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Skin Rash
My father has developed a rash/allergy-like skin issue on his leg. I’m attaching a photo for reference. Could you please have a look and let me know what it could be? Does it look more like an insect bite, an allergic reaction, or something else?
For history/info: he recently changed his diabetes and BP medications. He is also currently taking antibiotics for an intestinal infection, including Rifagut (rifaximin) and some other medicines. He has undergone CABG surgery in 2018.
Could any of these medicines be causing the rash? Please advise if he needs any treatment or if we should get it examined in person. Thank you.
Answers (13)
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I am Dr Shamoon. Thank you for the photos and the very useful drug history. In an elderly diabetic, hypertensive gentleman post-CABG who has recently been started on rifaximin plus other antibiotics for an intestinal infection, a new rash on the leg most likely is a drug-related eruption - a maculopapular drug rash. The timing is what points to it: if the rash appeared within days to about two weeks of starting the new antibiotics, drug hypersensitivity is far more likely than an insect bite. An insect bite is usually one or a few discrete raised itchy bumps with a central punctum, often around the ankles, whereas a drug rash is more widespread, symmetrical, reddish and blotchy, and may spread upward from the legs. Rifaximin acts mostly in the gut and rarely causes rashes, so the other antibiotic he received is the more likely culprit; some BP medicines (particularly amlodipine, which can also cause leg swelling and stasis changes) and, in diabetics, fungal or bacterial skin infection or diabetic dermopathy are the other realistic possibilities. His diabetes also matters because skin heals slowly, itching leads to scratching, and secondary infection or cellulitis can develop quickly in an elderly leg. I would not advise steroid creams or antibiotics blindly here - with his cardiac history and multiple drugs, the diagnosis must be confirmed by examination, and no medicine of his should be stopped without the treating doctor's advice.
Next Steps
1) Write down the exact date each new antibiotic was started and the date the rash appeared, and make a full list of all his medicines with doses - this single list usually identifies the culprit drug. 2) Show him to a physician or dermatologist in person within the next 1-2 days; a photo cannot replace examining the skin, and at 87 with diabetes and a cardiac history he should not be treated blindly. 3) Do NOT stop any antibiotic, BP or cardiac medicine on your own - the treating doctor must decide which drug to withdraw and what to substitute. 4) Meanwhile: keep the leg clean and dry, wash with plain water and a mild non-perfumed cleanser, apply a simple fragrance-free moisturiser twice daily, keep nails short and avoid scratching, use loose cotton clothing, and avoid all home remedies, oils, and over-the-counter steroid or antifungal creams. 5) Take a photo daily in the same light to track whether it is spreading. 6) Get a blood sugar check (fasting and post-meal or HbA1c) and CBC with eosinophil count and creatinine - poor sugar control worsens any skin condition and drug dosing depends on kidney function. 7) A non-sedating antihistamine such as levocetirizine at night is generally safe for itching in the elderly, but please confirm with his doctor given his cardiac medicines. 8) If it is confirmed as a drug rash, record that drug name as an allergy in his file permanently. You are welcome to consult me on Practo with the photos and his medicine list, or in person at Synergy Multispeciality Hospital, Miraj.
Health Tips
Word of caution: this needs emergency care if the rash spreads rapidly, blisters or peels, involves the mouth, eyes or genitals, or is accompanied by fever, facial or lip swelling, breathlessness, drowsiness or confusion - these suggest a severe drug reaction. Also seek urgent review if the leg becomes hot, swollen, very painful or starts oozing pus (cellulitis), which is a real risk in an elderly diabetic. Never stop or restart his cardiac or antibiotic medicines without his doctor.
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Cellulitis??
Augmentine duo625 three times a day after food for 7to ten days. Zerodol sp three times a day after food for five days.
Montek lc one at night for 7to ten days.
YET
YOU CAN CONSULT SUPERSPECIALIST LIKE GENERAL SURGEON
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Visit to Dermatologist
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Could be eczema. Please consult a dermatologist physically.
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Yes get it examined in person.
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kindly do connect and consult with me for better treatment plan and advice on your case via PRACTO app
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Yes,examination needed by dermatologist.
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If it is an itchy rash it could be allergy with probable cellulitis
Since he’s diabetic better to see a dermatologist for proper examination and assessment of the skin problem .is it in 1 leg or both ,is it painful?
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Dr. Rohan Gumber
General Physician
1 yrs exp
Sri Ganganagar
If you would like to discuss your concern in more detail, please feel free to contact me on WhatsApp at eight six one nine six six nine nine zero six. Alternatively, you can connect with me through the Practo app for a detailed consultation
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Dr. Vetsa Sri Krishna Chaitanya
General Physician
7 yrs exp
Rajahmundry
Need a few more details please consult for further evaluation and treatment
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Dr. Ashita Kuruvilla
General Practitioner
8 yrs exp
Kolkata
Need few more details for further evaluation. Please consult
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Dr. Gaurav Jaiswal
General Physician
7 yrs exp
Jhansi
Avoid fried and spicy food
Water intake more
Green leafy vegetables more
Fiber meal
Do connect and consult
Will help you
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Dr. Anuj Mothsra
General Practitioner
7 yrs exp
Jhunjhunu
Can help you , kindly consult and provide detailed history for proper diagnosis and further management
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