Skin Rashes Protocol
Definition
A rash is a change in the skin which affects its color, appearance, or texture. A rash may
be localized, or become generalized. Rashes may cause the skin to change color, to itch
or cause pain, become warm, bumpy, dry, cracked, blistered, or edematous. Many skin
rashes are short-lived and relatively minor; some skin rashes are highly contagious. Skin
rashes may also be the early signs of a number of serious, even life-threatening diseases.
Causes
For susceptible individuals a rash can develop by direct skin contact or exposure to an
irritating substance such as: dyes, chemicals found in clothing, elastic, rubber products,
cosmetics, poison ivy and poison oak, or by medications, foods, or insect bites that cause
allergic reactions. A rash may be caused by contagious viral, bacterial, or fungal agents.
In some cases anxiety, friction due to chafing of the skin, sun or heat exposure can also
cause a rash.
Some examples of life-threatening diseases with rashes include: meningitis, Lyme’s
Disease, typhoid fever, and Rocky Mountain Spotted Fever.
Assessment
1. Measure the parameters of the rash.
2. Describe the rash, erythema, edema, and other findings.
3. Search for accompanying symptoms such as: fever, swollen glands, numbness or
tingling sensation, other body part involvement, allergies, medication use, or new
skin product use; check history of any recent outdoor exposure such as
hiking/camping, or similar rash history.
Management
1. Clean skin rash site with mild soap or just water.
2. Loosen or remove irritating metal or clothing if appropriate.
3. If a rash is accompanied by: fever, malaise, fatigue, uncharacteristic mannerism or
behavioral changes in the student, send them home recommending medical
evaluation. Call EMS if symptoms indicate or if parent is unable to pick up.
4. Follow the Infectious Disease in School Settings manual recommendations.
5. Enforce hand hygiene with soap and water before eating and after using the
restroom.
6. Exclusion from school and sports activities should be reserved for those with
wound drainage (pus) that cannot be covered and contained with a clean, dry
bandage and for those who cannot maintain good personal hygiene.
7. For unknown or potentially contagious rashes, physician clearance may be
required for school attendance.
8. Communicate your findings with a parent/guardian; explain your concern to
student.
9. Document your findings.
Follow-Up
1. Follow the Infectious Disease in School Settings manual for exclusion criteria
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3.
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once the rash is diagnosed by a medical professional.
Monitor rash to ensure proper healing following the initial identification.
If parent has not taken student in for medical treatment/identification and the
rash continues or worsens, complete a medical referral accordingly.
Exclude student for drainage/discharge (especially if unable to cover),
worsening rash and/or symptom appearance until improvement noted or
cleared medically.
Notify janitorial staff to clean wrestling mat, classroom desk(s), and other
equipment where contamination is suspected.
Report to local public health agency if applicable and according to the
Infectious Disease in School Settings manual.
Bibliography
Guide to rashes on Medline Plus Medical Encyclopedia
(http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm) – includes photographs
Guide to rashes on RevolutionHealth.com
(http://www.revolutionhealth.com/conditions/skin/rash/)
Llardi, D., Anderson, B.J. (2009). Skin Infections in Athletes: Things You May Not
Know. School Nurse News, 26 (1), 25-29.
Infectious Disease in School Settings: Guidelines for School Nurses and Personnel
Revised December, 2004. Colorado Department of Public Health; Denver, Colorado
(http://www.cdphe.state.co.us/dc/Epidemiology/manual/School_Guidelines.pdf)
Slide show: rashes
http://www.medicinenet.com/skin_problems_pictures_slideshow/article.htm