I am a 19-year-old white girl from Canada currently volunteering at a community project in Kigali. I have been in Kigali for four months now. For the past two months I have noted pinkish spots on my skin especially around my shoulders and arms. They are not painful but they are not pretty to look at.

My white friend who volunteers with me says she had similar ones when she first came to Rwanda but after a while they went away without any medication. I rarely have allergic reactions and doubt my spots are allergic.  

I am considering waiting for mine to go away too but I don’t like that they cause me to get stares everywhere I go because I like wearing short sleeves. What medication would you recommend and what is the cause so that I avoid it next time? Thank you.

Laura, Kigali

Dear Laura,

To know precisely as to what is the cause for skin rashes in your case, more details are needed. Are they itchy, size of the rash whether small or big, shape bizarre or rounded, are they increasing in number and size, are there any associated eruptions, are they present continuously or number is fluctuating?  

The answers to these questions can provide more clues as to the underlying cause. 

The most common cause for skin rashes which are intermittent, i.e. come and go, could be due to allergy. I have seen allergic rashes and eruptions in people of different nationalities visiting Rwanda. Allergy could be due to some fungal spores, pollens, dust, e.t.c present in the environment or some food substances.

At times, drugs like pain killers can also cause allergic rashes. Skin rashes can also be a manifestation of the presence of worms in the intestines like ascaris, trichinosis, e.t.c. Their presence causes rashes due to allergy.

Exposure to the hot tropical sun can cause sun burn and can manifest as blotchy rashes. Individuals who are not accustomed to it are more prone to develop sun burn.

Yet another cause for painless rash is fungal infection. The rashes caused by it can be round as in ring worm infection or vague patches. It can also occur if one wears damp clothes. The rashes would be painless but associated with intermittent itching.

Viral infections can also manifest as skin rashes, but they would subside spontaneously after a week or so. Bacterial infection   is excluded because rashes caused by it would be painful. 

Insect bites could cause rashes, but they would be transient and associated with intense itching. 

Though you like wearing short sleeves, light cotton full sleeves and long dresses would be more suitable. Such    dresses will protect you against dust, sun and insect bites as well. Avoid body parts being damp and also avoid damp clothes as these increase chances of fungal infection. Get a stool sample examined to look for eggs and cysts of any parasitic or protozoal infection. If present, these are absolutely treatable conditions   and the rash will also subside. 

If the stool test is negative, apply an ointment over the rashes which contain a combination of antifungal medicine and corticosteroid. Use it twice everyday 12 hours. The corticosteroid will help in reducing allergy and the antimycotic element will take care of fungal infection if present.

Regarding the stares of people, please don’t feel conscious as that is certainly not due to your rashes. Innocently out of curiosity some people look at new foreign faces.

Dr. Rachna Pande is a specialist in Internal Medicine at Ruhengeri Hospital