Causes for Red Spots on Skin

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There are several causes of rash on the face which can be due to allergies, infections or other skin conditions. It can be itchy or non-itchy. The rash may be flat or look like red skin bumps. Similarly, red spots on feet and legs can occur due to causes like allergies, infections, insect bites, following certain skin conditions etc.

Especially rashes on the face may cause distress to the person cosmetically. Red spots on feet and legs may be irritable and sometimes painful depending on the cause.

Most of the time, these rashes can be treated with simple home remedies. However, there are certain conditions which need medical attention.

Potential causes of Rashes on face

1. Acne

Figure 1 Red spots on face due to Acne

Acne (also called pimples) is a skin condition which usually affects the face but also occurs over neck, chest, and back. Most people with acne are aged between 12- 25 years. Severity can range from mild to severe.

Acne is caused by overactivity of sebaceous glands in the skin. Sebaceous glands which are situated under the skin surface produce sebum (oil) that keeps skin supple. The sebum comes out through tiny pores. When these pores get blocked by thickening of the skin and dead cells the sebum collects under these blocked pores. There is a bacterium called propionibacterium acne which is normally found in the skin. It multiplies in trapped serum. Sometimes inflammation occurs making the surrounding skin red. These red spots can get larger and fill with pus. Acne can be associated with open comedones (blackheads) or closed comedones (whiteheads).

Treatment of Acne – There are various topical medications used to treat acne, such as retinoids, benzoyl peroxide, topical antibiotic gels etc. When severe oral antibiotics like doxycycline and antihormonal treatment is used by the dermatologists. Although completely treated, acne can be only controlled as it can always recur.

2. Rosacea

Figure 2 Reddish rash on face due to Rosacea

Rosacea is a skin condition which is common in ages between 30 – 50 years and white skinned population. Women are affected more than men. There are redness, flushing and visible blood vessels over face, sometimes associated with acne-like breakouts. The rash on face is mainly over the nose and cheeks but can spread beyond to involve forehead and chin. Rosacea can run in families. Common triggers for flare-ups are overheating and humidity, cold wind, certain foods etc.

However different people may have different triggers.

Treatment of Rosacea – Dermatologists can help to reduce or control skin symptoms and prevent it worsening. There is no cure for Rosacea.

3. SLE (Systemic Lupus Erythematosis) rash on face

Figure 3 Red patch on the forehead due to SLE

Systemic Lupus Erythematosis is an autoimmune disease. The immune system which is there to protect our body from foreign attacks like bacteria and viruses become the enemy here. In this condition, autoantibodies are formed which mistakenly attack and damage healthy tissues and organs in the body.

Lupus can affect not only the skin but also kidneys, blood vessels, nerves, and lungs.

There is a typical rash on face called the “Malar rash” or the “butterfly rash” because of its appearance. They will also have symptoms like fever, headache, arthritis (Joints become inflamed and be swollen and painful).

Treatment – It is a chronic disease and there is no cure. The patients analyzed with SLE need long-term medical management and follow up with a multidisciplinary team.

Red skin bumps

4. Urticarial rash (Hives)

Figure 4 Red wheal caused due to Hives

Urticaria can occur anywhere in the body, commonly face arms, legs, and back.

They are itchy red or skin colored raised bumps with a surrounding red halo.

When pressed on it, the bump becomes white or pale and when released it gets back to the previous color.

Possible causes – Hives can occur due to the allergic reaction to

Certain foods (peanuts, seafood, pineapple etc.)
Medications (such as antiepileptics- drugs used to treat seizures, certain antibiotic etc)
Some Cosmetics
Pollen
Excessive sun exposure
Insect Bites
Detergents

Although hives are quite common, the allergic reactions do not occur in everyone. It is due to hypersensitivity to the allergen in certain individuals only.

Sometimes the allergic reactions may be severe and cause anaphylaxis, which is life-threatening. If the urticarial rash is associated with any of these following symptoms immediate medical attention is necessary. These symptoms are difficulty in breathing, swallowing, dizziness, faintish, chest pain or swelling of eyes and lips. If you experience any of these symptoms, rush to an Emergency room or dial 911.

Red spots on feet and legs

5.Insect Bites

Some individuals develop an allergic reaction to insect bites. The red skin bumps occur in the place you are bitten. It is quite itchy and irritable. Sometimes you may experience pain in the surrounding area. Although common in legs and feet it can occur anywhere at the site of the bite. Sometimes the bite site can get infected and look like small pus-filled blisters.

Figure 5 Red inflammation on legs due to bite

Common insects causing an allergic reaction are;

Fleas, mosquitos, ticks, ants or bugs

Treatment and relief – can use over the counter antihistamine for itching and acetaminophen if painful. (Must take care of dose and frequency of administration)

Hydrocortisone cream (which is an over the counter product) can be applied over the spots for treatment.

6.Hand, Foot and Mouth Disease

Figure 6 Red bump on child due to Viral HFMD

Usually, this occurs commonly in children, although it can occur in adults too. This is a viral infection and it is contagious (spread from one person to another).

Red spots occur on palms and soles, which can be like red skin bumps or flat lesions. They may occur over buttocks, knees, and elbows too. The patient is usually ill with fever. Associated painful red sores or blisters on lips, gums, and tongue will make it difficult to swallow.

Treatment and relief –

Fever can be controlled with acetaminophen and lot of rest is necessary. Fluids should be taken adequately. Calamine lotion can be applied over the rash site for the soothing effect.

When to seek medical help – When the oral sores are really bad and the child doesn’t swallow fluids or if fever is high and if symptoms worsen with time.

7. Vasculitis

Figure 7 Vasculitis on Legs

Vasculitis is inflammation of blood vessels. There are several types of vasculitis and it is a systemic disease. That means apart from the skin involvement several organ systems like kidneys, lungs, joints, gastrointestinal tract, nerves and eyes can get affected. Patients are usually sick with fever, loss of weight, headache, fatigue, night sweats, aches, and pains.

The red spots on feet and legs occur due to leakage of blood from the damaged vessels. When the blood vessels are blocked, reduced blood flow to legs can lead to ulcers and even gangrene (dead tissue) and may cause severe pain.

Risk factors for vasculitis are smoking, certain infections (like Hepatitis), and autoimmune diseases.

Treatment – Immediate medical attention is a must when you experience the above symptoms.

8. Folliculitis

Figure 8 Red bumps on hair follicle due to Follucilitis

Folliculitis means the infection of hair follicles. These are red spots which can occur over legs, beard area etc. When skin gets damaged during shaving, the air follicle is exposed which causes bacteria to get in and cause infection. Sometimes they look like small pustules. It is worse during warm and humid climates especially when you sweat a lot.

Treatment – Usually no treatment is necessary unless the infection is severe and not resolving with time

Certain Platelet disorders causing red spots on feet and legs

Platelet is a blood cell which helps our blood to clot. When there is a reduction in the number of platelets (maybe during certain viral infections or due to chronic disease) or when there are disorders of platelets due to chronic diseases they cannot function properly. This can cause bleeding into the skin. This will look like tiny red spots (petichiae) or red patches (purpura). Bleeding into sthe kin can occur anywhere in the body but common over feet and legs.

Treatment – If there are red spots which are long lasting and worsening with time, seek medical help as the person needs to be investigated and treated accordingly.

9. Contact Dermatitis

Figure 9 Red pustules on hands due to Poison Ivy

Contact dermatitis is an itchy red colour rash caused by contact with a substance which is allergic to that particular person. Many substances are commonly found to cause an allergic reaction to certain individuals, such as; plants (poison ivy), jewelry, watches, perfumed spray, some cosmetics, some soaps and detergents, shoe straps etc. One substance which is allergic to a person may not be allergic to another.

The rash can develop soon after contact with the substance. Itching will be followed by the red rash. It can appear dry or scaly, but sometimes wet and oozing.

Scratching can lead to skin damage and may cause infection. Some individuals may experiencea severe allergic reaction and may get blisters leading to oozing and crusting. There will be pain and sa evere burning sensation if infected.

Treatment and relief –

Once identify the trigger substance which is causing the allergic reaction, you have to avoid further contact.

To reduce irritability and itching can apply hydrocortisone cream (found over the counter) or if itching is bad try an over the counter antihistamine like fexofenadine, being cautious of the dose and frequency of administration.

Cold compressed will soothe the area.

When further contact with the substance is totally avoided, the rash will settle within 2-3 weeks.

When to seek help –

When the rash is severe and spread in a wide area
Signs of infection – High fever, pus oozing from the rash
If the rash is over face and near eyes
If the rash doesn’t subside even after 2 weeks or worsen with time. (The possibility here may be that you are still in contact with the allergic substance)

Treatment and relief for red skin spots/ rashes

Home remedies –

Wash area of rash with warm water
Clean with mild soap or cleansers when washing body
Pat the rash dry without rubbing
Avoid scratching even when it is itching, do not squeeze (If the skin gets damaged it can get infected and rash may worsen)
Moisturize with unscented moisturizing cream
Cold compresses over the rash area
Applying calamine lotion or Aloevara gel over the rash for the soothing effect
If itchy can try hydrocortisone cream (which is an over the counter product), apply over the red spots. Over the counter antihistamines like fexofenadine, cetirizine may be tried but need to be cautious about proper dose and frequency.

Prevention –

If it is suspected due to an allergic reaction, you need to avoid the triggers (may be certain foods, cosmetics you suspect which may be the cause)
Eat a healthy diet
Good personal hygiene
Avoid excessive sun exposure, can use a broad spectrum sunscreen and wear protective clothing
Avoid insect bites – can use an insect repellent, covering the areas likely to be bitten by insects
Quit smoking
Avoid stress, good sleep, meditation

When to seek help when you develop a rash/ red spots on skin/ red skin bumps?

If there are danger signs of anaphylaxis like shortness of breath, dizziness, chest pain, feeling faint immediate medical attention is a must
When the rash doesn’t settle with time or worsen and is spreading
When there are features of systemic illness like high fever, loss of weight, joint pains, fatigue, night sweats
When the rash becomes infected (with pus) and associated with severe pain or fever

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