18 Acute Skin Rashes for Nurses to Know (With Pictures)

William Kelly, MSN, FNP-C

Updated June 2026 · Medically reviewed for nurses

18 min read

Skin rashes are one of the most common reasons patients and parents seek care. Some are temporary, some chronic — but you'll run into skin problems in every healthcare setting, so knowing the common types and their treatment matters.

This guide walks through taking the history, the language of the skin exam, and the key allergic, autoimmune, viral, fungal, bacterial, and bite-related rashes — what they look like and how they're treated.

Skin Rashes: Taking the History

To diagnose a rash, you need to ask the right questions.

The Skin Rash Physical Exam

Rashes are described with specific terms. A lesion is the umbrella term for any abnormal "spot" or region. Knowing the primary lesion types makes the diagnosis far easier.

Allergic Skin Rashes

Contact Dermatitismost common dermatologic diagnosis

A skin reaction to something it touched — 80% irritant, 20% allergic. Irritant (heavy metals, strong acids, alcohol, soaps/lotions) causes pain/burning with some itch; skin looks erythematous, dry, irritated, sometimes pustular. Allergic (nickel, black hair dye, topical meds, latex, poison ivy/oak) is itchier with less burning, sometimes with vesicles. Treatment: topical steroid (triamcinolone 0.5% daily × 2–4 weeks) for localized lesions, oral prednisone if widespread; Benadryl for itch.

Allergic Urticaria (Hives)itchy raised wheals

Itchy raised wheals, often erythematous or pale, frequently from an allergy (including anaphylaxis) — though many cases are non-allergic or idiopathic. Allergens may be environmental (dust, pollen), food (nuts, dyes), or medications (antibiotics); bug bites and stings can trigger it too. Treatment: antihistamines (Benadryl) and sometimes steroids (prednisone), depending on the cause.

Eczema (Atopic Dermatitis)"the itch that rashes"

A chronic, very itchy allergic condition: dry, erythematous skin with oozing, crusting, excoriation, and eventual lichenification. In adults it favors skin flexures (elbows, behind knees), face, neck, and hands. All patients should liberally use a water-based emollient (Cetaphil, Aquaphor, CeraVe). Steroid creams: hydrocortisone 2.5% (low potency) or triamcinolone 0.1% (mid potency), 1–2× daily × 2–4 weeks; calcineurin inhibitors or monoclonal antibodies (via dermatology) for severe disease.

Autoimmune Skin Rashes

Psoriasischronic autoimmune

A chronic autoimmune rash of erythematous, flaking, thick patches of skin that can itch and burn. Treatment depends on severity: topical steroids, retinoids, tacrolimus, and at times systemic steroids and immunomodulators.

Malar "Butterfly" Rashassociated with SLE

A hallmark facial rash over the cheeks and nasal bridge, frequently linked to Systemic Lupus Erythematosus (SLE). It's red, flat or raised, resembling butterfly wings; usually non-itchy and non-painful but photosensitive. It could also be rosacea — systemic clues (fatigue, joint pain, photosensitivity) point toward SLE. Treatment targets the underlying lupus: antimalarials (hydroxychloroquine), sun protection, and steroids for severe flares.

Viral Skin Rashes

Shingles (Herpes Zoster)reactivated varicella

Reactivation of dormant varicella (chickenpox) virus, almost always in adults >50. Begins as an erythematous maculopapular rash that develops fluid-filled vesicles, scabbing in 7–10 days and clearing by 2–4 weeks. It follows 1–2 dermatomes (zosteriform) and should not cross the midline. Often very painful and may itch before the rash. Treatment: pain control plus antivirals (acyclovir) started within 72 hours. Very contagious until lesions scab over.

Pityriasis Roseaself-limiting viral exanthem

A self-limiting rash thought to follow viral infection, often preceded by a viral prodrome (headache, malaise, arthralgias, chills). Starts as a herald patch — a single oval erythematous macule/patch on the trunk with central clearing — then a "Christmas tree" pattern of smaller lesions appears 1–2 weeks later. No specific treatment; time resolves it. Benadryl helps the itch. Not contagious.

Hand-Foot-Mouth DiseaseCoxsackievirus A16

A viral rash from Coxsackievirus A16 and other enteroviruses, occurring in summer outbreaks. Usually affects children but spreads easily to family members via droplets, with adults often having systemic flu-like symptoms. The rash hits palms, soles, buttocks, and mouth; oral lesions are painful football-shaped vesicles. Skin lesions go red papule (with red halo) → gray vesicle → ulcer → heal in 7–10 days. Treatment is symptomatic: antipyretics, NSAIDs, topical lidocaine, and hydration. Watch for encephalitis or myocarditis in severe cases.

Measlesmorbillivirus

Once nearly eradicated in the US, measles is resurging. Caused by the morbillivirus, it kills ~150,000 worldwide per year, mostly in children <5. The red-brown maculopapular rash starts 3–5 days after systemic symptoms (severe cough, congestion, red eyes, high fever, photophobia), beginning on the forehead and spreading down to face, neck, trunk, and extremities (palms/soles in 50%). Koplik spots — white spots with red halos on the buccal mucosa — are highly specific. Treatment is supportive (antipyretics, analgesics, vitamin A, hydration); severe cases need hospitalization and sometimes ribavirin.

Fungal Skin Rashes

Intertrigoskin-fold inflammation

Inflammation and infection of the skin folds, common in obese and diabetic patients — usually fungal (often Candida) with possible bacterial component. Presents with erythema, scaling, satellite lesions, and foul odor at the groin (tinea cruris), axillae, under breasts, and between fat rolls; itchy and burning. Treatment: reduce friction and moisture (talc powder), barrier cream, breathable fabric, and topical antifungals (clotrimazole cream or nystatin powder 2–3×/day).

Tinea Corporis (Ringworm)dermatophyte infection

A fungal infection of the trunk or extremities, spread by skin-to-skin contact or fomites — common in athletes (wrestlers) and warm, moist locker rooms. It's a pruritic, round, erythematous or hyperpigmented, scaly patch/plaque with a raised border, sometimes coalescing. Treatment: topical antifungals 1–2×/day for 1–3 weeks (e.g., clotrimazole 1% BID); oral antifungals for severe cases.

Bacterial Skin Rashes

Cellulitislocal bacterial skin infection

Infection of skin and soft tissue after a breach of the skin barrier, presenting as localized erythema, edema, pain, and warmth — often a unilateral leg. May have systemic symptoms (fevers, chills, malaise) and abscesses. Treatment: PO antibiotics (Keflex 500 mg QID × 7 days), or IV (Ancef 1 g q8h) if severe, high-risk, or systemically ill.

Folliculitisinfected hair follicle

A bacterial infection of the hair follicle, usually Staph aureus, causing a tender red papule/pustule wherever hair follicles are — common after hot-tub use. Mild cases are self-limiting; topical mupirocin TID × 7 days helps. Significant cases need PO antibiotics (dicloxacillin, Keflex) with MRSA coverage if suspected.

Furuncle (Boil) / Carbuncledeeper follicular infection

A larger, deeper, painful follicular infection — a well-circumscribed, purulent, erythematous lesion that can extend into the dermis and form an abscess, favoring friction areas (buttock, axillae, extremities, breasts). Multiple furuncles coalescing form a carbuncle. Small lesions respond to warm compresses; larger ones need incision & drainage. PO antibiotics (with MRSA coverage) are given for associated cellulitis, diabetes, systemic symptoms, or unreliable follow-up.

Bite-Related Skin Rashes

Bed Bugsblood-feeding insects

Bed bugs live in unclean homes and beds (common in group homes and homeless shelters) and feed on blood, causing itchy papules or wheals, macules, or bullae — classically in a linear pattern. They may appear on waking or take a few days. Treatment: Benadryl for itch, low-to-medium potency topical steroid for severe itching; a pest service is needed to clear an infestation.

Flea Bitesfrom infested pets

Transmitted from infested domestic cats and dogs to their owners, causing pruritic papules most commonly on the ankles — randomly placed or in clusters. Treatment: antihistamine (Benadryl, Zyrtec), ice packs, and calamine for itch; topical steroids are usually unnecessary. Prevention: regular cleaning/vacuuming and flea treatment for pets.

Spider Bitesactually pretty rare

Genuinely rare — most spiders can't pierce human skin, and most "spider bites" are something else (furuncle, abscess, MRSA). A true bite causes a papule, pustule, or wheal, sometimes with two central fang marks (axillae, waist, ankles/feet). Most venoms are benign and local; black widow, funnel-web, and Phoneutria can cause systemic symptoms, and brown recluse can cause significant local necrosis. Treatment: clean the area — most resolve in 7–10 days; antibiotics for associated cellulitis; severe reactions need supportive care/hospitalization.

Scabiesmite infestation

Not a bite but an infestation of the scabies mite, which burrows into the skin to lay eggs — associated with poor hygiene and crowded living. Begins as tiny erythematous papules that form vesicles/pustules, often in lines (burrows) in the finger web spaces, wrists, and elbows. Intensely itchy, with itch persisting 2–6 weeks after treatment. Treatment: permethrin 5% cream to the whole body overnight (8–14 hours), washed off in the morning and reapplied in one week. Wash recent bedding/clothing in hot water and heat-dry; bag non-washables for ≥1 week.

Erythema Migransearly Lyme disease "bull's-eye"

The "bull's-eye rash" of early Lyme disease, seen in 70–80% of cases, appearing 3–30 days after a deer-tick bite. It starts as a small red painless papule that expands into a circular erythematous rash with central clearing and induration, resolving in weeks even untreated. Systemic symptoms (fevers, chills, malaise, body aches) are common. Treatment targets the Lyme disease: doxycycline 100 mg BID × 21 days.

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