What Causes Red Inflamed Region On Torso?

Posted on Fri, 19 Jun 2015

Question: Approx. 6 days ago, rash started on my 17 MO daughter. Has become increasingly worse. Localized to only left side of torso and LUE. LUE is growing worse, red, inflamed, and appears to have fluid filled papules. Neither her father or I have a rash. She has not been exposed to anyone with chickenpox, no outdoor allergens. She is not scratching it, she's afebrile, currently on Amoxicillin 250mg/5ml 7.5ml BID x 10 days (on day 6) d/t left ear infection found when I took her to urgent care for the rash. She has NKA. She has had herpes zoster vaccination.

Answered by Dr. Albana Sejdini (1 hour later)

Brief Answer:
Possible allergy to amoxicillin,following details are needed...

Detailed Answer:
Hi my dear,

I have gone through the medical history of your daughter and noted the rash in her left side torso in the photos you provided.

You are saying that :
- the rash begin 6 days ago
- while 6 days ago you started amoxicillin for left ear infection

Let me understand: was the rash present when you started amoxicillin? or did the rash started after taking the first dose of amoxicillin?

To my opinion, if she was ok, with only left ear infection, then, allergy to amoxicillin is suspected.

Another possible cause could be insect bite. Can you see any insect bite locally?

Looking forward to have your additional information soon!
Dr.Albana

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Albana Sejdini (2 hours later)

I took her to the urgent care 6 days ago for the rash. Upon examination, a left ear infection was noted, but they also did not say anything regarding what was causing the rash. When I took her to her pediatrician this past Friday, he glanced over her and said it could be scabies. I beg to differ; she does not have any hallmark symptoms of having scabies. She is not itchy and she has not been exposed to any person who has it. I don't want to treat her with the harsh cream if it is not even scabies. I don't see any insect bites. The rash started on her torso first, than it spread to the inside of that arm and has progressively gotten redder and the bumps look somewhat filled with fluid. I'm just puzzled as a nurse and a mother!

Answered by Dr. Albana Sejdini (21 hours later)

Brief Answer:
Possible bacterial infection,further consultation with dermatologist advise

Detailed Answer:
Hi back my dear,

Now, let me understand:
- you sent her to ER for the rash? And during the examinations there, it was found ear infection? If I am correct, the rash appeared before treating her with antibiotics.

- at this point, rash is not related to antibiotic. If the pediatrician suspected of scabies, then, I need to know who is taking care of her during your work time? Do you send to any daycare center?

Scabies is associated with severe itchiness, which is not present in your daughter's case.

What I suspect is contact dermatitis or any type of skin infection. If clotrimazole is not helping, then, it is not a fungal infection, a bacterial infection is suspected with Staphilococcus as main culprit. I usually prescribe gentian violet solution on the affected parts.

However, my opinion is that the rash was due to any viral infection she had prior to ear infection, and might have been exacerbating by use of amoxicillin.

Hope it enlighten your daughter's case. Discuss it further with pediatriacian or dermatologist. Skin scrapping testing and culture can also be carried out to determine the right diagnosis together with biopsy.
Dr.Albana

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Albana Sejdini (38 minutes later)

Yes; I took her to the urgent care d/t the rash, and the PA noted her left ear was red and prescribed the Amoxicillin. I have been using a Benadryl gel to the effected extremity and her side, it seems to have cleared it up slightly. If the rash continues, would you recommend taking her to the doctor to assess for a staph infection? Thank you for all of your help! It's much appreciated.

Answered by Dr. Albana Sejdini (4 hours later)

Brief Answer:
Detailed below....

Detailed Answer:
Hi back my dear,

Now, if the rash is clearing after applying benadryl cream (which is an anti-hystamine), then, most probably the rash is an allergic reaction. Possible causes might be a previous viral infection exacerbating by oral amoxicillin.

Next, it is common for such rash to get co-infection with staph. However, she is already taking oral amoxicillin (which has a good effect on such infection). And perhaps, the use of oral amoxicillin together with applying benadryl cream locally might contribute simultaneously in clearing up the rash. To my opinion, can add a mixture of cream containing antibiotic/antifungal/antihystamine medications; it can be found over the counter. This is what I think in your daughter's case.

So, if the rash is clearing (and I strongly think it will clear up in a few days), then, we can say that she is completely treated. However, should continue with local hygiene and applying local antibiotic/antihystamine cream.

If still no improvement, or relapse, then, can go for other diagnostic tests as advised earlier.

Hope it was of help! Wish fast recovery!
Dr.Albana

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Albana Sejdini (2 days later)

Hi again; I wanted to wait a few days to respond. I got hydrocortisone ointment and have been applying liberally to the areas. There is no improvements. It continues to slowly spread down her arm and now upper back. It seems that it looks worse in the morning when she wakes up. What do you advise is my next step from here? Than you!

Answered by Dr. Albana Sejdini (1 hour later)

Brief Answer:
Another photo from close view is requested as following...

Detailed Answer:
Hi back my dear,

Now, at this point, you are saying that hydrocortisone cream did not help with rash; on contrary it is spreading slowing upwards in the arms. If it is not helping, then, it is a case of possible dermatitis (skin infection). She might need local anti-biotic cream.

Can you send again another clearer picture from close view?

If it is spreading, then, should consult with dermatologist-pediatrician to rule out any skin infection.

I also advise to stop using any medication or any other new food you might have introduced to her.

I still think it is infantile eczema. However, once again as it is continue spreading, it is time to consult a dermatologist.

All the best!

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. Chakravarthy Mazumdar