The sudden red spots on your body might not be eczema! Misdiagnosis could worsen the condition

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Many people have probably experienced this:suddenly red patches and small papules appear on the body, and they are itchy. Faced with such a situation, many people would quickly answer, “I must have eczema, right?”

In fact, it may not be the case. Some skin diseases are very similar to eczema and are easily confused. Among them, some diseases have similar treatment plans to eczema, while others require specialized treatment, and the treatment plans may be quite different.
If treated as eczema by mistake, it may backfire, affect the diagnosis, and even worsen the condition.

Whether adults or children,

eczema is very common, but

Indeed,whether adults or children, eczema is one of the most common skin diagnoses, which often refers to skin inflammatory reactions with a tendency to exude.

Acute eczema rash
is polymorphic and can manifest as red patches, papules, vesicles, erosions, exudates, and crusts, often accompanied by itching.

And
if it is not cured for a long time, it can develop into chronic eczema, withfused and thickened rash. There is also a subacute form characterized by papules, crusts, and scales.

Eczema

In the treatment of eczema,the core is anti-inflammatory, and the core approach to anti-inflammatory is the use of topical corticosteroids, so for any eczema, if you’re unsure, applying some “Piyanping” will always show effects, pushing this type of medicine as a self-help miracle drug, but“one trick does not fit all situations”.

These skin diseases look like eczema,

and the treatment methods are also similar

Itchy erythematous papules are far more than eczema, some rashes can be “muddled through” by treating them as eczema, such as:

Neurodermatitis

Neurodermatitis is a chronic skin disease closely related to emotional tension and excessive stress, medically known as lichen simplex chronicus.

The most obvious symptom isrecurrent unbearable severe itching at specific skin sites, commonly on the neck, wrists, elbows, lower legs, and other areas that are easily rubbed.

Neurodermatitis

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And this itching forms a vicious cycle of “itch and scratch, scratch and itch more”. Long-term repeated scratching can cause changes in the skin, originally smooth skin will gradually become thick and hard, and the surface will appear rough patterns similar to moss.

The skin inflammation pathway is also a core link in the itching and skin thickening of neurodermatitis, so applying topical corticosteroid ointment like eczema can relieve itching and prevent skin from thickening and hardening.

Psoriasis

Psoriasis is also a common chronic inflammatory skin disease with various clinical manifestations. The common type of psoriasis is characterized by clearly defined erythema,with rough scales on the erythema. Psoriasis rashes often show layers of scales when scratched with a cotton swab, and small bleeding points can be seen under the scales.

Psoriasis

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For mild psoriasis, our treatment is also to use topical anti-inflammatory ointments to fight inflammation, and the treatment method has some similarities with eczema.

However,psoriasis with large rash areas and frequent recurrences still requires comprehensive assessment to develop a more accurate plan.

The above are some diseases that have similar symptoms to eczema, and it is not easy to make mistakes when treated with eczema plans.

However,
there are some rashes,if only casually apply the commonly used drugs for eczema,it may make the situation worse.

The following are several rashes that require our high attention, have a certain similarity with eczema, but need specialized treatment.

These skin diseases look like eczema,

but the response plans are quite different

Allergic contact dermatitis

Contact dermatitis, as the name suggests, is dermatitis caused by contact with allergens, which is divided into irritant contact dermatitis and allergic contact dermatitis.

Among them,irritant contact dermatitis is caused by the direct cytotoxicity of the contact substance, such as strong acids and strong alkalis, which cause dermatitis to anyone who touches them.

And some allergic contact dermatitis is caused by allergies to contact substances in some people. A more typical example that we rarely confuse with eczema is the so-called “allergy” to adhesive plasters. It appears as erythema, papules, and vesicles that basically match the position of the adhesive plaster, with very clear boundaries.

And some allergic contact dermatitis, such as allergies to hair dyes, cleansers, or fragrances, may not cause erythema with very regular boundaries, which may be mistaken for eczema.

In treatment,if we simply treat the symptoms of eczema with anti-inflammatory,although it can briefly make the rash subside, but without avoiding contact with allergens, it will lead torepetition and aggravation of allergic contact dermatitis, giving us an illusion that the skin is“resistant” to steroid ointments.

So in the following situations, it is recommended that we better exclude the possibility of allergy before applying the medicine ourselves:the rash is relatively clear, and the position of the rash has recently come into contact with new substances.

For example:

The erythema on the scalp and behind the ear in the picture is due to an allergy to neomycin in the ear drops. If similar erythema appears near the hairline, we may also consider hair dyes and shampoos.

Image source Goodheart’s photoguide of common skin disorders, 2nd ed., Lippincott Williams & Wilkins, Philadelphia 2003. Copyright © 2003 Lippincott Williams & Wilkins.

Scabies

Scabies is a skin infestation caused by mite infection. Typical scabies usually manifest as multiple red papules, and papules are often scratched and broken due to itching. Commonly affected areas include the sides and webs of fingers, wrists, armpits, areolas, and genitals.

Scabies

In appearance, scabies and eczema are very easy to confuse, but several characteristics can warn us:

Scabies is a contagious disease, often with a history of living in unclean conditions or wearing dirty clothes before the rash appears;

itching worsens at night;

can invade the genitals(such as papules and nodules appearing on the scrotal skin folds).

If scabies is suspected, it is recommended to seek medical attention offline. Although the diagnostic standard is microscopic examination to find mites, eggs, or their excrement, it is often the case that patients have few mites, and sometimes the gold standard evidence cannot be obtained.

And experienced dermatologists can use dermatoscopy to find areas with mites or tunnels, or make a presumptive diagnosis based on medical history and physical examination results. If scabies is not treated properly, the mites can comfortably settle and reproduce on the body, and they also spread from one to two, which may lead to a whole house becoming a breeding ground for mites.

Skin fungal infections

When it comes to skin fungal infections, we may be unfamiliar, but when it comes to names like tinea corporis, tinea cruris, or even tinea pedis, commonly known as “athlete’s foot” and “onychomycosis” or “gray nail”, our ears are quite familiar.

Tinea pedis, especially the vesicular and hyperkeratotic types, is very easy to confuse with eczema in the eyes of many people.

And tinea corporis, especially in the early stages of development, before fully presenting the characteristics of clear red patches with slightly raised edges like petals, is also very easy to confuse with the acute eczema manifestations of the trunk and limbs, but
its treatment is completely different from eczema.

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Eczema requires anti-inflammatory treatment, and we often use topical corticosteroid ointments for anti-inflammatory purposes, while fungal infections require corresponding antifungal treatment.

If a rash of fungal infection is mistakenly treated with corticosteroids, the rash may seem to subside in the short term, but it will recur and worsen after stopping the medication, and this cycle may lead to the difficult-to-identify ringworm that we often see in dermatology case discussions.

So when we have relatively clear erythematous rashes on our body, especially if there are pets like cats and dogs at home;blisters on the feet, often starting unilaterally and with cohabitant has nail fungus and other factors, it is recommended to consider offline consultation, to assess whether there is a fungal infection factor. If it’s really unclear, we can also perform a fungal smear test to confirm whether there are fungi.

Peer review expert 
Zhong Hua

Distinct Dermatologist, Doctor of Medical University of the Army, Visiting Scholar at the University of Texas MD Anderson Cancer Center

References

[1] Contact Dermatitis: Rashid RS, Shim TN. Contact dermatitis. BMJ 2016; 353:i3299.

[2] Scabies, Tinea Pedis: Chosidow O. Scabies and pediculosis. Lancet 2000; 355:819.

[3] Fungi: Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses 2008; 51 Suppl 4:2.

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