What causes red spots on the skin?

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From Pityriasis rosea to heat rash we look at the common causes and treatment options for red spots on the skin.

By Dr Juliet McGrattan (MBChB)

Red spots on the skin are common, but working out what is causing them can be tricky. From minor irritations to life threatening situations, red spots anywhere on the body can cause anxiety and concern.

To put your mind at ease Dr Juliet McGrattan gives us a rundown of the most common causes of red spots on the skin, plus best treatment options and when to take action.

What causes red spots on the skin?

There are literally hundreds of reasons why you might develop red spots on your skin. Even with the help of internet search images, it can be hard to make a diagnosis. Getting the right treatment requires the correct diagnosis.

If you are ever unsure about what is causing your skin spots, then seek advice from a healthcare professional. Your local pharmacist is a great first port of call, they can suggest treatments you can buy over the counter and direct you to your GP if further assessment or a prescription is required.

⚠️ If you or your child have red spots and feel unwell with a high temperature, headache or vomiting, make an appointment to see your doctor.

The causes of red spots can be divided into four categories:

  1. Infections
  2. Reactions
  3. Long term conditions
  4. Other causes

Red spots can be caused by a variety of infections. Infections may be caused by bacteria, viruses or fungi. We’ll look at each in turn and find out the characteristics and treatment for each.

Bacterial infections

Bacterial infections which can cause red spots on the skin include the following:

  • Folliculitis

Infection around hair follicles, small spots which are raised from the skin and may contain pus or clear fluid. Requires skin cleansing and sometimes antibiotic cream or tablets to treat them.

  • Impetigo

Common around the nose and mouth, especially in children. Red spots can weep and develop a honey-coloured crust. Treated with antibiotic creams.

  • Scarlet fever

Flushed cheeks and a rough and bright red rash which starts on the chest or tummy. Usually preceded by a high temperature, sore throat and swollen neck glands. Treated with antibiotics.

  • Bacterial meningitis

Bacterial meningitis is a life threatening illness. Spots are not always present but when they are they are red or deep red and do not go away when a glass is pressed on them. Other symptoms include a high temperature, stiff neck, vomiting, headache and a dislike of bright light. Young children may just be unwell or drowsy. Dial 999 for an ambulance if you suspect meningitis. Treatment involves intravenous antibiotics, fluids and oxygen.

Viral infections

Viral infections which can cause red spots on the skin include the following:

  • Viral rashes

Blotchy rashes are common with mild viral illnesses. These are usually flat to the skin, turn white when you press on them and may feel warm to touch. They can appear anywhere on the body but are common on the chest and tummy. Treatment isn’t usually required and they fade as the virus clears.

  • Chickenpox

Raised red spots become little blisters which scab. They often spread rapidly and can be very itchy. Chickenpox is highly contagious. Use soothing creams, cool baths and try not to scratch. Adults who develop chicken pox should speak to a doctor. Pregnant women, new born babies and those with suppressed immune systems who develop chickenpox or have been near someone with chickenpox should get medical advice.

  • Shingles

Red blotches which turn into blisters and develop in a patch or stripe on one side of the body could be shingles (herpes zoster). The rash can be very painful, pain may appear before the spots and require strong painkillers. A vaccine against shingles is available on the NHS for those over 70.

  • Measles

Measles and characterised by a red, brown rash made of individual spots which all join together. It is flat to the skin and quite striking in appearance. Other symptoms include red eyes, a high temperature, a runny nose and cough. Measles has some serious complications. Speak to a GP if you think you have measles. The MMR vaccine has reduced the frequency of measles but cases are on the rise again due to lower vaccine uptake.

Fungal infections

Fungal infections which can cause red spots on the skin include the following:

  • Ringworm

Red spots which form a circle shape with normal skin in the centre can indicate ringworm. This is a fungal infection and nothing to do with worms! It can be anywhere on the skin, often in the groin or scalp and is usually itchy. May be single or multiple rings and they can grow large. Treatment is with anti-fungal creams that you can buy from the pharmacy.

  • Athlete’s foot

Itchy red spots that appear around and between the toes and on the skin of the foot could be athlete’s foot. Skin can also crack and flake. Common if you have sweaty feet and wear trainers a lot. Treatment involves careful washing and drying of the skin and anti-fungal creams.

Reactions

Reactions which can cause red spots on the skin include the following:

  • Heat and sweat rash

Small, red spots which are slightly raised from the skin and are mildly itchy or uncomfortable could be heat or sweat rash. Common on hot days and after exercise. Treat with a cool wash and soothing creams such as calamine lotion or sudocrem. Antihistamines may help too if itch is prominent.

  • Urticaria

Commonly known as nettle rash or hives, these red spots or red and white blotches often appear as a reaction to the environment. It could be a viral infection triggering them but it’s often heat, cold, water or even a reaction to a medication. Sometimes they’re recurrent and the cause is unknown. Treatment is usually with antihistamine tablets.

  • Contact dermatitis

Skin can react to being in contact with chemicals, metals or other materials. This is a type of eczema with small red, itchy spots which can bleed, weep and crust. Treatment is to avoid the trigger, moisturise the skin and if required use a mild steroid cream which you can speak to your pharmacist about.

  • Drug reaction

New red spots which appear after starting a new medication could be a drug reaction or allergy. Spot and rashes can vary and may or may not be itchy. Speak to your doctor if a rash appears after starting a new drug.

Long term conditions

Long term conditions which can cause red spots on the skin include the following:

  • Eczema

Often beginning in childhood, eczema is characterised by itchy red spots. There can be crusting, weeping or bleeding due to scratching. Patches can appear in skin creases such as behind knees and in elbows but more widespread eczema is common too. Eczema can range from occasional and mild to constant and severe. Treatment involves regular moisturiser (emollient) and use of steroid creams for flare ups. Severe eczema requires treatment by a skin specialist.

  • Psoriasis

Psoriasis is more associated with red, scaly patches but patches often start as smaller, individual, red spots. It can’t be cured and severe cases can affect people’s quality of life. Treatment involves steroid or Vitamin D creams, light treatment and moisturisers.

Red spots other causes

Other causes of red spots on the skin include the following:

  • Pityriasis rosea

This could be linked to a viral infection but it’s unclear. It begins with a ‘herald patch’ which is a red oval shaped area of skin of a few centimetres’ diameter, with a slightly raised edge (like ringworm), usually on the trunk. Sometimes there’s a headache, sore throat or fever. A couple of weeks later this is followed by a florid rash of multiple small patches. The patches are red on fair skinned people and grey or brown on darker skin. They’re scaly and often mildly itchy. Pityriasis rosea can take a few months to clear. It clears on its own but moisturisers, steroid creams and antihistamines can help to soothe any itch or discomfort.

  • Lichen planus

Depending on where this is on the skin its appearance can vary. Red or purplish, raised spots or blotches on the wrists, ankles or back could be lichen planus. It tends to appear as white patches if its inside the mouth. Lichen planus is poorly understood but it’s not contagious. It usually clears on its own but may require creams and ointments from the GP to ease any itch and prevent it worsening.

  • Bites

Don’t forget bites as a common cause of itchy raised red spots. This could be flea bites from a pet, bed bugs, insect bites or scabies. Prevention is better than cure so cover up and wear insect repellent if the risk of being bitten is high. Vacuum and hotwash bedding frequently. Seek advice if bites are becoming increasingly red or swollen or you feel unwell.

Net Doctor

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