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What Do Red Lesions On Skin Indicate?

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Posted on Mon, 10 Nov 2014
Question: I have small red pruritic papular lesions on my lower and upper abdomen and on the arms and legs. I am taking oral isotretinoin for cystic acne at 2X daily. The papules go away when I apply triamcinolone and the underlying skin becomes hypopigmented. I have googled many pictures and they look like a papular or maculopapular rash. I googled this type of rash and it seems very uncommon. I recently upped my dose of oral Isotrentinoin to 80mg (the highest). I am wondering, is this most likely a side effect of the oral Isotrentinoin or is this a more serious condition that I should investigate? The doctor doesn't seem to be concerned but I am concerned!
doctor
Answered by Dr. Johny Chacko (44 minutes later)
Brief Answer:
Please upload pictures

Detailed Answer:
Hello,

Welcome to healthcare magic forum.

I understand from your query that you are having a rash on your body.

Please provide me some more history so that I can assess your problem better.

1. For how long have you had the rash?

2. Is it itchy or asymptomatic?

3. For how long have you been on Isotretinoin?

4. Do any of your close contacts have a rash?

Please upload clear photographs of the rash so that I can assess better.
You have a feature to upload the images by yourself at the right side of the query page. You can also send the image as attachment to YYYY@YYYY , with the subject as 'Attn: Dr. Johny Chacko'.

Regards,
Dr. Johny Chacko
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Johny Chacko (52 minutes later)
I just uploaded photos,
It is itchy sometimes.
I have been on isotretinoin for 2months. I recently increased my dose to twice a day (80mg).
None of my close contacts have a rash. I am the only one.
Please tell me what kind of rash this and whether the Isotretinoin could be causing this, or what could be causing this if not. The rash is present on my arms, lower abdomen and legs. Please tell me what kind of rash. I have been on Isotretinoin for 2 months and no one else I know has this rash. Is this a drug side-effect? In your opinion What type of rash is this and what is causing it? Should I be concerned?
doctor
Answered by Dr. Johny Chacko (9 minutes later)
Brief Answer:
Pityriasis rosea

Detailed Answer:
Hello,

Thank you for the clarifications.

I have seen the pictures that you have uploaded.

From your history and photograph, I would consider the possibility of a condition called as Pityriasis rosea.

It is characterized asymptomatic to slightly itchy , scaly rashes on the trunk and limbs. It usually occurs as a reaction to a viral infection( which itself could have been asymptomatic) which you had 6-8 weeks ago. In many cases, there is no definite cause.

It will spontaneously resolve on its own in 6- 8 weeks. You could continue applying triamcinolone ointment for relief from itching.

It is not related to isotretinoin intake.

Hope this helps you.

Do not worry.

If you have any more queries, I will be glad to assist.

Take care.

Regards,
Dr. Johny Chacko

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Johny Chacko (26 minutes later)
Hello. I looked up the condition you are talking about and it refers to a "Herald Patch. I do not remember a herald patch. Could this occur without the herald patch. Is there any other condition it could be? Here is what I found on the herald patch. I believe I have an anxiety disorder, but I just want to make sure based on your experience that it is nothing bad like an STD lesion or a cancer lesion. Thank you


The herald patch measures 2-5 cm in diameter and is oval or round with a central, wrinkled, salmon-coloured area, separated from a dark red peripheral zone by fine scales. The herald patch is usually located on the trunk but may be seen on the neck or extremities.
The secondary rash is symmetrical and localised, predominantly to the trunk, neck and proximal extremities.
The lesions of the secondary rash are small versions of the herald patch, with the two red zones separated by a scaling ring. They are distributed in a 'Christmas tree' pattern.
In a minority of patients, the herald patch is either absent or confluent with the other lesions.
doctor
Answered by Dr. Johny Chacko (20 minutes later)
Brief Answer:
Pityriasis rosea

Detailed Answer:
Hello,

Pityriasis rosea could occur even without the herald patch.

The classical picture with " christmas tree " appearance is not seen in every patient. There are many deviations from the classic description. What we look for while considering this condition is " colarette of scales" which is quite striking in the pictures that you have sent me.

If you are suspecting a sexually transmitted disease, I would like to know if you have had any unprotected sexual exposure. And if yes, how many days / months prior to the onset of the rash? Did you have any ulcer/ erosion on the genitalia prior to onset of this rash.
The rash associated with secondary syphilis could present in this manner. i do not want to cause unwanted panic and anxiety. But since you have asked me specifically, I consider it my duty to tell you the possibilities.
You can confirm it by doing a blood test for VDRL and TPHA.

It definitely does not appear cancerous. Do not worry.

Hope this clarifies your doubts.

if you have any more queries, I will be glad to assist.

Regards,
Dr, Johny Chacko
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Johny Chacko (10 minutes later)
Hello,
Thank you for calming my fears. No I did not have unprotected sex, but I still worry. I did not have any lesions or signs on the genitalia, so I do not believe it is syphilis. I know HIV is very rare, but I googled and found papular eruptions as a symptom of HIV. This is called maculopapular macular/papular rash. Are you familiar with this type of rash? I do not believe it is. I want to make sure. It is very unlikely, but I still worry.
doctor
Answered by Dr. Johny Chacko (22 hours later)
Brief Answer:
Do not worry

Detailed Answer:
Hello,

Maculopapular rash of HIV looks completely different from what you have.

Moreover, I do not see any reason to worry about sexually transmitted diseases including HIV if you have not had any unprotected sex.

Relax and wait for a couple of weeks. The rash will resolve on its own. Till then, for symptomatic relief, continue the same ointment what you have been using so far.

Hope this puts your mind at ease.

Take care and wish you good health.

Regards,
Dr. Johny Chacko
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Answered by
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Dr. Johny Chacko

Dermatologist

Practicing since :2005

Answered : 1916 Questions

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What Do Red Lesions On Skin Indicate?

Brief Answer: Please upload pictures Detailed Answer: Hello, Welcome to healthcare magic forum. I understand from your query that you are having a rash on your body. Please provide me some more history so that I can assess your problem better. 1. For how long have you had the rash? 2. Is it itchy or asymptomatic? 3. For how long have you been on Isotretinoin? 4. Do any of your close contacts have a rash? Please upload clear photographs of the rash so that I can assess better. You have a feature to upload the images by yourself at the right side of the query page. You can also send the image as attachment to YYYY@YYYY , with the subject as 'Attn: Dr. Johny Chacko'. Regards, Dr. Johny Chacko