Vacation Gone Wrong: 7 Skin Rashes People Got Abroad
Vacation Rash on your Travels
Every year, many people’s vacation goes wrong because of travel-related rashes. The cause for these rashes is wide ranging: bed bugs in Airbnb, tick bites while hiking, unknown itchy red marks and so on.
What kind of travel-related rashes do people get?
According to the American College of Emergency Physicians, the most common dermatologic conditions in ill-returned travelers are arthropod-related ones (31%), pyodermas (13%), soil-related ones (11%), and animal-related ones (9%).
Over the past few summers, we’ve received many cases about travel-related rashes. Below you can read some of those questions.
Location: Thailand, Southern California
I noticed this rash about 2 weeks ago. However, it doesn’t itch or hurt. The bumps are red. The rash is about the size of a pea. I live in Southern California. I just recently returned from Thailand about 2 weeks ago.
Possibly dermatitis (eczema), inflammation of the skin. Often times, it’s caused by dry skin or by irritation from contact with water or chemicals. Moisturizing cream and a topical steroid would be recommended. Usually, mild steroid creams such as Hydrocortisone 1% are sold over-the-counter.
Apply twice daily for a couple of weeks to start with and apply moisturizer regularly as well. If not better, see a dermatologist in person to rule out other diagnoses. A more potent steroid creams may be needed for example requiring a prescription. Sometimes a biopsy is needed to determine the exact diagnosis.
2. Cutaneous Leishmaniasis
Location: Cruise, Mexico
Localized papules that appeared in April 2016 – approx 2 weeks post cruise in Mexico. Itches occasionally. They are in no other location of the body. They are red today from skiing/tubing activities over the weekend. No fever, no pain.
Based on your history and the photos you’ve taken, this is likely to cutaneous leishmaniasis: it is a parasite infection occurring in certain parts of the world including Mexico. It is being spread by infected sand flies.
Most of the lesions eventually develop into an oozing ulcer. The diagnosis is made from microscopy slides from the side of the lesion and treatment consists of injection with sodiumstibuguclonate. I suggest you see your local dermatologist as soon as possible.
3. Phytophotodermatitis, also known as “lime disease” (but not the same as Lyme disease) or “Berloque dermatitis”
Location: Tulum, Mexico
Right shin, red and brown tinge ,about 2.5cm, had for around 14 days. Came up whilst on holiday, after around 5 days in Tulum, Mexico. BABY IS 8 MONTHS OLD! No itch, no apparent pain, not flakey, no bump or not raised.
Thank you for sending your case. Based on the information and images, this is most likely caused by an external agent and possibly a PHYTOPHOTODERMATITIS: A phototoxic reaction to contact with certain plants and it generally occurs during the spring or summer or in sunny climates abroad following some outdoor activity on a sunny day during which there has been contacting with one of the responsible plants. Its name has 3 components: Phyto (plant), photo (light) and dermatitis (inflammatory rash).
During the acute inflammatory stage, reddened patches appear on exposed skin, usually the forearms or lower legs. These are often irregularly distributed and odd in shape. The skin disease is induced by the action of long wavelength ultraviolet radiation (UVA) on a plant chemical called furocoumarins (psoralens) on the skin surface. The reaction causes inflammation in the epidermis and activation of the pigment cells to produce melanin pigment.
Contact with the plant, fruit or vegetable may have been brief and unnoticed. The plants normally responsible for this reaction are parsley, parsnips, celery, carrot, fig, lime and several species of wild flowers (Umbelliferae). The plant may even be a component in a cream or essential oil. You may try to treat the rash with a topical steroid cream (Hydrocortisone 1%, available over-the-counter without a prescription), applied twice daily for a week, then once every week and later 1-2 times weekly as long as you have any symptoms. By the time pigmentation has occurred, the inflammatory phase of phytophotodermatitis is over and this means that anti-inflammatory treatments like topical steroids are only useful in the very early phase of redness and blistering.
The post-inflammatory pigmentation that follows responds poorly to treatment with bleaching creams. It fades gradually over weeks to months. Using covering clothing and broad-spectrum sunscreens, the affected skin should be protected from further sun exposure, which might cause the pigmentation to darken.
4. Pyogenic Granuloma
Location: Darwin, Australia and California, USA
I do a lot of traveling. The last month I have been in Darwin, Australia, central California (Where I first noticed this just before I left) and now Yokohama, Japan. It is located on the back of my scrotum behind the left testicle, it does not seem to directly itch, but there is a minor pain when I touch it. When I looked online I came across mites, ticks, and scabies and now I itch a lot but I am not sure if that is a symptom or just my imagination after reading all those articles. It has been 6 or 7 days since I first noticed it. Started smaller and it might be moving.
Thank you for sending your case. Based on the information and images, this is possibly a PYOGENIC GRANULOMA: Pyogenic granuloma is a common, benign growth that often appears as a rapidly growing, bleeding bump on the skin or inside the mouth. It can appear on the skin spontaneously or after some sort of trauma. It is composed of blood vessels and may occur at the site of minor injury.
Pyogenic Granulomas occur in people of all races. The most common locations for Pyogenic Granulomas are the lips, gums, and inner mouth. Typically, Pyogenic Granulomas appear as a beefy, red bump that enlarges rapidly over a few weeks. On average, Pyogenic Granulomas are about 5–10 mm in diameter. They may bleed easily and, in some cases, can be tender. Very rarely, more than one lesion of Pyogenic Granuloma may develop at the same time at the same site.
This should be electrocauterized or surgically removed by a Dermatologist, and the lesion sent to a lab for pathological examination. I would recommend that you see a Dermatologist in-person to confirm the assessment and for appropriate treatment. It doesn’t look like a tick or similar in your pictures but this can better be assessed at the dermatologist.
Location: Cusco, Peru
It’s now Wednesday evening and my 15 y.o. son first noticed this rash on Monday evening, two days ago, in Cusco, Peru, after being in Agua Calientes (a small town near Machu Picchu), Peru on Friday and in Macchu Picchu on Saturday. The rash is mainly on his back, from his shoulder blades down to his upper buttocks, but there is some rash on both sides of his torso. It is mostly red, small, irregular circles, interspersed with patches of noncircular red rash. He reports it is only mildly itchy, if at all. The red circles and patches of redness are very slightly raised. We are now in a small beach town in northern Peru, but there is a pharmacy with basic medicines.
Based on the information and images submitted, this is possibly a URTICARIA: Hives commonly caused by medication, infection or an external irritant resulting in an allergic reaction but can also be triggered by different stimuli such as contact with certain plants, insect bites, etc. The hives arise from the release of the substance histamine in the skin causing local inflammation.
Symptoms include swelling, itching or burning, raised, red skin welts. Acute urticaria, as in your son’s case, usually lasts days to weeks and can be treated with antihistamines (e.g. Aerius or cetirizine over-the-counter in most countries). If the reaction is acute, see a doctor immediately. If no improvement after some days or if it spreads, see a dermatologist or your doctor in person for an evaluation.
On both legs – about 4″x2″ on one leg (pictured) about 2″ X1″ on another leg. Have had this for about four days, began during a trip to Mexico. My very white legs were briefly exposed the sun, also several minutes in a sauna and a hot tub. Very itchy periodically (not continually); hurts when I scratch it. My primary concern, as a liver transplant recipient (6 years, very healthy) is that the skin has broken in several places, so I worry about infection.
Thank you for sending your case of a recent rash on both legs. Based on the information and images of your left lower leg, this is possibly a type of contact dermatitis: Contact dermatitis is a type of inflammation of the skin that is usually induced by exposure to allergens (Allergic contact dermatitis) or irritants (Irritative contact dermatitis).
Common allergens are nickel, chrome and other metals, perfumes, substances in hair dyes, preservatives such as formaldehyde, etc. In regards to irritants, contact with chemicals in cleaning products or even excessive exposure to water can be the cause. Irritant dermatitis can also be from contact with plants especially with subsequent sun exposure (A phytophotodermatitis).
The skin may appear red, dry and itchy. Scratching should be avoided since this just makes it worse. At-home treatment options include: avoiding substances that may be irritants, applying over-the-counter 1% hydrocortisone cream (twice daily for a week, then once daily for another week and then every other day for 2 weeks) plus moisturizing cream.
If it doesn’t improve, see a dermatologist in person for testing to rule out allergic contact dermatitis. More potent steroid creams requiring a prescription may be needed. The amount of surface abrasion does not look severe enough to be a risk of infection even in a transplant recipient but if the skin becomes more red or swollen or painful you should seek advice/treatment in person from your physician.
Location: Maldives and Thailand
I traveled to Maldives and Thailand with my wife and when we came back from Thailand after a 24-hour journey on air both me and her started getting these on our face burn mine is much worse. It started under my beard on a small side of my face 10 days ago. I thought it would go away but then my chin and under my mouth started getting it as well. However, the first part that started is almost healed after 10 days but it’s now spreading. Since doing some research, I am not sure if it’s ringworms or maybe psoriasis, please help me. I had clear skin before this and had no issues.
Thank you for submission. Based on the information and images, this is possibly a Tinea faciei: Tinea faciei (ringworm), a fungal infection of the skin. I would recommend that you see a family doctor or a dermatologist in person who can order a culture. If fungus is present, a 2-4 week treatment with oral terbinafine 250 mg can be prescribed.
Avoid applying any topical antifungal medicine until the culture has been done. Nevertheless, other diagnoses may also be considered including DERMATITIS (inflammation of the skin). If the culture comes back negative, dermatitis may be the diagnosis and a topical steroid cream and moisturizers may be applied to improve the symptoms.
Other Potential Rashes
Seabather’s eruption (hypersensitivity reaction jellyfish larval-stage)
Locations: Maldives, Long Island – New York, Florida coast and in the Caribbean
Dermatologist travel rash question
I am a 44 year old female. I have a non-itchy and painless rash everywhere, but my lower legs, face, and genitals. It’s mainly concentrated on my torso. Furthermore, it sort of broke out or expanded over several days and has gotten better in some places and worse in others. Now, I am taking prednisone (the 6,5,4…) pack, have taken both Benedryl and Atarax 25mg to little avail. I h
ad cosmetic surgery planned and got sent home. It’s not really getting better and doesn’t seem to react to much. There are only a couple things that stand out. 1. Before the full breakout I had a weird dry, hard patch of skin on my tricep. (Still there) I scratched it once and I felt like I had stuck a needle in my arm or popped a pimple. 2. I used a wetsuit twice in one day and took it off as soon as I was out of the water (Galapagos). No one else has broken out from hotel sheets, and I am not normally sensitive at all. Like…normally, I would be the only one unaffected whilst others are covered. I have never had a rash before. Help! Thank you!
Based on the images and information provided, this is most likely SEABATHERS’S ERUPTION: A rash caused by marine life larvae. This usually appears under covered areas such as the chest and swim trunk area. It is important not to rub the skin because that will cause the larvae to sting.
You should wash the clothes that you were wearing when this developed in hot water and soap and dry it in a dryer before you wear those clothes again. An over-the-counter antihistamine such as Zyrtec or Allegra as well as over-the-counter hydrocortisone cream 1% used twice daily can be helpful. You can continue the prednisone course prescribed by your physician. If no improvement in 10 to 14 days, you should see a dermatologist for evaluation and prescription treatment.
Cutaneous Larva Migrans
Location: Tropical and subtropical geographic areas and the southwestern United States. It has become an endemic in the Caribbean, Central America, South America, Southeast Asia, and Africa
Dermatologist travel rash question
I am a 36 year old woman. Firstly, I noticed some slightly itchy bumps on my ankles, I thought they were mosquito bites. They came and went – until last weekend when I noticed very long lines about 4-5 inches long and raised up my left leg. They are red and sometimes itchy, most of the time not so bad. After doing an ink test to see if it could be scabies, but no ink remained. Some are skin colored, some are red, and some have a purple appearance. Some have blistered. No one else that I have been in contact with over the past few months has had this, including roommates and family. I noticed it after a trip to Mexico.
My doctor prescribed me ivermectin though they were not sure what it was – and I followed all of the instructions to a-z and yet still wake up with new bumps every morning. The long lines were the first to appear and they are moving up my legs – I’ve heard that scabies burrows are usually difficult to spot but these long lines are the main symptom of my rash. Please help.
Thank you for sending your case. Based on the information and images, this is possibly Larva Migrans. Cutaneous larva migrans is a parasitic skin infection caused by hookworm larvae that usually infest cats, dogs and other animals. Humans can be infected with the larvae by walking barefoot on sandy beaches or contacting moist soft soil that have been contaminated with animal feces.
It is also known as creeping eruption as once infected, the larvae migrate under the skin’s surface and cause itchy red lines or tracks. Many types of hookworm can cause cutaneous larva migrans. Effective treatment is available to shorten the course of the disease. Anthelmintics such as tiabendazole, albendazole, mebendazole and ivermectin are used. Topical thiabendazole is considered the treatment of choice for early, localised lesions. Oral treatment is given when the cutaneous larva migrans is widespread or topical treatment has failed.
Itching is considerably reduced within 24-48 hours of starting antihelmintic treatment and within 1 week most lesions/tracts resolved. I suggest you see a dermatologist to verify the answer and get the right treatment. This may also represent a contact dermatitis or phytophotodermatitis. I hope I have been of some assistance.
Mallorca-acne or Acne aestivalis
I am a 22 years old woman from Stockholm, Sweden. The rash occur during the spring and summer especially while traveling. They are small, usually fluid-filled, they look similar to pimples. Usually they do not Itch. Occurs especially when I’ve been in the sun, getting worse if I’m hot and sweaty combined with sun.
Get them on the temples, around the ears, neck, chest and sometimes back. Generally I do not have sensitive skin or light to burn me in the sun, haired. I have tested the hydrocortisone but it does not help very much, it relieves some redness only. Sunscreen does sometimes seem to have some effect for preventative purposes, but has also made it worse sometimes if used when I already got the dots.
From The information and image, possibly Mallorca-acne or Acne aestivalis, this is not really acne but a reaction to the skin of the combination of fatty oils and heat – something that is unfortunately often found in sunscreen products, it is difficult to overcome and can keep long after you come home from holidays.
Products with vitamin A may have some effect on Mallorca-acne, but the best thing is to prevent it before it arises. There are sunscreen products that are formulated for that very reason – to counteract Mallorca – acne. The acne is linked to greasy sunscreen/solar oils associated with heat and sweating. This type of acne consists of small papules on the face and/or on the chest, occurs very quickly and disappears just as easily. You can test Basiron cream (prescription free) if no improvement, seek medical help.
Travel Rash Advice
In regards to your skin, most creams can be bought locally. However a tube of hydrocortisone, sunscreen and moisturizing cream can be advised and can usually solve most skin infections quickly.
To protect your skin from the sun, apply sunscreen and wear a sun hat or cap. Clothing is the best protection; dense fabrics protect better than thin ones. The sun’s radiation is the most intense, between ten and three o’clock in the day and it is recommended to stay in the shade at those hours. If you are not used to the sun, then for the first few days you should only be in the sun for short periods of time.
Beware that some medicines can increase your skin’s sensitivity to sunlight. When you are on the beach you should be extra careful; sand and water reflect the sunlight and the solar radiation can reach half a meter below the water surface.
Small children should not be in the sun at all during the most intense sun hours.
Do not bathe in fresh water
Do not swim in rivers or lakes in countries with subtropical or tropical climates as there is a risk of being infected by various parasites. The most common parasite is Schistosoma. It can penetrate the skin and cause a severe fever. It is, however, harmless to swim in chlorinated water such as pools and to shower in tap water.
Light clothing prevents skin rashes
The heat can sometimes cause small itchy rashes under the armpits or red itchy spots on the skin, especially in the groin area. It is often because the sweat glands are clogged or that fungi that are naturally found on the skin get the chance to grow. To avoid it dress airy and avoid jeans.
If you still have problems, you can use a hydrocortisone cream around the armpits. In the groin where fungal problems are more common, it can help with a hydrocortisone cream and anti-fungal.
Small wounds and insect bites
When it is hot and humid, an insect bite or wound can easily become infected. Wash with soap and water and temporarily protect the wound with an airy compress, it should be removed as soon as the wound is dry.
If the wound is infected if it starts to hurt and the skin around the wound swells and turns red. You can try to clean the wound again a couple of times a day. If it still does not help, but the redness instead spreads and you get a fever you should consult a doctor.
How First Derm Can Help
Navigating a healthcare system can be a daunting task, let alone in another country. Imagine you are on an international business trip and you suddenly develop a skin condition. What would you do?
Here is an example story from James, a native to the United Kingdom, who was working from the United States during a 3 month period.
Here is his story: It happened as soon as I arrived in San Francisco. The first day of my trip I had developed a red and itchy mark near my ear. It was really quite sudden, I didn’t know what it was or how I got it.
First, my initial concern was cost. Could I get this checked for a reasonable price? In the past i have had toothache whilst in the US. I contacted my travel insurance and they said it would be $700 for the check up as well as a copay. Frustrated, I decided to forgo the dental appointment and toughed it out until I got home. I have friends who have had even worse experiences. They’ve needed to get emergency treatment in the States — One of them is still on the hook for tens of thousands of dollars for her medical bills.
Choose The First Derm App
From my perspective I had two options: go to a dermatologist here (which could take months and cost a ton of money) or use a dermatology app that a friend had recommended. So in the spirit of being in Silicon Valley, I decided to give the app a shot. I downloaded First Derm, took two pictures of my rash, filled out some information, and submitted the case. It was a one time credit card payment of $25. Within two hours my First Derm doctor had let me know that it was eczema. He gave me some pointers on how to avoid common triggers and recommended a hydrocortisone treatment.
All in all First Derm was great because their advice let me effectively treat my rash at home. I got my results in a few hours and I went to the local pharmacy to pick up some hydrocortisone. Sure enough after a couple weeks of applying the cream as directed by First Derm the rash went away.
Ask a Dermatologist
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The Specialist doctor from the University Hospital in Gothenburg, alumnus UC Berkeley. My doctoral dissertation is about Digital Health and I have published 5 scientific articles in teledermatology and artificial intelligence and others.