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- Skin rash
- Skin rash causes
- Baby skin rash
Skin rash
It is difficult to comprehensively review generalized skin rashes because the topic is so broad. Diagnostic errors involving generalized skin rashes are common 1), 2). However, accurate diagnosis is important because treatment varies depending on the cause and because some skin rashes can be life-threatening if not treated promptly. Some generalized skin rashes have distinctive features that allow immediate recognition, such as psoriasis (silvery white scale on the knees and elbows), pityriasis rosea (herald patch) and atopic dermatitis (lichenified skin in flexural areas). But these conditions, like many others, can present with similar appearances and can be mistaken for each other.
Skin rash causes
The causes of a generalized skin rash are numerous, but most patients have common diseases (Table 1). Many common skin rashes improve spontaneously or with simple measures, such as discontinuing a medication. Life-threatening skin rashes are rare in the United States, so they can be easily missed because they are not considered.
Table 1. Common Causes of Generalized Skin Rash
|Key clinical features
Atopic dermatitis
Dry skin; pruritus; erythema; erythematous papules; excoriations; scaling; lichenification; accentuation of skin lines; keys to diagnosis are pruritus, eczematous appearance of lesions, and personal or family history of atopy
Skin biopsy is nonspecific and not often done*
Contact dermatitis
Erythema; edema; vesicles; bullae in linear or geometric pattern; common causes include cosmetics, topical medications, metal, latex, poison ivy, textiles, dyes, sunscreens, cement, food, benzocaine, neomycin; keys to diagnosis are linear or geometric pattern and distribution of lesions
Skin biopsy is nonspecific and not often done,* but it can help exclude other conditions
Drug eruption†
Many patterns, but most commonly maculopapular (95% of cases), common in patients taking allopurinol (Zyloprim), beta-lactam antibiotics, sulfonamides, anticonvulsants, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, hypoglycemics, and thiazide diuretics, but can occur with almost any drug; usually appears within 1 to 4 weeks of initiating drug; key to diagnosis is timing of rash appearance in relation to drug use
Skin biopsy is usually nonspecific and not often done*
Erythema multiforme
Round, dusky red lesions that evolve into target (iris) lesions over 48 hours; starts on backs of hands and feet and on extensor surfaces of arms and legs; symmetric; may involve palms, soles, oral mucous membranes, or lips; key to diagnosis is presence of target lesions
Skin biopsy is generally diagnostic and occasionally done; biopsy should be taken from the erythematous (not blistered) portion of the target
Fifth disease (i.e., erythema infectiosum)†
"Slapped cheek" appearance with sparing of periorbital areas and nasal bridge; unique fishnet pattern; erythema on extremities, trunk, and buttocks; keys to diagnosis in children are slapped cheek appearance and net-like rash, and in adults are arthralgias and history of exposure to affected child
Parvovirus B19 serology; skin biopsy is nonspecific and rarely done*
Multiple small pustules localized to hair follicles on any body surface; key to diagnosis is hair follicle at center of each lesion
Skin biopsy is often diagnostic but not often done*
Guttate psoriasis
Pinpoint to 1-cm scaling papules and plaques on trunk and extremities; often preceded by streptococcal pharyngitis 1 to 2 weeks before eruption; keys to diagnosis are scaling and history of streptococcal pharyngitis
Throat culture; antistreptolysin O titer; early skin biopsy may not be diagnostic and is not often done*
Insect bites
Urticarial papules and plaques; keys to diagnosis are outdoor exposure (usually) and distribution of lesions where insects are likely to bite
Skin biopsy is nonspecific and not often done*
Keratosis pilaris
Pinpoint follicular papules and pustules on posterolateral upper arms, cheeks, anterior thighs, or buttocks; keys to diagnosis are upper arm distribution, absence of comedones, and tiny palpable lesions
Skin biopsy can be diagnostic but is not often done*
Lichen planus
Violaceous flat-topped papules and plaques; commonly on ankles and wrists; 5 P's (pruritic, planar, polygonal, purple plaques); Wickham striae (reticular pattern of white lines on surface of lesions); lacy white buccal mucosal lesions; Koebner phenomenon (development of typical lesions at the site of trauma); keys to diagnosis are purple color and distribution of lesions
Skin biopsy is diagnostic and often done
Miliaria rubra (i.e., prickly heat, heat rash)
Erythematous nonfollicular papules associated with heat exposure or fever; lesions on back, trunk, neck, or occluded areas; keys to diagnosis are history of heat exposure and distribution of lesions
Skin biopsy can be diagnostic but is not often done*
Nummular eczema
Sharply defined, 2- to 10-cm, coin-shaped, erythematous, scaled plaques; lesions on dorsal hands and feet, extensor surfaces of arms and legs, flanks, and hips; key to diagnosis is sharply defined, round, erythematous, scaled lesions
Skin biopsy is nonspecific and not often done,* but it may help exclude other diagnoses
Pityriasis rosea
Discrete, round to oval, salmon pink, 5- to 10-mm lesions; "Christmas tree" pattern on back; often (17 to 50%) preceded by solitary 2- to 10-cm oval, pink, scaly herald patch; keys to diagnosis are oval shape, orientation with skin lines, and distinctive scale
Skin biopsy is nonspecific and not often done,* but it may help exclude other diagnoses; rapid plasma reagin testing is optional to rule out secondary syphilis
Psoriasis (plaque psoriasis)
Thick, sharply demarcated, round or oval, erythematous plaques with thick silvery white scale; lesions on extensor surfaces, elbows, knees, scalp, central trunk, umbilicus, genitalia, lower back, or gluteal cleft; positive Auspitz sign (removal of scale produces bleeding points); Koebner phenomenon; keys to diagnosis are distinctive scale and distribution of lesions
Skin biopsy can be diagnostic but is not often done*
Roseola (i.e., exanthem subitum, sixth disease)
Sudden onset of high fever without rash or other symptoms in a child younger than 3 years; as fever subsides, pink, discrete, 2- to 3-mm blanching macules and papules suddenly appear on trunk and spread to neck and extremities; key to diagnosis is high fever followed by sudden appearance of rash as fever abruptly resolves
Skin biopsy is nonspecific and not often done*
Discrete, small burrows, vesicles, papules, and pinpoint erosions on fingers, finger webs, wrists, elbows, knees, groin, buttocks, penis, scrotum, axillae, belt line, ankles, and feet; keys to diagnosis are distribution of lesions, intense pruritus, and positive mineral oil mount
Mineral oil mount is routinely done to identify mites or eggs; skin biopsy is usually nonspecific and not often done*
Seborrheic dermatitis
Erythematous patches with greasy scale; lesions behind ears or on scalp and scalp margins, external ear canals, base of eyelashes, eyebrows, nasolabial folds, central chest, axillae, inframammary folds, groin, and umbilicus; keys to diagnosis are greasy scale and distribution of lesions
Skin biopsy is nonspecific and not often done*
Tinea corporis
Flat, red, scaly lesions progressing to annular lesions with central clearing or brown discoloration; keys to diagnosis are annular lesions with central clearing and positive KOH preparation
KOH preparation is routinely done; skin biopsy can be diagnostic but is not often done*
Urticaria (i.e., hives)
Discrete and confluent, raised, edematous, round or oval, waxing and waning lesions with large variation in size; may have erythematous border (flare) and pale center (wheal); patient may have history of drug, food, or substance exposure; key to diagnosis is distinctive appearance of edematous lesions
Skin biopsy is nonspecific and not often done*
Vesicles on erythematous papules ("dewdrop on rose petal" appearance); all stages (papules, vesicles, pustules, crusts) are present at the same time and in close proximity; keys to diagnosis are crops of lesions in different stages, systemic illness, and exposure to persons with the infection
Diagnosis is usually clinical, but real-time polymerase chain reaction assay of skin lesion or direct fluorescent antibody testing of skin scrapings could be done; skin biopsy is often diagnostic but cannot distinguish herpes zoster or herpes simplex, and is not often done*
Viral exanthem, nonspecific
Blanchable, red, sometimes confluent macules and papules; may be indistinguishable from drug eruptions; keys to diagnosis are nonspecific generalized maculopapular rash in a child with systemic symptoms (fever, diarrhea, headache, fatigue)
Skin biopsy is nonspecific and not often done*
KOH = potassium hydroxide.
*— Skin biopsy is often not performed because the histology is nonspecific or because a biopsy is usually not needed for diagnosis.
†— Rashes that can have serious consequences for the patient or pregnant contacts of the patient.
Table 2. Uncommon Causes of Generalized Skin Rash
|Key clinical features
Bullous pemphigoid
Generalized bullae, especially on trunk and flexural areas; patient usually older than 60 years; Nikolsky sign (easy separation of epidermis from dermis with lateral pressure) usually negative
Skin biopsy with direct and indirect immunofluorescence is diagnostic and usually done
Dermatitis herpetiformis
Symmetric, pruritic, urticarial papules and vesicles that are often excoriated and isolated or grouped on extensor surfaces (knees, elbows), buttocks, and posterior scalp; most patients have celiac disease, but it is often asymptomatic; diagnosis is often delayed
Skin biopsy with direct immunofluorescence is diagnostic and routinely done
HIV acute exanthem*
Diffuse, nonspecific, erythematous, maculopapular, nonpruritic lesions; fever, fatigue, headache, lymphadenopathy, pharyngitis, myalgias, and gastrointestinal disturbances
Measurement of quantitative plasma HIV-1 RNA levels (viral load) by polymerase chain reaction; HIV serology (delay at least 1 month after acute illness); skin biopsy is nonspecific and not often done†
Id reaction
Follicular papules or maculopapular or vesiculopapular rash involving forearms, thighs, legs, trunk, or face; associated with active dermatitis (e.g., stasis dermatitis) or fungal infection elsewhere
KOH preparation to diagnose dermatophyte infection; skin biopsy is nonspecific and not often done†
Kawasaki disease*
Erythematous rash on hands and feet starting 3 to 5 days after onset of fever in children younger than 8 years (usually younger than 4 years); blanching macular exanthem on trunk, especially groin and diaper area; hyperemic oral mucosa and red, dry, cracked, bleeding lips
CBC to detect elevated white blood cell and platelet counts; measurement of C-reactive protein level and erythrocyte sedimentation rate; skin biopsy is nonspecific and not often done†
Lupus (subacute cutaneous lupus erythematosus)
Papulosquamous or annular pattern, mainly on trunk and sun-exposed face and arms; can be drug induced
Antinuclear antibody testing; skin biopsy with direct immunofluorescence is diagnostic and often done
Lyme disease*
Erythema migrans at site of tick bite, progressing to generalized macular lesions on proximal extremities, chest, and creases (median lesion size, 15 cm); history of outdoor activities; most common in northeastern U.S. seaboard, Minnesota, and Wisconsin
Serology; skin biopsy is nonspecific and not often done†
Nonblanching petechiae and palpable purpura, which may have gunmetal gray necrotic centers; usually spares palms and soles; may start as erythematous papules or pink macules
Positive cultures of blood, lesions, and cerebrospinal fluid; positive buffy coat Gram stain; skin biopsy is usually nonspecific and not often done†
Mycosis fungoides (i.e., cutaneous T-cell lymphoma)
Flat erythematous macules evolving into red scaly plaques with indistinct edges and poikiloderma (atrophy, white and brown areas, telangiectasia); can present as erythroderma (Sézary syndrome); diagnosis is often delayed; often confused with eczema
Skin biopsy is diagnostic and routinely done
Rocky Mountain spotted fever*
2- to 6-mm macules that spread centrally from wrists and ankles and that progress to papules and petechiae; often involves palms and soles; fever, severe headache, photophobia, myalgias, abdominal pain, nausea, and vomiting; history of outdoor activities in endemic area (e.g., Oklahoma, Tennessee, Arkansas, southern Atlantic states)
Serology; skin biopsy with direct fluorescent antibody testing is diagnostic and often done, if available
Scarlet fever*
Blanching sandpaper-like texture follows streptococcal pharyngitis or skin infection; Pastia lines (petechiae in antecubital and axillary folds); fever, vomiting, headache, and abdominal pain; most common in children
Antistreptolysin O titer; throat culture; skin biopsy is nonspecific and not often done†
Secondary syphilis*
Variable morphology, but usually red-brown scaly papules with involvement of the palms and soles; oral and genital mucosa also commonly affected
Positive syphilis serology (usually done); skin biopsy can be nonspecific and is not often done†
Staphylococcal scalded skin syndrome*
Starts with painful, tender sandpaper-like erythema favoring flexural areas, and progresses to large, flaccid bullae; positive Nikolsky sign; most common in children younger than 6 years
Skin biopsy is diagnostic and routinely done to distinguish from toxic epidermal necrolysis, which is rare in infancy and childhood; frozen section biopsy should be considered; eyes, nose, throat, and bullae should be cultured for Staphylococcus aureus
Stevens-Johnson syndrome* Toxic epidermal necrolysis*
Stevens-Johnson syndrome: vesiculobullous lesions on the eyes, mouth, genitalia, palms, and soles; usually drug induced Toxic epidermal necrolysis: life-threatening condition with diffuse erythema, fever, and painful mucosal lesions; positive Nikolsky sign
Skin biopsy is diagnostic and routinely done for toxic epidermal necrolysis; frozen section biopsy should be considered
Sweet syndrome (i.e., acute febrile neutrophilic dermatosis)
Red, tender papules that evolve into painful erythematous plaques and annular lesions on upper extremities, head, neck, backs of hands, and back; most common in middle-aged and older women
Skin biopsy is diagnostic and routinely done
Toxic shock syndrome*
Diffuse erythema (resembling sunburn); fever, malaise, myalgia, nausea, vomiting, hypotension, diarrhea, and confusion; conjunctival injection, mucosal hyperemia (oral or genital); late desquamation, especially on palms and soles; most common in menstruating women or postoperative patients
CBC to detect thrombocytopenia; blood cultures; skin biopsy is nonspecific and not often done†
CBC = complete blood count; HIV = human immunodeficiency virus; KOH = potassium hydroxide.
*— Rashes that can have serious consequences for the patient or pregnant contacts of the patient.
† — Skin biopsy is often not performed because the histology is nonspecific or because a biopsy is usually not needed for diagnosis.
Table 3. Rare Causes of Generalized Skin Rash
|Key clinical features
Lichen nitidus
1- to 3-mm, skin-colored, raised, flat-topped papules on trunk, flexor surfaces of extremities, dorsal hands, or genitalia
Skin biopsy is diagnostic and often done
Pityriasis lichenoides
2- to 10-mm, round or oval, red-brown papules progressing to hemorrhagic lesions on trunk, thighs, or upper arms
Skin biopsy is diagnostic and routinely done
Pityriasis rubra pilaris
Red or orange follicular papules on fingers, elbows, knees, trunk, or scalp; often mistaken for psoriasis; characterized by "skip areas" of normal skin
Skin biopsy is occasionally nonspecific but can help exclude other conditions, and is routinely done
Initial lesion, which may not be noticed by patient, begins as papule and evolves to vesicle, then crusts; generalized maculopapular vesicular exanthem can involve palms and soles; most common in large cities
Serology (immunoglobulin G for Rickettsia rickettsii and Rickettsia akari); biopsy with direct fluorescent antibody testing may be diagnostic but is not often done*
Round, pink macules and papules starting on forehead, neck, and face, then spreading to trunk and extremities, including palms and soles
Serology; skin biopsy is nonspecific and not often done*
Maculopapular purple-red lesions that may become confluent; start on face and behind ears and at anterior hairline; Koplik spots (i.e., tiny red or white spots with red halo on buccal mucosa)
Serology; skin biopsy is usually nonspecific and not often done*
*— Skin biopsy is often not performed because the histology is nonspecific or because a biopsy is usually not needed for diagnosis.
†— Rashes that can have serious consequences for the patient or pregnant contacts of the patient.
Table 4. Skin Rashes That Are Often Confused with Each Other
|Similar rashes (distinguishing features)
Atopic dermatitis
Contact dermatitis (not associated with dry skin)
Keratosis pilaris (nonpruritic, involves posterolateral upper arms)
Mycosis fungoides (lesion borders sharper, fixed size and shape)
Psoriasis (well-defined plaques, silvery white scale, involves extensor surfaces)
Scabies (involves genitalia, axillae, finger webs)
Seborrheic dermatitis (nonpruritic, greasy scale, characteristic distribution)
Contact dermatitis
Atopic dermatitis (symmetric distribution, history of hay fever or asthma, flexural areas, hyperlinear palms, family history, not limited to area of exposure, dry skin and itching precede skin lesions rather than follow them)
Dermatitis herpetiformis (vesicles on extensor surfaces, enteropathy, burning pain)
Psoriasis (patches on knees, elbows, scalp, and gluteal cleft; pitted nails)
Seborrheic dermatitis (greasy scale on eyebrows, nasolabial folds, or scalp)
Drug eruption (morbilliform)
Erythema multiforme (target lesions)
Viral exanthem (more common in children, less intense erythema and pruritus, less likely to be dusky red, more focal systemic symptoms, less likely to be polymorphic, less likely to be associated with eosinophilia)
Pityriasis rosea
Drug eruption (no scale, lesions coalesce)
Erythema multiforme (target lesions)
Guttate psoriasis (thicker scale, history of streptococcal pharyngitis)
Lichen planus (violaceous, involves wrists and ankles)
Nummular eczema (larger round [not oval] lesions, do not follow skin lines)
Psoriasis (thick white scale, involves extensor surfaces)
Secondary syphilis (positive serology; involves palms and soles)
Tinea corporis (positive KOH preparation, scale at peripheral border of lesions rather than inside border)
Viral exanthem (no scale, lesions coalesce)
Atopic dermatitis (atopic features, flexural areas, lichenification)
Lichen planus (violaceous, minimal scale, involves wrists and ankles)
Mycosis fungoides (lesion borders less distinct)
Pityriasis rubra pilaris (islands of normal skin)
Seborrheic dermatitis (greasy scale, involves anterior face)
Secondary syphilis (red-brown lesions on palms and soles)
Tinea corporis (thinner peripheral scale, positive KOH preparation)
Seborrheic dermatitis
Atopic dermatitis (nongreasy scale, atopic history, pruritic)
Psoriasis (silver scale, sharply demarcated lesions on extensor surfaces of extremities; involvement of scalp commonly extends onto forehead, whereas seborrheic dermatitis of scalp stops at scalp margin)
KOH = potassium hydroxide.
How is skin rash diagnosed ?
Accurate diagnosis of the generalized skin rash can be difficult because of the nonspecific appearance of many rashes.
Patients with acute generalized maculopapular skin rashes and no systemic symptoms are often treated symptomatically without a definitive diagnosis. If the skin rash does not resolve spontaneously, skin biopsy and blood testing (e.g., serologies, complete blood count) may be indicated. There are no widely accepted guidelines that address indications for skin biopsy, but Table1, 2 and Table 3 include common clinical practices. The patient should be referred to a dermatologist if the skin rash is progressive or does not resolve with observation or empiric treatment. For example, mycosis fungoides (cutaneous T-cell lymphoma) mimics eczema in its early stages and is rarely diagnosed correctly at initial presentation 35). Reevaluation and possible referral are imperative in chronic eczematous conditions that do not respond to therapy.
It is important to look beyond the appearance of the skin rash itself and search for clues from the patient's history, physical examination, laboratory tests, and skin biopsy.
Patient History
When the diagnosis of a generalized rash is not obvious, patients should be asked about recent travel, insect and plant exposure, drug exposure (including over-the-counter drugs, alternative medications, and illicit drugs), contact with persons who are ill, pets, hobbies, occupational exposures, chemical exposure, chronic illness, sexual history, and recent systemic symptoms, especially fever (Table 5). Patients should be asked about itchy skin, painful lesions, the initial site of involvement, and any personal or family history of atopy (e.g., asthma, allergic rhinitis, childhood eczema).
Table 5. Generalized Skin Rash: Conditions Suggested by Patient History
|Historical finding
Contact dermatitis
Chronic illness
Dermatitis herpetiformis
Seborrheic dermatitis
Contact with ill persons
Fifth disease (i.e., erythema infectiosum)
Roseola (i.e., exanthem subitum, sixth disease)
Scarlet fever
Viral exanthem, nonspecific
Drug exposure
Lupus (subacute cutaneous lupus erythematosus)
Drug eruption
Urticaria (i.e., hives)
Contact dermatitis
Insect and arthropod exposure
Insect bites
Lyme disease
Rocky Mountain spotted fever
Occupational exposures
Contact dermatitis
Plant exposure
Contact dermatitis
Recent systemic symptoms, fever
Fifth disease (i.e., erythema infectiosum)
HIV acute exanthem
Kawasaki disease
Roseola (i.e., exanthem subitum, sixth disease)
Scarlet fever
Viral exanthem, nonspecific
Sexual history
HIV acute exanthem
Secondary syphilis
Insect bites
Lyme disease
Rocky Mountain spotted fever
HIV = human immunodeficiency virus.
The patient's age may help narrow the possible diagnoses. For example, acute maculopapular rashes in children are usually caused by viral infections, whereas in adults they are usually caused by drug reactions 37). Some rashes are rare in children (e.g., nummular eczema, lichen planus, dermatitis herpetiformis), whereas others are rare in adults (e.g., roseola, Kawasaki disease, scarlet fever).
Patients should be asked about itchy skin, because some conditions routinely cause intense pruritus (e.g., scabies, urticaria, atopic dermatitis), whereas others are usually nonpruritic (e.g., seborrheic dermatitis, secondary syphilis, many viral exanthems; Table 6). Most generalized skin rashes are not painful, but Sweet syndrome, Kawasaki disease, and Stevens-Johnson syndrome are exceptions.
Table 6. Generalized Skin Rash: Conditions Associated with Itchy Skin
|Absent or rare
Atopic dermatitis
Drug eruption*
Fifth disease (i.e., erythema infectiosum)*
Contact dermatitis
Erythema multiforme
HIV acute exanthem*
Insect bites
Keratosis pilaris
Lichen planus
Guttate psoriasis
Lyme disease*
Nummular eczema
Kawasaki disease*
Pityriasis rosea
Miliaria rubra (i.e., prickly heat, heat rash)
Urticaria (i.e., hives)
Psoriasis (plaque psoriasis)
Rocky Mountain spotted fever*
Tinea corporis
Roseola (i.e., exanthem subitum, sixth disease)
Toxic epidermal necrolysis*
Toxic shock syndrome (late)*
Scarlet fever*
Viral exanthem, nonspecific
Seborrheic dermatitis
Secondary syphilis*
Staphylococcal scalded skin syndrome*
Stevens-Johnson syndrome*
Note: Table 6 includes all common skin rashes and all skin rashes that can have serious consequences for the patient or pregnant contacts of the patient (designated by *).
HIV = human immunodeficiency virus.
Systemic symptoms, especially fever, can help narrow the differential diagnosis 39). Skin rashes accompanied by fever are most commonly associated with infections, but drug eruptions and rheumatologic diseases can also cause fever. Although most maculopapular skin rashes that are associated with fever are caused by self-limited viral infections, empiric antibiotics and laboratory testing are indicated when the history, geography, demographics, and systemic manifestations suggest a more serious infection (e.g., meningococcemia, Lyme disease, Rocky Mountain spotted fever). Petechial skin rashes require immediate decisions about empiric antibiotics, but life-threatening infections characterized by petechiae (e.g., meningococcemia, Rocky Mountain spotted fever) can start as nonspecific maculopapular skin rashes 40).
Physical Examination
Characteristics of skin rash itself can help narrow the differential diagnosis. In dermatologic diagnosis, it is often helpful to focus on the clinical appearance of the rash after determining the patient's primary symptom, but before taking a more focused history. The size of individual lesions can vary from pinpoint to total-body redness (i.e., erythroderma; Table 7). The shape of individual lesions and their tendency to cluster can also provide important clues. For example, linear patterns of erythema or vesicles are typical of poison ivy; oval lesions are typical of pityriasis rosea; round lesions are typical of nummular eczema; annular lesions are typical of tinea corporis; and geometric patterns may imply a contact component. The color of the lesions should also be noted. Although most generalized skin rashes are pink or red, lichen planus is characterized by violaceous lesions, and secondary syphilis by red-brown lesions.
Table 7. Generalized Skin Rash: Conditions Suggested by Size of Lesions
|Size of lesions
Keratosis pilaris
Scarlet fever*
1 mm to 1 cm
Guttate psoriasis
Insect bites†
Lichen planus
Miliaria rubra (i.e., prickly heat, heat rash)
Rocky Mountain spotted fever*
Roseola (i.e., exanthem subitum, sixth disease)
1 to 25 cm
Lyme disease*
Nummular eczema
Tinea corporis
Urticaria (i.e., hives)
Atopic dermatitis
Contact dermatitis
Drug eruption*
Erythema multiforme
Fifth disease (i.e., erythema infectiosum)*
HIV acute exanthem*
Kawasaki disease*
Pityriasis rosea
Psoriasis (plaque psoriasis)
Seborrheic dermatitis
Secondary syphilis*
Staphylococcal scalded skin syndrome*
Stevens-Johnson syndrome*
Toxic epidermal necrolysis*
Viral exanthem, nonspecific
Erythroderma possible
Atopic dermatitis
Drug eruption*
Psoriasis (plaque psoriasis)
Sézary syndrome (i.e., chronic cutaneous T-cell lymphoma)
Toxic shock syndrome*
note: Table includes all common rashes and all rashes that can have serious consequences for the patient or pregnant contacts of the patient (designated by *).
HIV = human immunodeficiency virus.
†—Some insect bites may be larger than 1 cm.
In addition to the rash itself, the physician should evaluate the patient's lymph nodes, neurologic status, body temperature, and general appearance. Patients with fever and toxic appearance require prompt evaluation and possibly empiric treatment before reaching a definitive diagnosis.
Dermatologic Signs
Several dermatologic signs may help narrow the differential diagnosis. For example, the Koebner phenomenon (i.e., development of typical lesions at the site of trauma) is characteristic of psoriasis and lichen planus 42). The Nikolsky sign (i.e., easy separation of the epidermis from the dermis with lateral pressure) is associated with staphylococcal scalded skin syndrome and toxic epidermal necrolysis 43). The value of the Auspitz sign (i.e., the appearance of bleeding points when scale is removed from psoriatic lesions) in the diagnosis of patients with psoriasis has been questioned because of its low sensitivity and specificity 44). Blanching of erythematous lesions with brief downward pressure implies that the erythema is the result of vasodilation rather than dermal hemorrhage. Blanching is characteristic of drug eruptions, viral exanthems, Kawasaki disease, roseola, and scarlet fever, whereas the lesions of meningococcemia and the late petechial stage of Rocky Mountain spotted fever do not blanch. The physician should note the presence and quality of scale (e.g., psoriasis, tinea corporis, pityriasis rosea); whether the lesions are evanescent (e.g., urticaria) or stable (e.g., erythema multiforme); and whether lesions tend to become confluent (e.g., urticaria) or remain discrete (e.g., insect bites). When atopic dermatitis is considered, the physician should search for other signs of atopy, such as palmar hyper-linearity, infraorbital folds (Dennie-Morgan lines), dry skin, and lichenification 45).
Rash Location
Many rashes tend to avoid or favor certain regions of the body. Physicians should note whether the rash involves the palms, soles, mucous membranes, face, scalp, or extensor or flexor surfaces of extremities. For example, psoriasis usually does not involve the central face, and many generalized rashes avoid the palms and soles, whereas secondary syphilis, erythema multiforme, and rickettsial infections typically include the palms and soles (Table 8). Keratosis pilaris commonly involves the posterolateral upper arms. Scabies involves the fingers, finger webs, wrists, elbows, knees, groin, buttocks, penis, axillae, belt line, ankles, and feet. Seborrheic dermatitis most often involves the scalp margins, the area behind the ears, external ear canals, base of eyelashes, eyebrows, nasolabial folds, and central chest. Patients should be asked where the rash first appeared, because some rashes have a characteristic progression. For example, pityriasis rosea often starts with a relatively large herald patch on the trunk or proximal extremity several days before the smaller oval lesions appear. Rocky Mountain spotted fever often starts on the wrists and ankles before spreading centrally 46).
Table 8. Generalized Skin Rash: Involvement of Palms and Soles
|Absent or rare
Contact dermatitis Erythema multiforme Kawasaki disease* Rocky Mountain spotted fever* Rubella* Scabies (in infants) Secondary syphilis* Staphylococcal scalded skin syndrome* Stevens-Johnson syndrome* Tinea corporis Toxic epidermal necrolysis* Toxic shock syndrome*
Atopic dermatitis Drug eruption* HIV acute exanthem* Lichen planus Meningococcemia* Psoriasis (plaque psoriasis) Urticaria (i.e., hives)
Fifth disease (i.e., erythema infectiosum)* Folliculitis Guttate psoriasis Insect bites Keratosis pilaris Lyme disease* Miliaria rubra (i.e., prickly heat, heat rash) Nummular eczema Pityriasis rosea Roseola (i.e., exanthem subitum, sixth disease) Scarlet fever*† Seborrheic dermatitis Varicella* Viral exanthem, nonspecific
Note: Table 8 includes all common skin rashes and all skin rashes that, if left untreated, can have serious consequences for the patient or pregnant contacts of the patient (designated by *).
HIV = human immunodeficiency virus.
†—Palms and soles can desquamate.
Blood tests that may be helpful include a complete blood count to determine the presence of leukocytosis or thrombocytopenia, and serologic studies to identify various infectious causes. Mineral oil mounts and potassium hydroxide scrapings can be helpful when scabies or dermatophytes are considered. Skin biopsy, with or without direct or indirect immunofluorescence, is often helpful, especially to confirm lichen planus, dermatitis herpetiformis, mycosis fungoides, and staphylococcal scalded skin syndrome 48).
"Don't-Miss" Skin Rashes
"Don't-miss" skin rashes are those that can have serious consequences for the patient or pregnant contacts of the patient. These rashes include various infectious diseases, such as meningococcemia, Lyme disease, and Rocky Mountain spotted fever. Many of these rashes are associated with fever and manifest as petechiae or purpura 49). However, there are notable exceptions, such as Lyme disease, which is not petechial, and drug eruptions, which may not be associated with systemic symptoms. Don't-miss skin rashes can usually be ruled out on the basis of clinical features and demographics, but sometimes further testing is indicated. Some patients should be treated immediately, before a diagnosis can be established. For example, toxic-appearing children and adults with petechiae should be treated immediately for presumed meningococcemia, before undergoing any further evaluation 50). Patients from Oklahoma, Tennessee, Arkansas, or the southern Atlantic states who present in the spring or summer with fever, myalgia, and headache—with or without a rash—should be strongly considered for antibiotic treatment of Rocky Mountain spotted fever while awaiting the results of serology or skin biopsy 51). If the physician cannot distinguish between meningococcemia and Rocky Mountain spotted fever on clinical grounds (a common occurrence), patients should be treated for both before undergoing diagnostic tests 52).
Baby skin rash
Skin rashes are extremely common in newborns and can be a significant source of parental concern. A baby's skin may exhibit a variety of changes during the first four weeks of life. Most of these changes are benign and self-limited, but others require further work-up for infectious causes or underlying systemic disorders. Nearly all of these skin changes are concerning to parents and may result in visits to the physician or questions during routine newborn examinations.
Transient Vascular Phenomena
Newborn vascular physiology is responsible for two types of transient skin color changes: cutis marmorata and harlequin color change. These transient vascular phenomena represent normal newborn physiology rather than actual skin rashes, but they often cause parental concern.
Cutis Marmorata
Cutis marmorata is a reticulated mottling of the skin that symmetrically involves the trunk and extremities (Figure 1). I t is caused by a vascular response to cold and generally resolves when the skin is warmed. A tendency to cutis marmorata may persist for several weeks or months, or sometimes into early childhood.2No treatment is indicated.
Figure 1. Cutis marmorata, a normal reticulated mottling of the skin caused by vascular response to cold.
Harlequin color change
Harlequin color change occurs when the newborn lies on his or her side. It consists of erythema (redness) of the dependent side of the body with simultaneous blanching of the contralateral side. The color change develops suddenly and persists for 30 seconds to 20 minutes. It resolves with increased muscle activity or crying. This phenomenon affects up to 10 percent of full-term infants, but it often goes unnoticed because the infant is bundled. It occurs most commonly during the second to fifth day of life and may continue for up to three weeks. Harlequin color change is thought to be caused by immaturity of the hypothalamic center that controls the dilation of peripheral blood vessels.
Erythema Toxicum Neonatorum
Erythema toxicum neonatorum is the most common pustular eruption in newborns. Estimates of incidence vary between 40 and 70 percent 53). It is most common in infants born at term and weighing more than 2,500 g (5.5 lb) 54). Erythema toxicum neonatorum may be present at birth but more often appears during the second or third day of life. Typical lesions consist of erythematous, 2- to 3-mm macules and papules that evolve into pustules (Figure 2) 55). Each pustule is surrounded by a blotchy area of erythema, leading to what is classically described as a "flea-bitten" appearance. Lesions usually occur on the face, trunk, and proximal extremities. Palms and soles are not involved.
The cause of erythema toxicum neonatorum is not known 56). Lesions generally fade over five to seven days, but they may recur for several weeks. No treatment is needed, and the condition is not associated with any systemic abnormality 57).
Figure 2. Erythema toxicum neonatorum
Several infections (e.g., herpes simplex, Candida, and Staphylococcus infections) also may present with vesicopustular rashes in the neonatal period (Table 9) 58), 59); infants who appear sick or who have an atypical rash should be tested for these infections 60). In healthy infants, the diagnosis of erythema toxicum neonatorum is made clinically and can be confirmed by cytologic examination of a pustular smear, which will show eosinophilia with Gram, Wright, or Giemsa staining. Peripheral eosinophilia may also be present 61).
Table 9. Infectious Causes of Vesicles or Pustules in the Newborn
|Distinguishing features
Group A or B Streptococcus Listeria monocytogenes Pseudomonas aeruginosa Staphylococcus aureus Other gram-negative organisms
Other signs of sepsis usually present Elevated band count, positive blood culture; Gram stain of intralesional contents shows polymorphic neutrophils
Presents within 24 hours after birth if congenital, after one week if acquired during delivery Thrush is common Potassium hydroxide preparation of intralesional contents shows pseudohyphae and spores
Rare Lesions on palms and soles Suspect if results of maternal rapid plasma reagin or venereal disease research laboratory test positive or unknown
Cytomegalovirus Herpes simplex Varicella zoster
Crops of vesicles and pustules appear on erythematous base For herpes simplex and varicella zoster, Tzanck test of intralesional contents shows multinucleated giant cells
[Source 62)]
Transient Neonatal Pustular Melanosis
Transient neonatal pustular melanosis is a vesiculopustular rash that occurs in 5 percent of black newborns, but in less than 1 percent of white newborns 63). In contrast with erythema toxicum neonatorum, the lesions of transient neonatal pustular melanosis lack surrounding erythema (Figure 3). In addition, these lesions rupture easily, leaving a collarette of scale and a pigmented macule that fades over three to four weeks. All areas of the body may be affected, including palms and soles.
Clinical recognition of transient neonatal pustular melanosis can help physicians avoid unnecessary diagnostic testing and treatment for infectious etiologies. The pigmented macules within the vesicopustules are unique to this condition; these macules do not occur in any of the infectious rashes 64). Gram, Wright, or Giemsa staining of the pustular contents will show polymorphic neutrophils and, occasionally, eosinophils.
Figure 3. Transient neonatal pustular melanosis
Note: A baby with numerous discrete tiny pustules with hyperpigmented background, distributed over forehead, limbs, and trunk
Acne Neonatorum
Acne neonatorum occurs in up to 20 percent of newborns10 (Figure 4). It typically consists of closed comedones on the forehead, nose, and cheeks, although other locations are possible. Open comedones, inflammatory papules, and pustules can also develop.
Neonatal acne is thought to result from stimulation of sebaceous glands by maternal or infant androgens. Parents should be counseled that lesions usually resolve spontaneously within four months without scarring. Treatment generally is not indicated, but infants can be treated with a 2.5% benzoyl peroxide lotion if lesions are extensive and persist for several months 65). Parents should apply a small amount of benzoyl peroxide to the antecubital fossa to test for local reaction before widespread or facial application. Severe, unrelenting neonatal acne accompanied by other signs of hyperandrogenism should prompt an investigation for adrenal cortical hyperplasia, virilizing tumors, or underlying endocrinopathies 66).
Figure 4. Acne neonatorum
Milia are 1- to 2-mm pearly white or yellow papules caused by retention of keratin within the dermis. They occur in up to 50 percent of newborns 67). Milia occur most often on the forehead, cheeks, nose, and chin, but they may also occur on the upper trunk, limbs, penis, or mucous membranes. Milia disappear spontaneously, usually within the first month of life, although they may persist into the second or third month 68). Milia are a common source of parental concern, and simple reassurance about their benign, self-limited course is appropriate.
Figure 5. Milia
Miliaria results from sweat retention caused by partial closure of eccrine structures. Both milia and miliaria result from immaturity of skin structures, but they are clinically distinct entities. Miliaria affects up to 40 percent of infants and usually appears during the first month of life 69). Several clinically distinguishable subtypes exist; miliaria crystallina and miliaria rubra are the most common.
Miliaria crystallina is caused by superficial eccrine duct closure. It consists of 1- to 2-mm vesicles without surrounding erythema, most commonly on the head, neck, and trunk (Figure 6). Each vesicle evolves, with rupture followed by desquamation, and may persist for hours to days.
Figure 6. Miliaria crystallina
Miliaria rubra, also known as heat rash, is caused by a deeper level of sweat gland obstruction (Figure 7). Its lesions are small erythematous papules and vesicles, usually occurring on covered portions of the skin. Miliaria crystallina and miliaria rubra are benign. Avoidance of overheating, removal of excess clothing, cooling baths, and air conditioning are recommended for management and prevention of these disorders 70).
Figure 7. Miliaria rubra (heat rash)
Seborrheic Dermatitis
Seborrheic dermatitis is an extremely common rash characterized by erythema and greasy scales (Figures 8). Many parents know this rash as "cradle cap" because it occurs most commonly on the scalp. Other affected areas may include the face, ears, and neck. Erythema tends to predominate in the flexural folds and intertriginous areas, whereas scaling predominates on the scalp 71). Because seborrheic dermatitis often spreads to the diaper area, it is important to consider in the evaluation of diaper dermatitis 72).
Seborrheic dermatitis can be difficult to clinically distinguish from atopic dermatitis, but age at onset and the presence or absence of pruritus can be helpful (Table 10) 73). Psoriasis also has a clinical appearance similar to that of seborrheic dermatitis, but it is less common.
The exact etiology of seborrheic dermatitis is unknown. Some studies have implicated the yeast Malassezia furfur (previously known as Pityrosporum ovale) 74). Hormonal fluctuations may also be involved, which would explain why seborrheic dermatitis occurs most often in areas with a high density of sebaceous glands. Generalized seborrheic dermatitis accompanied by failure to thrive and diarrhea should prompt an evaluation for immunodeficiency 75).
Infantile seborrheic dermatitis is usually self-limited, resolving within several weeks to several months. In one prospective study, children with infantile seborrheic dermatitis were reexamined 10 years later 76). Overall, 85 percent of children were free of skin disease at follow-up. Seborrheic dermatitis persisted in 8 percent of children, but the link between infantile and adult seborrheic dermatitis remains unclear. In addition, 6 percent of children in this study later were diagnosed with atopic dermatitis, illustrating the difficulty in distinguishing these conditions during infancy.
Given the benign, self-limited nature of seborrheic dermatitis in infants, a conservative stepwise approach to treatment is warranted. Physicians should begin with reassurance and watchful waiting. If cosmesis is a concern, scales can often be removed with a soft brush after shampooing. An emollient, such as white petrolatum, may help soften the scales. Soaking the scalp overnight with vegetable oil and then shampooing in the morning is also effective.
If seborrheic dermatitis persists despite a period of watchful waiting, several treatment options exist (Table 11). Tar-containing shampoos can be recommended as first-line treatment 77). Selenium sulfide shampoos are probably safe, but rigorous safety data in infants is lacking. The use of salicylic acid is not recommended because of concerns about systemic absorption 78).
Evidence from small randomized controlled trials supports the use of topical antifungal creams or shampoos if treatment with tar-containing shampoo fails 79). Mild steroid creams are another commonly prescribed option. One meta-analysis found that topical ketoconazole (Nizoral, brand no longer available in the United States) and steroid creams are effective in the treatment of infantile seborrheic dermatitis, but ketoconazole may be better at preventing recurrences 80).
Figure 8. Seborrheic dermatitis
Table 10. Distinguishing Features of Seborrheic and Atopic Dermatitis in Infancy
|Seborrheic dermatitis
|Atopic dermatitis
Age at onset
Usually within first month
After three months of age
Self-limited, responds to treatment
Responds to treatment, but frequently relapses
Scalp, face, ears, neck, diaper area
Scalp, face, trunk, extremities, diaper area
Pruritus (itchy skin)
Table 11. Treatment Options for Infantile Seborrheic Dermatitis
White petrolatum
Apply daily
May soften scales, facilitating removal with soft brush
Tar-containing shampoo
Use several times per week
Use when baby shampoo has failed Safe, but potentially irritating
Ketoconazole (Nizoral, brand no longer available in the United States), 2% cream or 2% shampoo
Cream: apply to scalp three times weekly Shampoo: lather, leave on for three minutes, then rinse. Use three times weekly
Small trial showed no systemic drug levels or change in liver function after one month of use
Hydrocortisone 1% cream
Apply every other day or daily
Limit surface area to reduce risk of systemic absorption and adrenal suppression
May be especially effective for rash in flexural areas
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text:
Awaken to many Realities – by Guruji Krishnananda
We have to awaken to many Truths, many Realities. We have to awaken from ignorance. Sometimes people say that in Hinduism there are so many gods. All these gods do exist. Lord Mahavishnu is in-charge of Life and Life Forces. Lord Shiva is in-charge of the forces of destruction. Lord Brahma is in-charge of creation. And hordes of gods assist these processes.
All gods/deities are manifestations from a single God. There is one God. And here, on this earth, we can imagine Him to be Light. And from that Light all these emanations, all these manifestations came forth. God is energy. God is Light. And God is omnipresent. Everyone has to awaken to the Truth that there is only one God and all others are manifestations.
People have to awaken to the reality that the idols represent gods or deities. A god or deity is energy. The idol carries these energies. Idols are to be worshipped, no doubt, but they themselves are not the deity. Usually, the field of energy is under the ground, beneath the idol. Only a small quantity of energy is present in the idol.
Once we tried to worship Lord Shiva in Nandi Hills. We were told the energies are so huge that the entire hill carries those energies. So, the energies are under the ground and they are the deity, not just the idol.
We have to awaken to the fact that we have to go beyond ritualistic worship or Pooja. Poojas are good, but again we have to go beyond. While performing Pooja we consciously remain distant and distinct from God. When I worship and He gets worshipped, there is duality; there is distance. We have to go beyond this. There are still higher ways of Poojas and worship.
Pooja is a form of expression of our Love and respect. In Meditation, the expression reaches its maximum. We surrender to Him. We merge with Him. That is the highest form of expression of Love.
We are aware of Papa and Punya (merits and demerits). But Punya does not take us to Mukti. A good deed or Karma will give us a good effect, that's all. Punyas take us only to heaven, not to Mukti. This does not mean that we should not do good deeds but we must know and clearly realize that putting a huge amount in a hundi (donation box) does not help us in attaining Mukti. These are simple Truths. They do not need any explanation.
We cannot appease gods by Shanti Homas or Mantras. Gods do not accept bribes and keep quiet. Most importantly, God is not pleased when we suffer. Some people pierce their tongues and cheeks with needles, etc. Those who do such acts think that God is pleased. God will never appreciate such things. You do not have to suffer. You do not have to even fast to please Him. God is not pleased by these ways.
We must awaken to the reality that God is everywhere, in and around. All that is required is a connection from our pure heart. We have to awaken to this reality. Accept this and begin living accordingly. Interact with God who is everywhere.
(Source – From Book – Guruji Speaks Volume 5)
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text:
Ani DiFranco with Special Guests Gracie and Rachel
Tarrytown Music Hall • 05.06.18 • 7 PM
Ani Difranco, a Music Hall favorite, returns again in support of her latest album 'Binary'. With her twentieth studio album, the iconic singer/songwriter/activist/poet/DIY trendsetter returns to territory that brought her to the world's attention more than twenty-five years ago. One of the first artists to create her own label in 1990, she has been recognized among the feminist pantheon for her entrepreneurship, social activism, and outspoken political lyrics. At a time of global chaos and confusion, DiFranco is kicking ass and taking names, with a set of songs offering a wide range of perspective and musical scope.


text:
In 1990, the Eurythmics, a new wave duo who had hits all through the previous decade, informally dissolved. Annie Lennox, the Scottish singer-songwriter who made up half of the band, took a few years off from the music industry, partly due to the birth of her eldest daughter.
Thankfully, she didn't stay away for long. In 1992, she released her first solo album: Diva. More along the lines of soul pop than actual pop pop, Diva lets Lennox show off her voice and her songwriting talent. She's amazing at this sort of genre, drawing out pathos and emotion from every note for a beautifully polished finish.
Diva is an odd album: since it's the early 1990s, the musical stylings of the 1980s haven't entirely vanished, lingering on in synthesizer stylings and percussion backings. Songs like "Money Can't Buy It," with it's 1980s synths and it's 1990s percussion, straddle the two decades giving the album a bit of a beautifully schizophrenic feel. Still, Diva mostly manages a deft mix between the two genres, as the 1980s stylings of her previous work in the Eurythmics expertly blend with her venues into more of a melodramatic, soulful style. It's occasionally jarring, but never awkward or out of place.
The word 'diva' technically means 'a distinguished female singer, usually operatic'. However, the term carries a whole host of connotations; a diva is demanding, commanding, and overdramatic. You can tell that Lennox was trying to project that image straight from the album cover, where Lennox peers at the viewer from an over the top and slightly ridiculous feathered headdress. But if any song off of Diva is the diva song, it's "Walking on Broken Glass," the third single released from the album. This is the diva song, the big important showstopping single. Everything is so dramatic. Those dramatic strings, Lennox pulling as much emotion out of phrases as she can, Lennox takes this song and the song's beautiful pathos up to eleven. These lyrics are also pure diva: "the sun's still shining in the deep blue sky / but it don't mean nothing to me." This is so over the top and so overdramatic but the happy tone and major key stop it from going full tilt early 2000s emo pop angst. Also the video is amazing: Dangerous Liaisons mixed with Blackadder mixed with a soap opera (John Malkovich and Hugh Laurie, the stars of both of those pieces of media, appear in the video). A perfectly melodramatic video for a perfectly melodramatic song.
While the album has plenty of highs, it also has plenty of slower moments. Songs like "Why" and "Stand By Me" are calmer, as Lennox shows off her vocal prowess by taking things incredibly slow. She's amazing at these languid, slow, drawn-out sort of melodies where she can take one phrase and stretch it out over literal measures. Her voice lilts through various phrases as the backing line is wisely restrained, letting her vocals take the spotlight. These tilt more to the soul aspect of soul pop as Lennox wails and laments over these blues-ish backings, letting her vocals take the show.
All in all, Diva is an amazing solo debut album. It shows Lennox's strengths as a singer and a songwriter, proving to the world that she doesn't just have an amazing voice, but has an in-depth knowledge of how to write songs that fit it perfectly.


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Delay in cutting interest rates would imply that the RBI is looking to bet on a horse after it has won the race.
The camp is clearly divided. There are the "bad" industrialists, the ones who always say that the Union Budget deserves 8 +/10, are saying the time has come for RBI to relax its ultra-tight monetary policy, prevailing for most of the last few years, and especially since September 2013, when Raghuram Rajan assumed control. There are also the recent converts to a rate cut—the Technical Advisory Committee (TAC) to the RBI members voted 4-3 to cut rates at its September meeting.
In the other corner are the "good" guys, comprising—apart from Rajan and his deputy, Urjit Patel—the prestigious IMF economists, and the policy economists at the major investment houses (both domestic and international) and rating agencies like CRISIL. Their view is that the clamour for a rate cut now is bordering on nonsense. This is what one representative of this distinguished club (CRISIL) stated on November 2.
"The chorus on an interest rate cut to revive the economy has got louder with the recent climb-down in inflation. To be sure, the monetary policy tool of cutting the interest rate is conventionally used to energise a flagging economy. ..But this does not hold true under all circumstances. Our study shows that factors behind the recent slowdown in economic growth and investment in India have little to do with high interest rates … leaning on monetary policy to revive investments will yield little benefit. And, it carries the risk of reversing the recent gains in inflation, which, in any case, is nothing much to write home about" (emphasis added).
In a November 4 editorial, the newspaper Mint confidently stated that declining CPI inflation was due to a tight monetary policy, and equally confidently, forecast the future path of inflation: "[The RBI should] stay on course for at least a couple of more quarters, rather than act in a hurry … tightening of policy since Rajan took charge is one important reason why inflation has begun to decline in India … It is not yet clear whether the recent sharp decline in inflation is sustainable or a temporary base effect.. Yet, this base effect is expected to wear off in the first 3 months of 2015.. It is only after April 2014 that we can get a clear picture about inflation."
So, who is right and, therefore, what should RBI do? It should go by the evidence—and the evidence is that from the demand (output) side, the economy is hurting, and hurting bad. In normal circumstances, this large negative gap alone would justify a series of large rate cuts.
But India, at least until recently, was not a normal economy, especially with low growth and high inflation. This strange combination should have given a clue to experts that it wasn't monetary policy that was causing the high inflation; rather a cost-push supply-side inflation over which the monetary authorities had precious little control.
The question is whether India is fast approaching normality with respect to inflation. Consider the following facts. CPI inflation of 6.5 % (new 2010 series) was the lowest rate ever in September 2014, i.e., the lowest for the last 45 months. A weighted average of the two old series—rural CPI(AL) and urban CPI(IW)—yields a national CPI series which was the lowest since the 6.0% inflation observed in February 2008, i.e., the lowest in 78 months. WPI inflation, of 2.7%, is the lowest since the 4.7% level of September 2009, the lowest in 60 months. The government-administered minimum support price (MSP) inflation, at 2.7 % in 2014, is the fifth-lowest in 39 years, and the lowest since the 2.4% level observed in 2005—the lowest in 108 months.
But this is not even considered admissible evidence for a rate cut by our base-effect vigilantes. Something that has baffled me in reading the various expert reports for the last several years is the constant allusion to "base-effects"—and intrigued me because of the dangerous, and disingenuous, interpretation of the base-effect reality. If an inflation estimate comes in below the "expert" view, the refrain is: "This is due to the base-effect" and soon inflation will rise again. If inflation comes in high as per the expert prediction, the base-effect is not invoked, and instead we get: "We told you so".
What is this base-effect and how does one measure it? Assume for a moment that September 2013 yoy inflation was higher than normal. Then, one should expect, ceteris paribus, that September 2014 inflation will be lower than normal. But this begs the question—what is "normal" inflation in any given month? One reasonable approximation for normal inflation for any month is a three-year average. For example, average September CPI inflation for the previous three years (2010, 2011 and 2012) was 9.7%, and this is the expected normal inflation estimate for September 2013. Actual September 2013 inflation: 9.4%, which is 0.3% below normal. Hence, the base-effect for September 2014 is plus 0.3%, i.e., expected inflation in September 2014 is the previous three-year average of 9.7% plus 0.3%, or 10%.
This forecasting game (no economics, no modelling, no nothing) yielded brilliant results during the steady near 10% inflation between January 2011 and June 2013; an average forecast error of only 0.1%(!) with the worst and best forecasts of minus 1.4% and 1.1%, respectively. However, the simplistic base-effect model has completely broken down since June 2013 with average forecast errors of minus 1.0% (July to Dec. 2013) and minus 3.1% January-September 2014!
This explains both the confidence of the base-effect calculators (and this includes RBI and the IMF) till some 15 months ago, and their complete lack of credibility today. Which means that RBI has now lost both its legs for supporting a tight monetary policy—base-effect, and anchoring of inflationary expectations. Regarding the latter, the junk RBI expectations survey (when will they stop?) in March 2014 reported a three month expectation of 12.9 % inflation. Actual September 2014 inflation was almost half, at 6.5% (and was 7.4 % for the June-September quarter). And expectation of three month inflation in September 2014 is an even more junk estimate of 14.6%! Let me restate the finding: actual inflation in September 2014 is 6.5%, RBI's anchoring inflation expectations survey claims more than a doubling of inflation in the next three months! Somebody is smoking something—please pass the weed.
It is time the base-effect and other inflation hawks admitted to a few realities and moved on. One of the most important lessons the financial markets teach you is humility—and the fact that very smart people, and very dumb people, and everyone in between, make mistakes every day. So what is the harm in RBI, and the IMF, and investment bank experts, and three members of the TAC admitting they were wrong and asking, nay pleading, for an aggressive interest rate cut policy?
If they don't do so, my guess is that history will judge them harshly. Expertise and/or wisdom is not revealed by betting on a horse after it has won the race.
The author is chairman, Oxus Investments and a senior advisor to Zyfin, a leading financial information company. Twitter: @surjitbhalla
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Top 10 Best Waterproof Mattress Protectors in 2019 Reviews
A mattress protector is used to protect your mattress from liquid spill, dust, dirt, allergens, and urine. Today a high-quality mattress doesn't cheap. To keep it in top condition, we need to protect it from nasty stains that are caused by liquid spills, sweat, and urine. As you probably know this might not be simple especially for mattress used by pets and children. This is where the mattress protector comes in. By selecting the best model, you can keep your mattress clean, dry, and well maintained for a good night sleep and healthy lifestyle.
In this buying guide, we have included helpful information to assist you in making an informed decision. We will start by looking at the consideration to make when picking the best model then review the best selling mattress protectors on the market.
Considerations to make when getting the best mattress protector
Getting the best mattress protection entails a lot of work. For you can pick the right model, you need to read relevant information and reviews available online. Although preference differs from one individual to the other, you need to select a model that suits your need. Here are some of the specific features that will guide you on getting the best mattress protector
- Size
The first thing you should consider is the size of your mattress. Each mattress protector comes with a specific size that is entitled to fit a particular mattress size. Make sure that the protector fits your mattress perfectly.
- Comfort
The best mattress protector should offer you with maximum comfort. Look at the texture of the mattress and ensure that it feels soft. The materials should also be durable and noiseless when you turn during sleep.
- Hypoallergenic
Hypoallergenic is a crucial consideration especially if you are asthmatic or sensitive to allergies. A mattress protector with hypoallergenic property prevents allergies giving you a good night sleep.
- Waterproof
Another feature to look at is whether the mattress is waterproof. Mattress protectors with waterproof surfaces will protect your mattress from liquid spills, sweat and urine stains.
- Breathability
The best mattress protectors are also breathable. Breathable protectors will not only give you a cool surface that you can lie on, but also your mattress smells fresh.
Top 10 Best Waterproof Mattress Protectors Reviews
Here are the best mattress protectors available on the market today. Going through each one of them will enable you to find the model that match your needs perfectly.
Contents Table
- 1. Queen Size SafeRest Premium Hypoallergenic Waterproof Mattress Protector
- 2. LINENSPA Premium Smooth Fabric Mattress Protector
- 3. LUCID Premium Hypoallergenic 100% Waterproof Mattress Protector
- 4. Utopia Bedding Premium Hypoallergenic Waterproof Mattress Protector
- 5. King Size Luna Premium Hypoallergenic Waterproof Mattress Protectorhttps
- 6. Zen Bamboo Cool and Breathable Mattress Protector
- 7. HYPNOS King Size Mattress Pad Protector
- 8. Ultra Block UltraPlush Premium Twin XL Waterproof Mattress Protector
- 9. CalmNite King Size Mattress Pad Protector
- 10. Coop Home Goods Ultra Bamboo-derived Viscose Rayon Mattress Pad Protector
1. Queen Size SafeRest Premium Hypoallergenic Waterproof Mattress Protector
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Thanks to its thin and quiet design, this queen size mattress protector ensures that all the sides of your mattress are protected against spills, sweat, urine, bacteria, and allergens. Besides, this protector will keep your mattress free from Dust mites, which are a constant problem for individuals suffering from asthma triggers and daily allergies.
SafeRest is a well-known manufacturer that makes premium protectors against allergens, fluids, dust mites, and perspiration. The company has tailor-made their services to help those with pets, allergies, and kids.
Top features
- Invisa shield
This protector surface will not interfere with the feel of your mattress, giving you the same comfort you have always had from the mattress.
- Cool, breathable cotton
This mattress cover is made from high-quality components that ensure that your sleep experience remained comfortable and quiet.
- Waterproof membrane
This membrane protects the mattress from fluid spills like urine and sweat.
What we liked:
- Easy to clean
- Breathable and noiseless
- Very comfortable
What we didn't liked:
- Tends to wear out fast
2. LINENSPA Premium Smooth Fabric Mattress Protector
Do you sweat a lot when sleeping and you would like a mattress protector, which is a hundred percent waterproof? Well, this mattress has a soft, quiet and a hundred percent waterproof surface that repels all liquids.
The Linen spa brand uses modern undetectable sleep technology to bring you a wide number of mattress protectors that a hundred percent water-resistant. This company provides you with protectors that are durable, affordable, and easy to clean.
Top features
- Waterproof
This mattress is breathable to avoid trapping of heat and has the ability to keep any fluids from reaching your mattress. This includes urine, perspirations, as well as accidental spills.
- Fit
This mattress protector fits your mattress securely. This minimizes chances of gathering up or sliding over the mattress.
- Smooth top surface
The surface of this protector is made of smooth hypo allergic fabric, which is breathable and quiet.
What we liked:
- Protects your mattress against dust mite and liquids
- Secure fitting
- Breathable fabric
What we didn't liked:
- Reduces effectiveness after washing
3. LUCID Premium Hypoallergenic 100% Waterproof Mattress Protector
This mattress protector allows you to have a sound and healthy surface for comfortable sleep. With this protector, you will keep your mattress free from bedbugs, dust mites, as well as allergens. We love it's a 100 percent waterproof nature that enhances its security when it comes to fluid spills.
Over the time, it has been on the market; Lucid has remained in the forefront of providing their customers with mattress protectors that come with all-around protection. This includes waterproof surface, keeping the bugs out, as well as inhibiting allergy-causing bacteria.
Top features
- Hundred percent waterproofs
This protector repels all the liquids including the bodily fluids such as urine, sweat, and accidental spills.
- Hypoallergenic cotton terry surface
The surface is comfortable and doesn't cause any noise while turning and tossing.
- Ultra-thin design
Unlike other thick mattress protectors that change the way your mattress feels, this protector is thin ensuring that your mattress gives you the same solid feel.
What we liked:
- Reasonably priced
- Provides you with noiseless and comfortable sleep
- Smooth and hypoallergenic cover
What we didn't liked:
- Challenging laundry instructions
4. Utopia Bedding Premium Hypoallergenic Waterproof Mattress Protector
Thanks to its waterproof design, this mattress protector does a great job when preventing your mattress from liquid stain, perspiration. Because of its hypoallergenic properties, this protector will prevent attacks by allergens, dust mites, bacteria, mildew, and mold.
Utopia Bedding is another worthy contender in the world of mattress protectors. These mattress protectors are highly durable, affordable and keep your mattress from various elements including spills, sweat, dust mites, and allergens.
Top features
- Airflow technology
This mattress protector is fitted with an all-round elastic material that has the airflow technology. This allows it to circulate air through the protector while still making it waterproof
- Cotton terry surface
Nothing feels uncomfortable like a noisy, cold to touch mattress protector made from the cheap plastic material. Well, you can forget all these inconveniences when you purchase this mattress cover. It is made using a blend of cotton terry that preserves the soft cozy of your mattress.
- Easy to wash
This protector is machine washable, making it easy to clean
What we liked:
- Waterproof top
- Has a breathable and noiseless feel
- Reasonable price
What we didn't liked:
- Doesn't provide complete protection against dust mites and bed bugs
5. King Size Luna Premium Hypoallergenic Waterproof Mattress Protectorhttps
If you are suffering from asthma, eczema or any other form of allergy, you should start making use of t his mattress protector from Luna. This premium mattress protector boast of hypo-allergic terry cotton surface that prevents dust mites, bedbugs, and other allergens.
Luna mattress protectors are premium accessories that offer both adults and kids with numerous benefits. Besides being durable, this brand manufacturer soft mattress protectors that fights allergens giving you a good night sleep.
Top features
- Great for allergy sufferers
This mattress protector is designed to protect against dust mites, allergens, bacteria, and mold.
- Luna Airflow Technology
This allows air to circulate through the mattress for a comfortable and less sweat during the night.
- Comfortable
With this mattress, you never have to worry about noise when turning around or excess sweat during the night.
What we liked:
- Ideal for allergy sufferers
- A hundred percent waterproof
- Safe for children and pets
What we didn't liked:
- A bit expensive
6. Zen Bamboo Cool and Breathable Mattress Protector
If your main aim is to get a mattress protector that is resistant to wear and tear, this might be your best bet. Remember, a good mattress is expensive. For this reason, it deserves better protection to stay in top condition for longer. This mattress protector is designed to offer you at this convenience.
Zen Bamboo brand uses a different but more effective approach in making their mattress protectors. These protectors are designed to offer you with similar benefits you get from high-end mattress protectors, but it will last longer.
Top features
- Durable materials
This mattress protector is made using forty percent bamboos, and sixty percent microfiber that are more durable than regular protectors made from cotton are.
- Hypoallergenic
With this protector, you can sleep better knowing that you are protected from dust, dust mites, and other allergens.
- Ultra cool, breathable technology
The constructions materials are breathable, allowing for ultra cooling technology that keeps you comfortable.
What we liked:
- Protects against allergens
- Ultra cooling technology
- Durable materials
What we didn't liked:
- Drying using machine is not recommended
7. HYPNOS King Size Mattress Pad Protector
Having trouble sleeping at night because of excess heat? This is the high time you consider replacing your current mattress protector with the HYPNOS Mattress Pad Protector. This mattress protector is made using cotton terry surface that has polyurethane Coating Backing.
The HYPNOS is known to manufacture soft and calm mattress covers. Unlike other brands, this mattress gives you with maximum protection against allergens, spills, and excess heat while maintaining an affordable price.
Top features
- Health-friendly
These mattress protectors are made using high-grade materials that are chemical free and soft for maximum comfort.
- Easy to maintain
The construction materials are easy to care, crinkle-free and easy to wash and dry with a machine.
- Hypoallergenic Cotton Terry Surface
The cotton terry surface backed by membrane coating makes this mattress breathable, waterproof, and noiseless.
What we liked:
- Hypoallergenic surface
- Breathable and comfortable
- Easy to maintain
What we didn't liked:
- Complains of water leaking when left to soak
8. Ultra Block UltraPlush Premium Twin XL Waterproof Mattress Protector
This wonderful mattress protector protects your mattress from getting soaked with urine and spillages. It is a great choice for parents who are looking for a hundred percent mattress protector for their children.
Ultra Block is synonymous with creating ultra plush mattress protectors with the aim of adding a soft, warmer feel to your mattress. Besides, these protectors are great in protecting the mattress from spill and urine.
Top features
- 100 percent waterproof barrier
You can sleep comfortably knowing that your kid mattress is a hundred percent protected from spill, urine, and liquids.
- Hypoallergenic
This mattress protector is luxuriously soft and eliminates dust mites and other allergens.
- Advanced breathable technology
Despite the fact that the mattress doesn't allow water in, it doesn't mean that it is not breathable. This protector is breathable, allowing you to sleep cooler and better.
What we liked:
- Waterproof keeping your mattress stain proof
- Keeps your mattress from bacterial and dust mite invasions
- Adds a soft feel to your mattress
What we didn't liked:
- Not very durable
9. CalmNite King Size Mattress Pad Protector
Looking for a quality mattress cover that keeps your mattress from invasive mites and allergic reactions? The CalmNite King Size Mattress Pad Protector comes with excellent features that improve the quality of your sleep.
They say Old is gold. CalmNite is one of the earliest brands that have made mattress protectors for years. Thanks to their waterproof design, these mattresses will prevent bed-wetting, liquid and perspiration stains on your mattress.
Top features
- Airflow
For your mattress to remain odorless, it needs to have free air circulation. This mattress protector has microscopic pores that keep your mattress fresh.
- Phthalate free
This is a perfect choice for people wh0 suffer from allergens as its made using Phthalate free material.
- Easy to clean
You simply need to toss it to your washer and dryer and it will be ready once again to protect your mattress.
What we liked:
- Cool and comfortable
- Effectively protects you from allergens
- Hundred percent waterproofs
What we didn't liked:
- Some complaints of some users sweating during sleep
10. Coop Home Goods Ultra Bamboo-derived Viscose Rayon Mattress Pad Protector
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Coop Home Goods Ultra Bamboo mattress protector will work for you if you are looking for a high-quality encasement for your mattress. This protector has a waterproof surface that protects your mattress from stains that results when sweat, liquids, and urine find it way inside the mattress.
Coop Home Goods mattress protectors bring you effective protection against dust mites, fluids, urine, allergens, and bacteria. This company has won various awards is one of the best mattress protectors for allergy sufferers.
Top features
- Hypoallergenic materials
This material keeps you from allergenic reactions. The material is also designed to provide you with enhanced comfort.
- Cooling Lulltra Polyester
The Cooling Lulltra Polyester, as well as Viscose Rayon that is derived from bamboo blend, facilitates a waterproof membrane that keeps your mattress protected from spills, sweat, and urine.
- High performance
The mattress pad is noiseless and will never have crinkly plastic sounds when you turn. This gives you with better sleep and comfort.
What we liked:
- Easy to wash and clean with a machine
- Durable and comfortable
- A hundred percent waterproof membrane
What we didn't liked:
- It doesn't come with sufficient padding
Many advantages come with using the best mattress protector. They will not only keep your bed clean but also allow your mattress to last for long. Besides, they will protect you from allergens, bacteria, and bed bugs. All the above-mentioned products are easy to clean and reusable. Get more out of your mattress by getting any of the above choices today.


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Importance of maintaining your AC machines
It is important to take care of your AC machines to keep them in good health. The air conditioning and heating equipment in your domestic and commercial spaces need regular maintenance, so that they can deliver the desired standard of service. Well-maintained machines are more economic, as they consume lower amounts of electricity. You can reach out to a reputed ac repair company for maintenance of these machines. These are routine tasks, and the AC remains in optimal functional conditions, with timely care.
First of all, maintaining the AC machine from time to time keeps up its operational efficiency. Proper care, at professional hands, increases the lifeline of the machine. The AC machines consume a large amount of electricity. Regular maintenance ensures that you can keep your bills under control. Every year, the functional efficiency of an average machine decreases by 5%. A well-maintained AC machine can reduce the electricity bills by as much as 25%.
Well, an AC machine, in good condition, eliminates the health risks resulting from inhaling poor-quality air to a great extent. Proper installation and maintenance reduces this risk to a great extent. Reach out to the established companies and seek the maintenance services to recover the lost efficiency of your AC machine. Professional care can retain the functional efficiency of the machines to a great extent. Get across to the website of one of the reputed service providers for timely maintenance of your AC machines.
The professionals inspect the various parts of the AC during maintenance. In case any part requires replacement, they change the same instantly. The established companies carry all the necessary inventories while inspecting the machines. They take care of the machines to maximize the cooling experience. Get across to the reputed service providers for reliable services. This will keep your AC machines in optimal health conditions.


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The forthcoming Bobby Jindal administration has gotten off to a somewhat disappointing start for those of us in the Houma-Thibodaux area.
Jindal tapped a Houma businessman for his transition team studying candidates for the next secretary of the Department of Wildlife and Fisheries.
And he placed outgoing state Rep. Loulan Pitre Jr., R-Cut Off, on the Coastal Restoration and Hurricane Protection Group.
But the most visible issue of Jindal�s campaign -- finance reform -- will be overseen by a panel that includes no local faces.
The ethics transition team will include 38 members from every metropolitan area of the state, except ours.
Each area of the state has multiple members on the committee, with Baton Rouge boasting 11 and New Orleans contributing 10.
Houma-Thibodaux, though, has no members.
We wonder why the governor-elect is overlooking the large number of talented people right here in our area who would give insightful input into the process of crafting reform. They would also lend it credibility with local legislators, who will ultimately help decide the plan�s fate.
We were disappointed to see that the local talents we have in our many public servants and private residents -- many of whom have expertise in political and governmental matters -- were ignored when making the ethics panel.
But as a whole, the picture is even more bleak.
Jindal�s transition will include teams overseeing a number of issues, none of which will have local input.
Youth development, crime and public safety, health care, government and fiscal reform, veterans� affairs, education and economic development are all teams that lack local representatives.
We certainly aren�t arguing that Jindal should enact some sort of quota system to ensure that each geographical area receives the exact same number of appointments.
But we must register our displeasure that so many vital issues are being undertaken without our local talents being utilized.
We certainly hope the reason isn�t political. Our area supported Jindal in the Oct. 20 election, giving him 60 percent of the votes in Terrebonne and 57 percent in Lafourche.
With that kind of support, it seems, the incoming governor could find some like-minded, politically astute contributors in our local ranks.
That would simultaneously give him great input on the process that will go a long way toward deciding whether his administration is a success.
And it would give local residents an indication that their concerns are being addressed by Jindal�s transition teams.
We don�t see how anyone can lose -- unless they�re not even invited to play.
Editorials represent the opinion of The Courier and not of any one individual. Questions or comments concerning editorials may be addressed to the Editor, P.O. Box 2717, Houma, LA 70361 or e-mail at: email@example.com.
Why no local voices on Jindal transition team?
The forthcoming Bobby Jindal administration has gotten off to a somewhat disappointing start for those of us in the Houma-Thibodaux area.


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Our 2012-17 Strategic Plan sets out to define us as world leaders in the field of childhood disability
Generating innovative programs to improve the lives of children with disabilities and their families.
Helpful information about visiting Holland Bloorview
Accessibility is foremost in our planning, program development and services
Meet our therapeutic clowns
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Borrow adapted recreation equipment for up to two weeks free of charge
Explore our facility
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When at Holland Bloorview, please visit our onsite Grocery Foundation Resource Centre on the first floor
Learn about food options at for visitors and inpatients
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Paricipate in education sessions and research studies
See what groundbreaking BRI research has made it into the news
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In early 2019, the Ministry of Children, Community and Social Services made several announcements related to the Ontario Autism Program. Please see below for more information.
1. Where can I find information about the Ontario Autism Program?
2. Were you consulted on the OAP? What does Holland Bloorview think of the changes?
Holland Bloorview was not consulted on changes to the OAP.
Over the past several weeks, Holland Bloorview clinical staff and leadership have met with and listened to several parents of children with ASD as they shared their feedback and concerns about recent changes to the OAP.
We recognize and appreciate that these changes are likely to have an adverse impact on certain families. For this reason, we remain committed to partnering with all stakeholders, including government and families, to continue to advocate for and deliver high-quality service.
Recent changes to remove income-testing, expand eligible services and provide transition funding are welcome as we know more can be done to enhance timely access to diagnosis and treatment. New provincial funding for the five autism diagnostic hubs (including Holland Bloorview) will provide families access to increased diagnostic services sooner.
On April 2, 2019, the government announced public consultations and an advisory panel to further inform enhancements to the OAP. These are important changes that will provide families a chance to express their hopes and concerns about the OAP. Holland Bloorview will make information about consultations available to families once published.
Overall, we advocate for a consultative and evidence-informed approach to decision-making. To this end, Holland Bloorview's Autism Research Centre scientists recently published an opinion piece on the evolution of autism therapy and emerging directions.
3. What role does Holland Bloorview play in autism?
Holland Bloorview is a non-partisan, publically funded hospital that plays an important system role as a diagnostic services provider and in capacity building. We also offer a host of complementary programs to support children with diverse abilities:
Holland Bloorview's ASD program includes a capacity building focus and the world-class Autism Research Centre that conducts research aimed at improving outcomes and quality of life for children with ASD and their families. Our research encompasses many areas including genetics and biology, innovative technologies, developmental and behavioural interventions, and new care models.
Holland Bloorview also offers the Extension of Community Healthcare Outcomes (ECHO) Ontario Autism program. The ECHO Ontario Autism program links Holland Bloorview's team of experts with primary care clinicians in local communities in Ontario to build capacity and their ability to screen, diagnose, and support children and youth with ASD.