe topical or systemic drugs (eg antihistamines, antibiotics, sterile dressings, antiseptics, anti-inflammatories, short course of oral corticosteroids, immunosuppressants, etc.). To counter the red spots on the skin, dermocosmetic treatments and natural remedies are also available to facilitate healing.

In any case, it is advisable to consult the doctor to define the most appropriate therapeutic regimen.

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