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Not all rashes are created equal. There are those that are fairly innocuous and those that are contagious. Some are chronic and some are acute. They may be caused by a virus, bacteria, allergy or injury. Some rashes have unknown origins. While the general rule for rashes with regard to massage is to avoid the area affected, there may be some situations where certain rashes indicate a systemic avoidance.
How do you know which is which and when it may be necessary to refer your client to a physician for a definitive diagnosis? Unless you have an in-depth knowledge of dermatology, it can be quite difficult to differentiate among the many skin reactions. Massage therapists are not qualified to give a diagnosis, but should be familiar with the different types of rashes and what action is appropriate in terms of hands-on bodywork.
Classifying a Rash
A rash can be defined as a change in the skin affecting its color, appearance and/or texture. A rash can affect only a few centimeters of skin or it can affect the whole body. They can be itchy, flaky, bumpy, blistered, warm to the touch – or none of the above.
Sometimes all it takes is simply asking the client about the rash. They may have already had it diagnosed, though sometimes a client may be unsure of what it is. Occasionally they may not even know they have a rash, especially if it doesn’t itch or burn and it is on the back or other unseen parts.
When analyzing a rash, there are several things to consider in determining what it is and if it needs to be looked at by a physician – as well as if, or when, massage can be administered:
- General Appearance: Are there multiple small bumps, creating an area that looks like sandpaper or larger bumps spread out? Are they flat, scaly or blistery? What color does the skin and/or bumps have? Is the whole area red, or the bumps red and the rest of the skin its normal tone? If it isn’t red, what color is it?
- Distribution and Location: Some rashes affect only one side of the body, such as shingles. Some affect only certain areas. An example of this would be rosacea which affects the face. Certain rashes follow the dermatomes of the body; others may show up along skin creases or damp areas such as the arm pits or groin.
- How It Feels: Does the client complain of itchiness? Does it burn or tingle?
- Contact: Has the client been in contact with anyone else who has had a similar rash? Asking this might give you an indication as to if the rash is contagious or not.
Common Rashes and Their Symptoms
- Hives: Hives (also referred to as urticaria) can be caused by allergies, stress, viral infections as well as a number of other things, including extreme temperature and sunlight. They appear on the body in a variety of forms and are usually the result of a release of histamines. Hives appear as dark red, itchy bumps and can appear anywhere on the body. They will often appear and disappear within a short period of time. While hives themselves are not contagious, they can be symptomatic of a contagious viral condition, such as a cold.
- Atopic Dermatitis: This is the most common form of eczema and can appear anywhere on the body, though it is most often seen on the arms, legs, torso and scalp. The skin can get itchy and inflamed. The skin may appear red, flaky and dry, as coin shaped lesions with yellowish, oily patches or as blistered, weepy skin. There is no known specific cause for eczema, but it can be aggravated by extreme weather conditions, allergies and stress.
- Contact Dermatitis: Caused by an allergic reaction, contact dermatitis is a result of the skin coming in contact with an allergen or irritant. The rash resulting from poison ivy is an example of contact dermatitis. Not as widespread as atopic dermatitis, the rash is usually confined to the location that was exposed to the allergen.
- Fungal Infections: Rashes caused by fungal infections are sometimes difficult to diagnose and can be mistaken for other skin disorders. The fungi that cause the rashesm such as those seen in athlete’s foot (tinea pedis) or body ringworm (tinea corporis), live off of dead skin cells and thrive in warm, moist places, which is why they are seen most often in body folds and creases. These rashes are extremely contagious and are often difficult to treat. Ringworm will appear as a distinct circle outline, while athlete’s foot will appear as red, painful and can have a weepy discharge from blisters.
- Bacterial Rashes: Impetigo would be an example of a rash caused by the streptococcal or staphylococcus bacteria. It starts out as small blisters or pus filled bumps (pustules) that eventually break open. It is extremely contagious.
- Viral Rashes: Like fungal and bacterial rashes, a rash caused by or symptomatic of a viral infection is contagious. Herpes and shingles are examples of rashes caused by a virus. Except for herpes and shingles, most viral rashes are symmetrical and can appear all over the body; chickenpox and measles would be examples of this. The rash will usually appear as red, itchy bumps or patches on the skin. It can remain active for a day or two or take several weeks to clear up, but will usually go away on its own.
- Lichen Planus: This appears as rows of itchy, flat-topped bumps (resembling tree bark) usually on the arms and legs, but it can also appear on the scalp and the mucous membranes of the body. It has been reported as a complication of chronic Hepatitis C, but more often it seems to be related to stress. Lichen planus is not infectious. It affects middle-aged adults, the majority of them being women.
Some rashes can be treated with antihistamines or corticosteroids; others must be treated with anti-fungal medications or antibiotics. Some will recede and vanish when the irritant causing them also disappears and is no longer in contact with the body. Then there are those that seem to come and go at whim no matter what treatment is given.
Impact of Rashes on Massage Therapy
For massage therapists, the general guideline is still the best. If the rash is deemed to be contagious or if it is systemic, then no massage should be administered. If the rash is localized and non-contagious, then massage is locally contraindicated. Never massage a rash or skin that is compromised in any way directly. To do this may only serve to exacerbate or worsen the condition, and in some cases may spread the condition to others.
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“Can Stress Cause Hives?.” Healthy-Skin-Guide.com. Web. 12 Jan 2010. http://www.halthy-skin-guide.com/can-stress/cause-hives.html.
Rockoff, Alan, MD. “Rash 101: Introduction to Common Skin Rashes.” MedicineNet.com. 1/11/2008. Web. 12 Jan 2010. http://www.medicinenet.com/script/main/art.asp?articlekey=1992.
Werner, Ruth. A Massage Therapist’s Guide to Pathology. 3rd ed. Baltimore: Lippincott Williams & Wilkins, 2005. Print.