Ringworm/Body Ringworm/Scalp Ringworm

What Is Ringworm? What Is Body Ringworm? What Is Scalp Ringworm?

We use the term ringworm or tinea when referring to several types of contagious fungal infections of the top layer of the skin and scalp, as well as the nails. We call it ringworm because the itchy, red rash has a ring-like appearance. There is no connection between ringworm and worms.

Dermatologists (skin specialist doctors) say that approximately 10% to 20% of us will develop one or more fungal infections in our lifetime.

According to Medilexicon's medical dictionary, tinea (ringworm) is "A fungus infection (dermatophytosis) of the keratin component of hair, skin, or nails. Genera of fungi causing such infection are Microsporum, Trichophyton, and Epidermophyton."

We classify ringworm according to which part of the body is affected. The most common ones are: Tinea captis (scalp ringworm), Tinea corporis (skin or body ringworm), Tinea cruris (groin infection), Onychomycosis (Fungal nail infection), Tinea pedis (athlete's foot).

Scalp ringworm - much more common among young children than children who have reached puberty. Adults can be affected, but this is rare. When a human enters puberty the glands in the scalp change, resulting in a scalp that is less attractive to fungi.

Scalp ringworm is more common among children who live in urban environments, as well as Afro-Caribbean children, according to the National Health Service (NHS), UK. Experts say that there is a higher incidence in urban environments because people are closer together, giving the fungus more opportunities to spread to other people.
Body (skin) ringworm - this can affect babies, children and adults. Health authorities are unsure how many people are affected because most patients self-treat with OTC (over-the-counter, non-prescription) medications and never see their doctor about it.
Groin infections - also known as jock itch. This is much more common among young men. As most patients self medicate, it is also difficult to know how common it really is.

What causes ringworm?

Ringworm is caused by fungi (singular: fungus). Fungi are similar to plants, with one big difference - plants can turn sunlight into food (photosynthesis) while fungi can't. Fungi need to break down living tissue in order to feed themselves - this includes living human tissue.
A dermatophyte is any fungus that infects our skin, hair or nails. Keratin, a protein which can be found in our nails, hair, as well as the outer surfaces of our skin, attract dermatophytes. Dermatophytes only attack our skin, scalp, hair and nails because those are the only parts of the body with enough keratin to attract them.

Dermatophytes are microscopic spores which can survive on the surface of the skin for months. They can survive equally well in towels, combs, the soil and other household objects - they are incredibly resilient.

Dermatophyte spores spread in four main ways:

Human-to-human - if an infected person touches another person.
Animal-to-human - if an infected animal is touched or touches a human. Pet dogs and cats may be infected and can pass it on to humans who pet (stroke) them. Cattle, pigs, horses and rabbits are also carriers.
Object-to-human - infected people and animals may deposit fungi spores on objects and surfaces when they touch them. If they touch things other people commonly touch, such as towels, bed linen, combs, brushes, door handles, and even clothing, another person who touches those objects may become infected.

Although children invariably show symptoms when they become infected, many adults don't. The older you get, the more likely it is that your immune system will protect you - but you may still be a carrier and pass the spores onto others.

People with athlete's foot may then go on to develop a groin infection. It happens when the patient scratches his/her infected feet and then transfers the spores to the groin when going to the toilet or dressing.

What are the risk factors for ring-worm?

A risk factor is anything that is likely to increase the chances of something happening. The following risk factors either increase your chances of developing ringworm, or will most likely make the symptoms worse:

Age - very young and very old people are much more likely to develop ringworm than other people.
Diabetes type 1 - this is the diabetes caused by the destruction of beta cells, the body does not produce insulin.
Obesity
Weakened immune systems - patients with HIV/AIDS are more likely to get ringworm.
Some medical treatments - medications that lower the immune system, such as steroids (long-term), chemotherapy, and immunosuppressants (common among transplant recipients), have a significantly higher risk of developing ringworm compared to other people.
Previous fungal infections - especially if they occurred repeatedly.
Arteriosclerosis - this is when the arteries harden.
Vascular problems - especially if the patient's veins have difficulty in moving blood back to the heart.
Housing conditions - people who live in damp, humid, crowded conditions have a considerably higher risk.
Close proximity to infected people/animals - you are more likely to touch an infected animal or person, or touch places he/she/it has touched, and become infected yourself, compared to other people.
Hyperhidrosis - this is when the patient tends to sweat excessively.
Contact sports - such as rugby, wrestling, or judo. Any sport where human-to-human contact is the main part of the activity. If sports changing rooms are crowded and you do not wear slippers or sandals when walking about inside them, the risk of infection is greater.
Tight clothing - fungi love humid and dark places. Tight clothing restricts ventilation, making conditions ideal for the fungus to thrive.

What are the symptoms of ringworm?

Symptoms of scalp ringworm

Small patches of scaly skin appear on the scalp
Patches may feel tender
Patches may be inflamed
Patches may be painful
Hair on the patches breaks away
Some hair near the patches breaks away
Kerion - this is a large inflamed lesion or sore which forms on the scalp. It may ooze pus. The patient may have a temperature and have swollen glands (nymph nodes). This is uncommon and is a more serious case of scalp ringworm.

Symptoms of body (skin) ringworm

Rash - with a ring-like appearance. The skin may be red and inflamed around the outside of the ring, but look fine in the middle of it.
More rings - they may multiply and grow.
Merging rings - when there are enough of them they will merge together.
Rings are raised - when you touch them they may feel slightly raised.
Itchiness - especially under the rash.

Symptoms of a groin infection

Itchiness - especially in and around the area of the groin.
Redness - the affected area becomes red, it may sometimes feel like burning.
Inner thighs - the skin in this area may become flaky and scaly.
Movement worsens things - if you walk, run, or exercise the symptoms get worse.
Tight clothing - tight clothing makes your symptoms worse, compared to loose clothing.

When should I see a doctor?

If you develop body or groin ringworm most doctors say you should wait a few days, even a couple of weeks as most cases resolve themselves with self-medication and home treatments. A qualified pharmacist should be able to help you find the right remedies. If, on the other hand, you have a medical condition or are receiving medical treatment such as long-term steroids, or chemotherapy, you should see your GP (general practitioner, primary care physician) straight away.

If your child develops scalp ringworm you should seek medical advice immediately. Anti-fungal creams you buy at the pharmacy do not work because they do not penetrate the entire scalp. Anti-fungal tablets are used for treating pediatric scalp ringworm, and they can only be obtained with a doctor's prescription (in most countries).

Diagnosing ring worm

Body ringworm and groin ringworm diagnosis

A good doctor should be able to diagnose ringworm or groin infection after examining the affected area and asking the patient about his/her medical history and symptoms. The doctor should be able to determine whether or not the skin problem is being caused by some other disorder, such as psoriasis or atopic dermatitis. Further testing is not usually needed, unless symptoms are particularly severe.

If symptoms have not improved after treatment the doctor may remove a small piece of infected skin and send it to the lab to be analyzed. The sample will be examined under a microscope - this will make it possible to identify whether fungi are present, and if so, what type they are.

Scalp ringworm diagnosis

Generally, a physical examination as all that is required to diagnose scalp ringworm. However, being able to identify the specific fungi helps, because some anti-fungal medications are better targeted at specific types of fungi. In other words, if the doctor can identify the type of fungi he is able to prescribe a more specific medication. Therefore, after diagnosing scalp ringworm the doctor will most likely remove a sample of scalp and send it to the lab.

Unfortunately, scalp ringworm lab tests take a long time to come back, approximately a couple of weeks. In the UK most doctors will prescribe terbinafine straight away and then review his/her choice of medication after checking the lab results.

Treatment for ringworm?

Scalp ringworm treatment

The most common treatment for scalp ringworm are oral anti-fungals (tablets). Examples include, Terbinafine (Lamisil) and griseofulvin (Grisovin). However, the choice of medication will depend on the type of fungi involved, as well as patient preference.

Terbinafine (Lamisil) - taken once daily for four weeks. Side effects are generally mild and do not last long, they may include:

Diarrhea
Skin reactions (rash)
Indigestion
Nausea
Sense of taste affected - rare

If you have a history of liver disease you should not take terbinafine.

Griseofulvin (Grisovin) - taken once or twice daily for about two months. Side effects, which usually go away fairly quickly, may include:

Vomiting
Nausea
Headache
Indigestion
Diarrhea (mild)

Griseofulvin must NOT be taken by pregnant women or women planning to become pregnant as there is a risk of birth defects. Women should not try to become pregnant for at least one month after treatment has stopped. Men should wait until six months after treatment has stopped before trying to get a female partner pregnant.

Patients taking combined or progestogen-only oral contraceptives and take griseofulvin should use a barrier form of contraception, such as a condom, because griseofulvin interferes with the contraceptive's efficacy.

Griseofulvin may affect your ability to drive safely, or operate heavy machinery.

Griseofulvin makes the effects of alcohol more pronounced.

Anti-fungal shampoos - they can help prevent the spread of ringworm and may speed up recovery, but they do not cure it. Examples of anti-fungal shampoos include selenium sulphide. They should be used about twice a week.

Shaving a child's head - all this will do is give him/her a head with no hair. There is absolutely no evidence that this reduces ringworm infection, or accelerates recovery time.

Skin ringworm and groin infections treatment

The majority of cases may be treated with OTC (over-the-counter, no prescription required) anti-fungal creams. Those that contain terbinafine have been proven to be effective, according to studies. A qualified pharmacist should be able to help you.

Apply the cream to the affected areas once daily for two weeks. Read instructions carefully - anti-fungal creams do not all have the same instructions.

If your symptoms do not change after the two weeks, see your doctor.

If symptoms are severe, of if they cover a large area of the body and do not respond to OTC medications, the doctor may prescribe a prescription-strength topical medication. A topical medication is one that you apply to the skin, such as a lotion, cream or ointment.

The most common topical medications prescribed in the USA are:

Butenafine (Mentax)
Ciclopirox (Loprox)
Econazole
Miconazole (Monistat-Derm)
Oxiconazole (Oxistat)
Terbinafine (Lamisil)

The doctor may prescribe an oral medication (taken by mouth). These may include:

Itraconazole (Sporanox)
Fluconazole (Diflucan)
Ketoconazole (Nizoral)
Terbinafine (Lamisil)

These oral medications may have some side effects, including stomach upset, rash, or abnormal liver function. If you are taking medications for ulcer disease or GERD (gastroesophageal reflux disease), the oral antifungal may not work so well. Oral medications for ringworm may make the drug-thinning blood warfarin less effective.

Caring for your skin - skin ringworm and groin infections

Wash the skin gently
Dry the skin thoroughly, but gently. Pat the skin with a towel in tender areas, don't rub. Make sure folds and areas between the toes are dried thoroughly.
Change your underwear more often than usual (groin infection)
Athlete's foot and groin infection - always treat both areas at the same time. Groin infections are often caused by infection that started with athlete's foot, and sometimes vice-versa. Put your socks on before your underwear if you have athlete's foot.

Prevention of ringworm

If somebody has ringworm in the house:

Pets - if the pet is found to be the source of the infection you will need to take it to the vet. One of the signs of ringworm may be patches of missing fur.
Wash your hands regularly. Get an antibacterial and anti-fungal soap, or one that contains tea tree oil, which contains terpinen-4-ol.
Check yourself - everyone in the house should check themselves for signs of ringworm.
Do not share combs, hairbrushes, clothing, bed lining, towels, or shoes/slippers/sandals.
The patient should not scratch the affected areas as this increases the risk of spreading the infection. This is easier said than done, especially if one of the symptoms includes itchiness.
Clothing - remember that tight and thick clothing make the fungi's environment ideal. Wear light loose clothing, especially if the weather is warm.
Sweating - try to avoid excessive sweating.
Avoid walking around the house with bare feet.
Wash clothes in hot water with fungicidal soap if there is ringworm in the house.

Complications of ringworm

Fungal infection very rarely spreads below the surface of the skin. The risk of any serious illness is very small. If complications do occur, they may include:

Spreading - the infection may spread from one part of the body to another - this is the most common complication.
Bacterial infections - if the skin is broken bacteria may get in and cause an infection. In such cases the patient may need an antibiotic.
Weakened immune systems - people with HIV, and other conditions that weaken the immune system are much more likely to experience spreading of ringworm. It is much more difficult to get rid of the infection if your immune system is weak.

Rosacea

What Is Rosacea? What Causes Rosacea?

Rosacea is a chronic, inflammatory skin condition which principally affects the face. Rosacea causes facial redness and produces small, red, pus-filled pustules (bumps). Rosacea worsens with time if left untreated. It is often mistaken for acne or eczema, or some other skin allergy.

According to Medilexicon's medical dictionary, rosacea is " Chronic vascular and follicular dilation involving the nose and contiguous portions of the cheeks; may vary from mild but persistent erythema to extensive hyperplasia of the sebaceous glands, seen especially in men in the form of rhinophyma and of deep-seated papules and pustules; accompanied by telangiectasia at the affected erythematous sites."

Approximately 1 in every 20 Americans - 14 million people - are estimated to be affected with rosacea. As it is frequently misdiagnosed the incidence may be a lot higher. A Gallup survey revealed that 78% of Americans do not know anything about rosacea, its symptoms or what to do about it.

Rosacea is more common among fair-skinned people of northern European ancestry. However, studies have revealed that its incidence in many parts of Asia, including the Middle-East, South Asia, and China is growing, especially in regions that have undergone socioeconomic development in recent years. This has triggered speculation that lifestyle may be a risk factor, and not just skin color. Others say incidence has grown in those areas because healthcare and diagnosis techniques have improved.

What are the signs and symptoms of rosacea?

Many signs and symptoms are associated with rosacea, however they may vary considerably from person-to-person. The following signs and symptoms tend to be present in most cases: Flushing (easily blushing)

This is usually the first sign of what many call pre-rosacea. Flushing episodes can last as long as five minutes. The blush can spread from the face down to the neck and chest. Some people say the skin feels unpleasantly hot during flushing episodes.
Facial skin hyper-reactivity

Sensitive blood vessels dilate very easily to topical triggers (touch), and some other physical stimuli, such as sunlight. Many mistakenly refer to this as "sensitive skin", but with rosacea it is sensitive blood vessels and not sensitive skin cells which cause this.
Persistent redness

Sometimes the flushing episodes may eventually be followed by bouts of persistent facial redness. The redness, like a patch of sunburn, may not go away. This occurs because hundreds of tiny blood vessels near the surface of the facial skin dilate (expand).
Spots, papules, and pustules (Inflammatory rosacea)

Small spots, papules and pustules sometimes appear on the face - this is also known as inflammatory rosacea. Misdiagnosis is common because of their teenage acne appearance. However, with rosacea the skin has no blackheads, unlike acne.
Inflamed blood vessels (vascular rosacea)

As the signs and symptoms of rosacea progress and get worse, small blood vessels on the nose and cheeks swell and become visible (telangiectasia) - they sometimes look like tiny spiderwebs. The skin on the face can become blotchy, similar to the skin of some alcoholics. However, it is caused by inflammation of tiny blood vessels in the surface of the skin, and not alcohol. People with rosacea may become concerned and distressed at being labeled hardened drinkers because of this. Although alcohol may trigger rosacea flare-ups in patients who already have rosacea, alcohol consumption is never the source of the condition.
Rhinophyma - Excess facial skin around the nose

Severe rosacea can result in the thickening of facial skin, especially around the nose. The nose can become bulbous and enlarged (rhinophyma). This is a very rare complication, and tends to affect males much more than females.
Ocular rosacea

There is a burning, gritty sensation in the eyes, making them bloodshot. The inside of the eyelid may become inflamed (blepharitis) and appear scaly, causing conjunctivitis. Some people may not tolerate contact lenses and styes may develop. In very rare cases vision may become blurred. Approximately 50% of patients with rosacea experience some kind of eye irritation or symptoms.
Facial swelling

Excess fluid and proteins leak out of the blood vessels and eventually overwhelm the lymphatic system that cannot drain the leakage away fast enough. This results in fluid buildup in the facial skin.

What are the causes and risk factors of rosacea?

Experts are not sure what the exact causes of rosacea are. The following related factors are said to contribute:

Abnormalities in facial blood vessels

Skin specialists (dermatologists) suggest that a major factor is probably abnormalities in the blood vessels of the face, which cause the flushing, persistent redness and visible blood vessels. What causes the inflammation of the blood vessels is still a mystery.
Light skin color

A much higher percentage of people with fair skin develop rosacea compared to other people.
Demodex folliculorum (microscopic mite)

Demodex folliculorum lives on human skin and usually causes no problems. However, patients with rosacea have much higher numbers of these mites than others do. Experts do not know whether the mites cause the rosacea, or whether the rosacea causes the overpopulation of the mites - i.e. whether the high population of demodex folliculorum is the cause or the effect of rosacea.
H. pylori bacteria

H. pylori, a bacteria found in the gut, stimulates the production of bradykinin, a protein known to cause blood vessels to dilate. Experts suggest that this bacterium may play a role in the development of rosacea.
Family history (inheritance, genes)

30% to 40% of patients with rosacea have a close relative with the condition. Unfortunately, scientists do not yet know how which genes are involved and how they are passed on.
Triggers

Some factors can aggravate rosacea or make it worse by increasing blood flow to the surface of the skin. Below are some of these factors:
- Hot foods
- Hot drinks
- Caffeine
- Spicy foods
- Dairy products
- Extremes of temperature
- Sunlight
- Humidity
- Wind
- Stress, anxiety, anger, embarrassment
- Vigorous exercise
- Hot baths
- Saunas
- Corticosteroids
- Some medications - such as those for treating high blood pressure
- Acute medical conditions - such as a cold, cough, or fever
- Some chronic medical conditions - such as hypertension (high blood pressure)
- Alcohol - alcohol does not cause rosacea, but it can be a trigger for people with the condition. Rosacea is not caused by alcohol abuse.

How is rosacea diagnosed?

There is no clinical test for rosacea. The GP (general practitioner) reaches a diagnosis after examining the patient's skin, and asking about symptoms and triggers. The presence of enlarged blood vessels will help the physician distinguish it from other skin disorders.

The presence of a rash on the scalp or ears usually indicates a different or co-existing diagnosis. Rosacea signs and symptoms are mainly on the face.

Early diagnosis and subsequent prompt treatment significantly reduces the risk of rosacea's progression.

If the doctor suspects there may be an underlying medical condition or illness, such as lupus, blood tests may be ordered.

The GP may refer the patient to a dermatologist.

What are the treatment options for rosacea?

There is no cure for rosacea. However, there are various treatments which can relieve the signs and symptoms. A combination of medications and lifestyle changes generally give the best results.

The doctor may prescribe camouflage creams that mask disfigurement of the skin.

A study conducted at the University of California, Irvine, of mild to moderate rosacea patients found that Pyratine XR - a non-prescription, physician-dispensed product - showed improvement for all of the major signs and symptoms of rosacea.

Medications

Treatment may involve a combination of prescribed topical medications (applied to the skin) and oral drugs (swallowing pills, tablets or capsules).

Topical medications - these help reduce inflammation and redness and are applied to the skin either once or twice a day. They are commonly used in combination with some oral medications. Antibiotics (metronidazole), tretinoin, benzoyl peroxide and azelaic acid are examples of commonly prescribed topical medications.
Oral antibiotics - for the treatment of rosacea oral antibiotics are prescribed more for the anti-inflammatory properties. Oral antibiotics tend to give faster results than topical ones. Examples include *tetracycline, minocycline and erythromycin.
Isotretinoin (Accutane) - this oral medication is sometimes used for severe cases of inflammatory rosacea if other treatments have not worked. Isotretinoin is a powerful drug that inhibits the production of oil by the sebaceous glands. As side effects may be severe the patient needs to be monitored closely.
Blephamide - a specific type of steroid eye drop which is sometimes prescribed for patients with ocular rosacea (eye symptoms). Eye drops are applied daily for three days to one week, followed by a break or tapered use.
Tetracyclines - these are sometimes prescribed for patients with symptoms of ocular rosacea. Doxycycline helps improve dryness, itching, blurred vision and photosensitivity (sensitivity to light).

contraception

Laser treatment

For patients with visible blood vessels (telangiectasia) laser treatment, which uses intense pulsed light, is used to shrink them. This will be done by a dermatologist. Although the procedure may cause some pain, most patients can tolerate it without the need for an anesthetic.

Laser treatment can sometimes cause bruising, crusting of the skin, swelling, tenderness, and very rarely infection. These complications will usually disappear within a few weeks, although infection will require antibiotics.

Plastic surgery for thickened skin (rhinophyma)

If the patient develops a bulbous enlarged red nose and puffy cheeks, and possibly thick bumps on the lower half of the nose and the nearby cheek areas, he/she may be referred to a plastic surgeon. Laser or scalpel surgery may be performed to remove excess tissue and remodel the nose. A carbon dioxide laser can also be utilized to shrink the tissue.

Lifestyle and home remedies

These lifestyle and home measures will contribute significantly to controlling symptoms, and should be applied in addition to any medical treatments. The key here is to minimize exposure to anything that may trigger symptoms or exacerbate them. Below is a list of measures, some of which may apply to some patients:

When exposed to the sun wear a broad-spectrum sunscreen with a sun protection factor of at least 15.
In wintertime protect your face with a scarf or ski mask.
Try to refrain from rubbing or touching the skin on your face.
When washing, apply a gentle cleanser to the problem areas.
Do not use any facial products that contain skin irritants or alcohol.
If your skin is sore use a moisturizer.
Only apply moisturizers after the topical medication has dried.
Only use products labeled as noncomedogenic. These do not block the oil and sweat gland openings.
Do not allow yourself to get too hot.
Avoid consuming alcoholic beverages.
An electric shaver is less likely to trigger flare ups than normal razors.
Avoid spicy foods.
Built up a list of likely foods and drinks that may be triggers and avoid them.
Green or yellow pre-foundation creams and powders may help mask the skin redness.
Avoid OTC (over-the-counter) steroid creams unless your doctor has included them as part of your treatment. In the medium or long term they may worsen symptoms.

Stress - experts say stress is an important trigger of rosacea. Any measures to reduce stress levels will help prevent flare-ups and existing symptoms from getting worse. Steps to reduce stress may include regular exercise, getting at least 7 hours good quality sleep every night, and eating a healthy and well-balanced diet. As vigorous exercise is often a trigger, patients with rosacea are advised to do low-intensity exercise, such as walking or swimming. Yoga, tai-chi, breathing exercise, and some meditations may also help reduce stress.

What are the possible complications of rosacea?

Ocular rosacea

If the rosacea affects the eyes the eyelids can become inflamed (blepharitis). Treatment involves a daily application of topical antibiotic creams, and/or oral antibiotics.
Self-esteem, embarrassment and frustration

Even though rosacea is not a life-threatening condition, its effect on appearance often leaves the patient embarrassed, frustrated, anxious, and lacking in self-confidence. Studies indicate that over three-quarters of rosacea patients are affected psychologically and emotionally.

A National Rosacea Society survey revealed that the impact of rosacea goes far deeper than physical effects: it impacts the emotional health of sufferers. Forty-two percent of respondents with rosacea felt sad or depressed about the appearance of their skin, and more than half (55 percent) said rosacea was one of their top three physical concerns as they age, second only to weight gain (in a list that included wrinkles, high cholesterol and thinning hair). Rosacea patients also take steps to hide their condition. Nearly one in six respondents made excuses and stayed home from work/social events to hide their rosacea.

Patients who are well informed about rosacea tend to cope better because they are well prepared to deal with complications or recurrences. Follow your treatment regime and all your doctor's instructions carefully. Studies indicate that emotional health is generally restored when symptoms are successfully addressed - this is more likely to happen if you comply with long-term medical therapy and take measures to minimize the factors that aggravate your condition.

It is important to talk to your doctor if you experience intense feelings of distress, embarrassment, or frustration. Talking to a counselor or medical social worker is also advisable.

If there is a self-help group in your area you may find that talking to people who share your experiences and problems may help.

If you have a flare up and find people staring at you, remember that few people know about rosacea. You can address this by explaining your rosacea and educating the starer. Staring is due to curiosity and ignorance.

Rubella

What Is Rubella? What Are German Measles? What Causes Rubella Or German Measles?

Rubella, also known as German measles, is an infectious disease caused by the rubella virus. The virus passes from person-to-person via droplets in the air expelled when infected people cough or sneeze - the virus may also be present in the urine, feces and on the skin. The hallmark symptoms of rubella are an elevated body temperature and a pink rash.

Although rubella can infect people of all ages, it most commonly affects young children. If a pregnant woman becomes infected with Rubella there is a serious risk of birth defects in the unborn baby. If the pregnant mother is infected within the first 20 weeks of pregnancy the child may be born with congenital rubella syndrome, which consists of a range of serious incurable illnesses. About one-fifth of infected pregnant women will miscarry.

The name "rubella" comes from the Latin word rubella meaning "little red". As the disease was first described by German doctors in the mid-eighteenth century, it is also known as German measles.

Rubella is usually mild and frequently passes unnoticed. The disease can last from one to three days. Children usually recover faster than adults.

What are the signs and symptoms of rubella?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Rubella's incubation period is from 14 to 21 days. Some people may be infected and never know it.

Patients typically have flu-like symptoms. The main symptom is a rash - pink or light red - on the face, which then spreads to the chest, stomach, back, arms and legs. When the rash reaches other parts of the body it usually fades from the face. Within about three days the rash goes away with no staining or peeling of the skin. After it has cleared up the skin may shed very small flakes where the rash was.

While the rash is present there may be itching.

Patients may also have a slight fever and swollen glands (which may persist for a week), headache, conjunctivitis and joint pains.

The older the patient is the more severe symptoms tend to be.

A significant number of older girls and adult women may have arthritic type symptoms.

Infected people are contagious about one week before the rash appears and about one week after it has cleared up.

What causes rubella?

Rubella is caused by an extremely infectious virus that is transmitted from person-to-person in droplets in the air. When an infected person sneezes or coughs, those nearby are at risk of becoming infected.
It is also possible to infect another person if they come into contact with the saliva of an infected person.

The virus is capable of crossing the placenta and infecting the unborn child (feuts) where it stops cells from developing or destroys them.

Diagnosis of rubella

The National health Service (NHS), UK instructs people who suspect somebody in the household may have rubella to call their doctor - not to visit, as there is a risk others in the clinic or GP practice, including pregnant women, may become infected.

Since the rubella rash is similar in appearance to irritations caused by other viral infections, a GP will confirm the diagnosis by doing a virus culture or a blood test. The presence of different types of rubella antibodies will corroborate the diagnosis. By law, doctors have to notify the local authority of all suspected rubella cases. The child's school or nursery should be told immediately.

IgM (rubella virus specific) antibodies are found in individuals who have been recently infected. However, these antibodies may persist for a long time, sometimes for over a year. Therefore, a positive blood test result needs to be interpreted with caution.

Treatment options for rubella

In the vast majority of cases rubella infection signs and symptoms will resolve within a week or two. Patients should stay at home and avoid contact with other people, especially pregnant women. The NHS advises people to stay away from work/school for at least five days.

If there is any fever or aches an OTC (over-the-counter), such as Tylenol (paracetamol) or ibuprofen may help. Do not give aspirin to children under the age of 16 years.

To avoid dehydration it is important to consume plenty of liquids, preferably water.

Prevention of rubella

Immunization with the MMR vaccine is the most effective way to protect against rubella. It is a combined vaccine that protects children against all three conditions - measles, mumps and rubella. It contains the safest and most effective form of each vaccine. This is usually given to children between 12 and 15 months followed by a booster injection before entering school (usually between three to five years of age).

Children who are too young to have had the MMR vaccine and are exposed to the virus may be given an injection of immunoglobulin antibodies which provide short-term but immediate protection against the disease.

As a pregnant mother passes on her own immunity to her baby, the baby is protected at least during his/her first six months of life.

Despite fears of an association between the MMR vaccine and autism risk, all studies over the last decade have shown that there is no link.

Complications of rubella

Complications, if they do occur, tend to be mild and may include diarrhea, vomiting, otitis media (inner ear infection), and convulsions (if there is a fever). Much more rarely, there is a risk of encephalitis, croup, bronchitis, and pneumonia.

The most important complication is if a pregnant woman becomes infected, especially during the first 11 weeks of her pregnancy (the danger is present throughout pregnancy). Her offspring may suffer from heart defects, stunted growth, hearing problems, organ defects, eye problems (cataracts) and cognitive defects.