Dermatologist Warns Dengue Bleeding Spikes 48 Hours After Fever Ends

Dr Dray

Severe dengue complications peak 24 to 48 hours after fevers break rather than during the febrile illness itself, turning defervescence into the most dangerous window of infection.

AI-assisted summary of Dengue Fever Symptoms: Rash, Petechiae & Warning Signs — original source. Check the original for full context.

Source published: 2026-09-29

Key ideas

Locally acquired dengue cases in Florida underscore the threat posed by Aedes aegypti mosquitoes, which transmit four distinct viral serotypes following an incubation window of 4 to 10 days. (0:00)
The classic dengue rash presents with distinctive 'islands of sparing' amidst diffuse erythema, though on deeper skin tones it often appears violaceous, grayish, or darker rather than bright red. (1:53)
The most hazardous phase of dengue occurs 24 to 48 hours after the fever breaks, a critical window where patients risk sudden decompensation, capillary leakage, and life-threatening hemorrhage. (5:53)
Secondary infection with a different dengue serotype carries a heightened danger of severe dengue and shock due to antibody-dependent enhancement. (10:41)
Aspirin and NSAIDs like ibuprofen are strictly contraindicated in suspected dengue due to platelet dysfunction and hemorrhage risk; supportive fever management relies on acetaminophen. (8:57)

Detailed notes

## Background Published on YouTube by dermatologist Dr. Dray on September 29, 2026, this video addresses reports of locally acquired dengue fever cases in Florida. According to the page description, Dr. Dray explains what dengue fever can look like on the skin, highlights warning signs of severe illness, discusses diagnostic considerations, and details how to reduce mosquito exposure.

## TL;DR Dr. Dray details the clinical spectrum of dengue fever, focusing on cutaneous signs like petechiae, purpura, and the classic morbilliform eruption characterized by 'islands of sparing' across varied skin tones. She warns that visual skin changes alone cannot diagnose dengue and highlights the critical window 24 to 48 hours after fever resolves, during which severe complications and internal hemorrhage can suddenly arise. Management relies strictly on supportive care such as hydration and acetaminophen, with aspirin and NSAIDs avoided due to bleeding risks, while secondary infections with different serotypes drastically increase the danger of severe disease. Ultimately, she emphasizes prompt medical care for hemorrhagic signs alongside vigilant daytime mosquito bite prevention.

## Atmosphere & style The presentation blends clinical precision with an approachable, conversational bedside manner. Dr. Dray delivers calm, measured guidance, periodically interjecting dry humor about medical jargon, daytime mosquitoes, and discarded tires being a 'harbinger of doom.' Despite the lighthearted demeanor, the tone shifts into serious urgency when addressing severe bleeding red flags, leaving viewers informed, alert, and reassured rather than alarmed.

## Bulletin - [00:00](https://www.youtube.com/watch?v=8874sh9CXkk&t=0s) Locally acquired dengue cases in Florida underscore the threat posed by Aedes aegypti mosquitoes, which transmit four distinct viral serotypes following an incubation window of 4 to 10 days. - [01:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=113s) The classic dengue rash presents with distinctive 'islands of sparing' amidst diffuse erythema, though on deeper skin tones it often appears violaceous, grayish, or darker rather than bright red. - [05:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=353s) The most hazardous phase of dengue occurs 24 to 48 hours after the fever breaks, a critical window where patients risk sudden decompensation, capillary leakage, and life-threatening hemorrhage. - [10:41](https://www.youtube.com/watch?v=8874sh9CXkk&t=641s) Secondary infection with a different dengue serotype carries a heightened danger of severe dengue and shock due to antibody-dependent enhancement. - [08:57](https://www.youtube.com/watch?v=8874sh9CXkk&t=537s) Aspirin and NSAIDs like ibuprofen are strictly contraindicated in suspected dengue due to platelet dysfunction and hemorrhage risk; supportive fever management relies on acetaminophen.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=8874sh9CXkk&t=0s) Dengue is caused by four viral serotypes transmitted by Aedes aegypti mosquitoes, with an incubation period of 4 to 10 days before classic symptoms like retro-orbital pain, high fever, and severe bone pain emerge. - [01:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=113s) The classic dengue exanthem is a maculopapular rash characterized by 'islands of sparing,' creating an appearance described as a sea of red with interspersed patches of normal skin. - [03:13](https://www.youtube.com/watch?v=8874sh9CXkk&t=193s) Skin tone significantly alters the visual presentation of a dengue rash, appearing bright red on fair skin but violaceous, grayish, or darker than baseline on deeper complexions. - [03:43](https://www.youtube.com/watch?v=8874sh9CXkk&t=223s) Petechiae are pinpoint hemorrhages that do not blanch under pressure, a feature that can be clinically assessed using diascopy with a clear glass slide. - [04:40](https://www.youtube.com/watch?v=8874sh9CXkk&t=280s) While petechiae can occur from elevated intrathoracic pressure like vomiting or coughing, petechiae in dengue reflect thrombocytopenia and endothelial damage. - [05:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=353s) The critical phase of dengue paradoxically occurs 24 to 48 hours after fever resolution (defervescence), meaning clinical vigilance must increase when the fever subsides. - [07:09](https://www.youtube.com/watch?v=8874sh9CXkk&t=429s) Warning signs demanding immediate emergency evaluation include severe abdominal pain, persistent vomiting, mucosal bleeding from the gums or nose, vomiting blood, and extreme lethargy. - [08:06](https://www.youtube.com/watch?v=8874sh9CXkk&t=486s) Purpura refers to larger, bruise-like pooling of extravasated blood compared to pinpoint petechiae, signaling more extensive vascular leakage. - [08:57](https://www.youtube.com/watch?v=8874sh9CXkk&t=537s) Dengue shares overlapping clinical presentations with other arboviruses like Zika and chikungunya, as well as measles, making timed laboratory diagnostics such as RT-PCR, NS1, and serology essential. - [09:40](https://www.youtube.com/watch?v=8874sh9CXkk&t=580s) Medical management is entirely supportive; NSAIDs and aspirin must be avoided due to bleeding risks, leaving acetaminophen as the preferred antipyretic. - [10:41](https://www.youtube.com/watch?v=8874sh9CXkk&t=641s) Infection provides lifelong immunity only to the specific infecting serotype; reinfection with another serotype can trigger antibody-dependent enhancement, causing severe hemorrhage and shock. - [11:36](https://www.youtube.com/watch?v=8874sh9CXkk&t=696s) A 'wait and see' or 'ride it out' approach is unsafe once hemorrhagic manifestations or severe warning signs manifest, requiring prompt hospital evaluation. - [12:37](https://www.youtube.com/watch?v=8874sh9CXkk&t=757s) Dengue prevention relies on daytime mosquito avoidance and vector control, including eliminating small reservoirs of standing water and using DEET-based repellents with protective clothing.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=8874sh9CXkk&t=0s) Dengue Emerges in Florida and the Role of the Skin

With reports of locally acquired dengue fever cases emerging in Florida—particularly in South Florida, where officials declared a local emergency—Dr. Dray examines the clinical realities of this mosquito-borne viral illness. While news of local transmission can cause alarm, she cautions viewers not to jump to conclusions if they develop an unexpected rash. A wide variety of everyday viral infections, including seasonal colds and flus, as well as distinct dermatologic conditions, can produce eruptions that closely mimic dengue. A rash by itself does not confirm an infection; rather, it provides an accessible clinical clue that must be considered alongside broader exposure and systemic symptoms.

Dengue is caused by dengue viruses across four distinct serotypes and is transmitted primarily through the bite of an infected *Aedes aegypti* mosquito. Following a bite, the virus undergoes an incubation period of approximately 4 to 10 days before symptoms emerge. Clinical presentations fall along a wide spectrum, from mild febrile sickness to life-threatening complications. Classic symptoms include a sudden fever, headache, muscle aches, joint pain, and severe bone pain, frequently accompanied by retro-orbital pain ("pain behind the eyes"). While the majority of symptomatic cases remain uncomplicated, the transition toward severe dengue can happen abruptly, making an understanding of dermatologic and systemic warning signs essential.

- **Primary Vector:** *Aedes aegypti* mosquito. - **Viral Serotypes:** Four distinct serotypes of dengue virus. - **Incubation Window:** 4 to 10 days following an infectious bite. - **Classic Presentation:** Fever, severe headache, retro-orbital pain, myalgias, arthralgias, and intense bone pain. - **Disease Course:** Ranges from mild self-limiting illness to severe disease marked by sudden decompensation into hemorrhage, plasma leakage, shock, and organ failure.

---

[01:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=113s) The Classic Dengue Rash: "Islands of Sparing" Across Skin Tones

The hallmark cutaneous eruption of dengue is classically described as a diffuse, widespread maculopapular or morbilliform rash—meaning it consists of both flat and raised reddish lesions. Dr. Dray jokes about medical terminology, noting, "we give everything two names." What makes the dengue rash distinctive is its tendency to spare random, unaffected patches of skin. Dermatologists describe this appearance as "islands of sparing," resembling a "sea of red with little random white islands interspersed throughout." Rather than presenting as a solid, uniform sheet of erythema, the rash exhibits a mottled pattern with interspersed patches of completely normal-appearing skin.

```mermaid flowchart TD accTitle: Dengue Infection Progression and Warning Signs accDescr: Flowchart illustrating the progression of dengue from mosquito bite to the critical post-fever phase and potential severe complications.

subgraph Phase1["1. Incubation & Onset"] A["Infected Aedes aegypti bite"] -->|"4–10 days"| B["Acute Febrile Phase: High fever, bone pain, retro-orbital pain, maculopapular rash"] end

subgraph Phase2["2. Critical Window (Defervescence)"] B -->|"Fever resolves"| C["24–48 Hours Post-Fever: High risk of sudden decompensation"] end

subgraph Phase3["3. Severe Warning Signs"] C --> D["Bleeding: Petechiae, purpura, epistaxis, gum bleeding"] C --> E["GI & Systemic: Severe abdominal pain, persistent vomiting, hematemesis, melena, lethargy"] end ```

This rash typically appears within the first few days of illness alongside fever and headache. However, because many common viral exanthems look nearly identical, the visual appearance of the rash cannot stand alone as a diagnostic tool. A physician must evaluate it in the context of recent mosquito exposure, travel history to regions with active outbreaks, and laboratory work.

Furthermore, the rash does not present uniformly across all skin tones: - **Lighter Skin Tones:** The rash tends to be easily recognizable as bright pink or vivid red, making the white islands of sparing stand out clearly. - **Deeper Skin Tones:** The eruption often lacks bright red tones, presenting instead as violaceous, grayish, or simply darker than the patient's baseline skin tone. In some cases, the only discernible baseline skin visible is within the spared islands. Dr. Dray stresses that clinicians and patients should not discount a dengue rash simply because it lacks obvious bright redness.

---

[03:43](https://www.youtube.com/watch?v=8874sh9CXkk&t=223s) Petechiae, Non-Blanching Redness, and Diascopy

Beyond the diffuse morbilliform eruption, dengue frequently triggers petechiae—tiny pinpoint hemorrhages resulting from blood leaking out of small vessels into the skin. Depending on individual complexion, petechiae appear as small red, purple, or brownish dots. Dr. Dray highlights a key clinical technique to distinguish petechiae from ordinary vascular erythema: the blanching test. When pressure is applied to standard erythema, the underlying blood vessel compresses, forcing blood away and causing the redness to temporarily disappear (blanch). Petechiae, by contrast, consist of extravasated blood outside the vessel wall and will not blanch under pressure.

To perform this test clearly when a pinpoint lesion is too small to assess under a finger, dermatologists use a method known as diascopy. Dr. Dray demystifies the medical jargon: "We give it a fancy name, but it's literally just taking a microscope slide and pressing it on the skin." Viewing the pressed skin through transparent glass immediately reveals whether the red spot fades or remains fixed.

While petechiae in dengue signal vascular fragility and hematologic disturbance, Dr. Dray emphasizes that they can also occur from benign physical strain. Any event that sharply elevates intrathoracic pressure can cause transient capillary bursts in the upper body, especially on the face: - Violent or persistent coughing fits during an ordinary viral illness - Forceful vomiting - Strenuous activities like blowing up balloons

In dengue, however, petechiae demand close observation because the virus can impair blood clotting and damage the vascular endothelium. When dengue depresses platelet levels—a condition called thrombocytopenia—capillary leakage and bleeding complications can escalate into life-threatening emergencies. The convergence of petechiae, fever, bone pain, and mucosal bleeding serves as a red flag that prompt medical intervention and close clinical monitoring are necessary.

---

[05:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=353s) Mucosal Bleeding, the Critical Phase, and Warning Signs of Severe Dengue

When a patient with suspected mosquito exposure starts displaying bleeding from mucous membranes—such as spontaneous nosebleeds (epistaxis) or bleeding gums—it represents a dangerous escalation. Dr. Dray stresses that severe hemorrhage, including hematemesis (vomiting blood) or blood in the stool (melena), constitutes an absolute emergency requiring an immediate trip to the emergency room rather than a wait-and-see approach.

One of the most dangerous and counterintuitive aspects of dengue is the timing of its critical phase. Severe decompensation does not coincide with the highest temperature of the fever. Patients typically endure several days of high fever and debilitating flu-like aches, but as the fever breaks, they often assume they are on the road to recovery. In reality, the most hazardous window occurs 24 to 48 hours *after* the fever resolves:

> "The more worrisome bleeding signs often start to appear 24 to 48 hours after the fever has gone away. So, if someone has had several days of fever, flu-like symptoms, especially joint pain, bone pain, muscle pain, I would not necessarily say, 'Oh, you're all clear once the fever goes away.' You want to be very careful and watch them."

Because the skin is fully accessible to direct inspection without complex machinery, it provides an invaluable window into systemic disease. However, skin findings must always be cross-referenced with general warning signs of severe dengue. Healthcare providers must be contacted immediately if a patient exhibits: - Severe, localized, or diffuse abdominal pain and stomach tenderness - Persistent, uncontrollable vomiting - Frank bleeding: vomiting blood, rectal bleeding, or bleeding from the gums and nose - Profound lethargy, extreme fatigue, severe restlessness, or marked irritability

Dr. Dray emphasizes that patients should never dismiss their illness simply because their rash lacks classic "islands of sparing," noting that "the rashes don't always follow the textbooks."

---

[08:06](https://www.youtube.com/watch?v=8874sh9CXkk&t=486s) Purpura and Overlapping Viral Illnesses

In addition to tiny pinpoint petechiae, dengue-induced vascular breakdown can produce broader, more extensive areas of bleeding under the skin known as purpura. Dr. Dray draws a clear distinction between the two based on scale: petechiae can be visualized as "pinhead-size bruises," whereas purpura refers to much larger, extensive bruise-like patches. The coloration and prominence of purpura also shift dramatically depending on the patient's underlying skin pigmentation.

Finally, Dr. Dray highlights why clinical diagnosis remains difficult: dengue shares its vector and symptom profile with other viral pathogens. In areas with mosquito activity, arboviruses such as Zika virus and chikungunya present with overlapping clinical features, including high fevers, severe arthralgias, and maculopapular rashes. Furthermore, non-arboviral illnesses like influenza and measles—which Dr. Dray points out is experiencing significant resurgences—frequently present with fever and widespread skin eruptions, underscoring the absolute necessity of laboratory confirmation and comprehensive clinical evaluation.

[08:57](https://www.youtube.com/watch?v=8874sh9CXkk&t=537s) Differential Diagnosis, Lab Testing, and Medical Management

Dr. Dray contextualizes dengue among other viral exanthems, pointing out that viral rashes are extraordinarily common, particularly in young school-age children. At the time of recording, Pennsylvania was experiencing severe cases of critically ill children, and other illnesses such as rubella (German measles) and common pediatric viral infections can produce similar cutaneous eruptions. A rash by itself does not immediately equal dengue; rather, it is the comprehensive clinical picture—especially a history of potential geographic exposure and mosquito bites—that places a patient in the category where dengue must be seriously investigated.

Confirmation of dengue relies entirely on laboratory testing, where timing is critical. Because different assays are sensitive during distinct phases of the disease, selection depends on how many days have elapsed since initial symptom onset. Early on, molecular diagnostic tests (such as RT-PCR) or NS1 antigen testing are employed, often alongside antibody panels (IgM and IgG) as the infection progresses.

When addressing medical management, Dr. Dray highlights that there is no targeted antiviral drug for dengue virus. Care is purely supportive and symptomatic: - **Rest and hydration:** Fluid intake is vital; depending on the severity of illness, patients may require intravenous (IV) fluids and close clinical monitoring in a hospital setting. - **Medications to strictly avoid:** Patients must avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, unless explicitly instructed by a physician. Because dengue causes vascular fragility and drops in platelet counts, NSAIDs significantly heighten the risk of severe bleeding complications. - **Recommended fever/pain relief:** Acetaminophen (paracetamol) is the agent of choice to control fever and pain. - **No self-treatment:** Unclear symptom presentations or uncertainty regarding over-the-counter medications should always prompt an evaluation by a medical professional rather than attempting to self-manage at home.

---

[10:41](https://www.youtube.com/watch?v=8874sh9CXkk&t=641s) The Danger of Secondary Infection: Four Serotypes and Antibody-Dependent Enhancement

Dr. Dray explains a counterintuitive and hazardous aspect of dengue: contracting the virus once does not grant lifelong protection against all dengue infections. Instead, a subsequent infection can make someone far sicker than their initial encounter.

```mermaid flowchart TD accTitle: Dengue Reinfection Mechanism accDescr: Flowchart showing how infection with one dengue serotype leads to lifelong immunity to that type but increases severe disease risk upon reinfection with a different serotype. subgraph Primary["Primary Infection"] A["Infection with Serotype 1"] --> B["Lifelong Immunity to Serotype 1"] A -.-> C["No Long-Term Immunity to Serotypes 2, 3, or 4"] end subgraph Secondary["Secondary Exposure"] C --> D["Bitten by Aedes aegypti carrying Serotype 2, 3, or 4"] D --> E["Cross-Reactive Antibodies Interfere"] E --> F["Severe Dengue, Capillary Leak & Hemorrhage"] end ```

Because dengue consists of four distinct viral serotypes (DENV-1 through DENV-4), an infection confers permanent immunity only to the specific serotype involved. If a patient recovers from serotype 1 and is later bitten by an *Aedes aegypti* mosquito carrying serotype 2, 3, or 4, the immune system produces a paradoxical reaction. Rather than neutralizing the new virus, pre-existing antibodies can exacerbate the illness, placing the individual at a drastically higher risk of severe bleeding complications, dengue hemorrhagic fever, and shock.

---

[11:36](https://www.youtube.com/watch?v=8874sh9CXkk&t=696s) When to Seek Urgent Medical Care

Dr. Dray warns patients against adopting a "ride it out" mentality as if dengue were merely a routine common cold or influenza. While many benign viral infections produce a mild fever and rash that self-resolve without medical intervention, dengue carries life-threatening potential. If an individual develops a fever and rash alongside an exposure history to areas with active outbreaks or known *Aedes aegypti* populations, they should be clinically evaluated.

Immediate, urgent emergency care is mandatory if any evidence of hemorrhagic manifestations appears: - Petechiae (pinpoint non-blanching red or purple macules) - Purpura or widespread bruising - Bleeding gums or frequent nosebleeds (epistaxis) - Blood in the stool (melena or hematochezia) - Vomiting blood (hematemesis)

Dr. Dray underscores that once bleeding manifestations appear, patients can deteriorate rapidly into critical illness, making prompt hospitalization essential.

---

[12:37](https://www.youtube.com/watch?v=8874sh9CXkk&t=757s) Prevention Strategies and Mosquito Control

The only definitive way to prevent dengue is to prevent mosquito bites entirely. Dr. Dray jokes about her personal relationship with insects—noting that while she has fortunately never contracted dengue, "mosquitoes, they love me." The primary vector, *Aedes aegypti*, thrives in close proximity to human dwellings and requires only tiny volumes of stagnant water to lay eggs and reproduce. Diligent environmental vector control around homes and apartment complexes is paramount.

Practical steps for prevention include: - **Eliminating standing water:** Emptying, scrubbing, turning over, or discarding artificial containers that trap rainwater—specifically targeting flower pots, bird baths, outdoor containers, and discarded tires, which Dr. Dray playfully terms a "mosquito harbinger of doom." - **Skin and clothing protection:** Applying an EPA-registered insect repellent containing DEET, and wearing long-sleeved shirts and long pants ("sleeves and slacks"). In addition to bite prevention, she notes this has the added dermatological bonus of shielding skin from damaging ultraviolet (UV) radiation. - **Daytime vigilance:** While many common mosquito species swarm heavily at dusk or lakefronts at night, *Aedes aegypti* are notorious daytime biters. Relying on protective clothing and DEET solely after dark is insufficient; daytime bite precautions are equally critical.

---

[13:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=833s) Conclusion and Channel Sign-Off

Dr. Dray concludes by reminding viewers that while a characteristic rash does not automatically confirm dengue, recognizing these cutaneous findings in conjunction with systemic symptoms and potential mosquito exposure is crucial. She engages her audience by asking if they have encountered dengue before, especially viewers residing in Florida where local transmission has been reported. She mentions other educational videos on her channel detailing cutaneous manifestations of serious infections—including measles, Ebola, Chagas disease, and leprosy—before signing off with her signature catchphrase: "sunscreen and subscribe."

## Notable quotes > [01:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=113s) we give everything two names. — Dr. Dray

> [01:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=113s) islands of sparing — Dr. Dray

> [01:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=113s) sea of red with little random white islands interspersed throughout. — Dr. Dray

> [03:43](https://www.youtube.com/watch?v=8874sh9CXkk&t=223s) We give it a fancy name, but it's literally just taking a microscope slide and pressing it on the skin. — Dr. Dray

> [05:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=353s) The more worrisome bleeding signs often start to appear 24 to 48 hours after the fever has gone away. So, if someone has had several days of fever, flu-like symptoms, especially joint pain, bone pain, muscle pain, I would not necessarily say, 'Oh, you're all clear once the fever goes away.' You want to be very careful and watch them. — Dr. Dray

> [05:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=353s) the rashes don't always follow the textbooks. — Dr. Dray

> [08:06](https://www.youtube.com/watch?v=8874sh9CXkk&t=486s) pinhead-size bruises — Dr. Dray

> [12:37](https://www.youtube.com/watch?v=8874sh9CXkk&t=757s) mosquitoes, they love me. — Dr. Dray

> [12:37](https://www.youtube.com/watch?v=8874sh9CXkk&t=757s) mosquito harbinger of doom. — Dr. Dray

> [12:37](https://www.youtube.com/watch?v=8874sh9CXkk&t=757s) sleeves and slacks — Dr. Dray

> [13:53](https://www.youtube.com/watch?v=8874sh9CXkk&t=833s) sunscreen and subscribe. — Dr. Dray

## Mentioned Dr. Dray, Aedes aegypti, DEET, EPA, Acetaminophen, Aspirin, Ibuprofen, Zika virus, Chikungunya, Rubella, Measles, Ebola, Chagas disease, Leprosy, Florida, Pennsylvania

## Video description With dengue cases being reported in Florida, dermatologist Dr. Dray explains what dengue fever can look like on the skin and the important warning signs that should prompt medical attention.

Dengue is a mosquito-borne viral infection that can cause fever, headache, muscle and joint pain, pain behind the eyes, and a characteristic rash. The skin can also develop petechiae, purpura, bruising, and other bleeding manifestations. One classic description of the dengue rash is a diffuse red or pink eruption with areas of normal or pale skin, sometimes described as “islands of sparing.”

Dr. Dray explains why a rash alone cannot diagnose dengue and why skin findings can look different across different skin tones. She also discusses petechiae, how they can appear on the skin, and why new unexplained bleeding or bruising during a febrile illness deserves medical evaluation.

Most importantly, this video covers the warning signs of severe dengue, including abdominal pain, persistent vomiting, nose or gum bleeding, vomiting blood, blood in the stool, and significant lethargy or restlessness. Warning signs can become apparent 24 to 48 hours after the fever resolves, so feeling better as the fever comes down does not necessarily mean the risk has passed

The video also explains how dengue is diagnosed, why other mosquito-borne illnesses such as Zika and chikungunya can cause similar symptoms, what to do if dengue is suspected, and how to reduce mosquito exposure and prevent mosquito breeding around the home.

TIMESTAMPS 0:00 Introduction 1:05 What Is Dengue? 1:53 What Does the Dengue Rash Look Like? 3:13 Dengue Rash on Different Skin Tones 3:43 Petechiae: Small Red or Purple Dots 5:53 Nose and Gum Bleeding 6:31 Why the Timing of Warning Signs Matters 7:09 Warning Signs of Severe Dengue 8:06 Bruising, Purpura and Other Skin Findings 8:30 Dengue vs. Other Mosquito-Borne Illnesses 9:34 How Is Dengue Diagnosed? 9:51 What to Do if You Think You Have Dengue 11:36 When to Seek Urgent Medical Care 12:37 How to Prevent Dengue 13:53 Bottom Line

Important: A rash cannot confirm or rule out dengue. Anyone with concerning symptoms, particularly signs of bleeding or other warning signs of severe dengue, should seek medical evaluation.

#Dengue #DengueFever #DengueRash #DengueSymptoms #DengueWarningSigns #MosquitoBites #Florida #SkinRash #Petechiae #Dermatologist #Dermatology #DrDray

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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=8874sh9CXkk)

中文简报

皮肤科医生警告：登革热退烧后48小时内出血风险激增登革热重症并发症的高峰期出现在退烧后24至48小时，而非发热期本身，这使得退热期成为感染过程中最危险的窗口期。 Dr. Dray详细阐述了登革热的临床表现谱，重点关注不同肤色人群中出现的瘀点、紫癜以及以“白岛”（islands of sparing）为特征的典型麻疹样皮疹等皮肤体征。她警告称，单凭肉眼可见的皮肤变化无法确诊登革热，并强调了退烧后24至48小时这一关键窗口期，在此期间可能会突发严重并发症和内出血。治疗严格依赖补水和对乙酰氨基酚等支持性治疗，因出血风险需避免使用阿司匹林和NSAIDs；而二次感染不同血清型则会大幅增加罹患重症的风险。最后，她强调出现出血征象应立即就医，并在日间保持警惕以防蚊虫叮咬。佛罗里达州出现的本地登革热病例凸显了埃及伊蚊（Aedes aegypti）带来的威胁；该蚊在4至10天的潜伏期后可传播四种不同的病毒血清型。 (0:00) 典型的登革热皮疹表现为弥漫性红斑中夹杂独特的“白岛”（islands of sparing），但在较深肤色上通常呈现紫罗兰色、发灰或颜色加深，而非鲜红色。 (1:53) 登革热最危险的阶段发生在退烧后24至48小时，这是一个关键窗口期，患者面临突发病情恶化、毛细血管渗漏和危及生命的出血风险。 (5:53) 由于抗体依赖性增强作用，二次感染不同血清型的登革病毒会导致发生重症登革热和休克的风险显著升高。 (10:41) 因存在血小板功能障碍和出血风险，疑似登革热患者严格禁用阿司匹林及布洛芬等NSAIDs；支持性退热治疗依赖对乙酰氨基酚。 (8:57)

Reading summary

Following reports of locally acquired dengue cases in Florida, dermatologist Dr. Dray outlines the clinical manifestations of this mosquito-borne virus, emphasizing that dermatologic clues must be evaluated alongside systemic symptoms. She warns that dengue's most dangerous complications typically emerge after the initial fever breaks, requiring careful monitoring and strict avoidance of NSAIDs. Cutaneous Presentations Across Diverse Skin Tones (1:53) The hallmark dermatologic sign of dengue is a widespread maculopapular or morbilliform rash classically characterized by "islands of sparing"—a mottled eruption resembling a red sea interrupted by patches of completely normal skin. Dr. Dray notes that this rash cannot serve as a standalone diagnostic marker because numerous common viral exanthems look nearly identical. Clinical evaluation must incorporate mosquito exposure and classic systemic indicators such as high fever, retro-orbital pain, severe headache, and intense joint or bone pain. The rash's visual presentation varies significantly across different skin complexions. While lighter skin tones typically present with vivid pink or red erythema that contrasts sharply against the spared pale islands, deeper skin tones often lack bright redness entirely. In darker complexions, the eruption may appear violaceous, grayish, or simply darker than baseline skin, with baseline pigmentation visible only within the spared patches. Dr. Dray cautions clinicians and patients against dismissing potential dengue simply because an eruption lacks obvious redness. Petechiae, Diascopy, and Capillary Fragility (3:43) Beyond diffuse rashes, dengue frequently induces petechiae—pinpoint red, purple, or brown hemorrhages caused by blood extravasating from capillaries into the skin. To distinguish petechiae from standard vascular erythema, clinicians use diascopy, a technique in which a transparent glass microscope slide is pressed firmly against the skin. Ordinary inflammatory redness blanches under pressure as blood is forced out of compressed vessels, whereas petechiae fail to blanch because the blood resides outside the vessel walls. While transient petechiae can stem from benign spikes in intrathoracic pressure—such as coughing fits, forceful vomiting, or blowing up balloons—their emergence alongside viral symptoms signals vascular endothelial disruption and thrombocytopenia. When combined with fever and bone aches, petechiae or larger bruise-like purpura reflect compromised clotting mechanisms, serving as an early indicator that close clinical monitoring is necessary. The Defervescence Window and Severe Warning Signs (5:53) A critical and deceptive feature of dengue is the timing of its most dangerous phase. Severe physiological decompensation does not peak alongside the highest fevers; instead, the critical window occurs 24 to 48 hours after the fever resolves (defervescence). Patients often assume they are recovering when the fever breaks, making this post-febrile window the most hazardous period for sudden vascular leakage, hemorrhage, and shock. Immediate emergency evaluation is necessary if patients exhibit signs of vascular collapse or internal bleeding. Critical red flags include spontaneous mucosal bleeding (frequent nosebleeds or bleeding gums), gastrointestinal hemorrhage (hematemesis or melena), severe abdominal pain and tenderness, persistent vomiting, and marked lethargy or restlessness. Dr. Dray stresses that patients should never delay emergency care if bleeding manifestations appear. Diagnostic Testing, Supportive Care, and Secondary Risks (8:57) Because dengue shares clinical overlap with arboviruses such as Zika and chikungunya, as well as measles and pediatric viral infections, diagnosis requires laboratory confirmation. Depending on disease timing, diagnostic panels use molecular assays like RT-PCR or NS1 antigen detection during early onset, transitioning to IgM and IgG serology as the infection evolves. There is no targeted antiviral drug for dengue; clinical management is supportive, focusing on rest and rigorous fluid hydration, which may require hospitalization and intravenous fluids in severe cases. Dr. Dray highlights that patients must strictly avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Because dengue induces thrombocytopenia and capillary fragility, NSAIDs heighten the risk of severe hemorrhage; acetaminophen is the drug of choice for fever and pain. Furthermore, initial recovery provides lifelong immunity only to that specific serotype among the four circulating dengue viruses (DENV-1 through DENV-4). Subsequent infection with a different serotype introduces the risk of antibody-dependent enhancement, where cross-reactive antibodies exacerbate viral uptake, sharply elevating the likelihood of severe hemorrhagic fever and shock. Vector Behavior and Daytime Mosquito Control (12:37) Dengue prevention relies entirely on vector control and personal protection against the primary vector, the *Aedes aegypti* mosquito, which incubates the virus for 4 to 10 days before transmitting it to humans. Unlike mosquito species that are primarily active around dusk or evening, *Aedes aegypti* are notorious daytime biters that live near human dwellings. Effective defense requires applying EPA-registered insect repellents containing DEET and wearing protective long-sleeved clothing during daytime hours. In addition, environmental management around homes is vital: individuals must routinely eliminate standing water by emptying, scrubbing, or discarding artificial catchments such as flower pots, bird baths, outdoor containers, and discarded tires. Dr. Dray emphasizes that while cutaneous signs provide an immediate clinical window into dengue infection, rashes often deviate from classic textbook presentations and cannot replace laboratory confirmation. With local transmission emerging in regions like South Florida, managing the disease requires maintaining vigilance 24 to 48 hours after fever breaks, adhering strictly to safe fever management, and curbing daytime vector exposure.

Source quotes

[1:53] Dr. Dray: we give everything two names. [1:53] Dr. Dray: islands of sparing [1:53] Dr. Dray: sea of red with little random white islands interspersed throughout. [3:43] Dr. Dray: We give it a fancy name, but it's literally just taking a microscope slide and pressing it on the skin. [5:53] Dr. Dray: The more worrisome bleeding signs often start to appear 24 to 48 hours after the fever has gone away. So, if someone has had several days of fever, flu-like symptoms, especially joint pain, bone pain, muscle pain, I would not necessarily say, 'Oh, you're all clear once the fever goes away.' You want to be very careful and watch them. [5:53] Dr. Dray: the rashes don't always follow the textbooks. [8:06] Dr. Dray: pinhead-size bruises [12:37] Dr. Dray: mosquitoes, they love me. [12:37] Dr. Dray: mosquito harbinger of doom. [12:37] Dr. Dray: sleeves and slacks [13:53] Dr. Dray: sunscreen and subscribe.

Original transcript

[0:00] Well, hey guys. Welcome back. If you're [0:01] new here, I'm Dr. Dray, I'm a [0:03] board-certified dermatologist. Now, [0:05] recently you may have heard on the news [0:07] about dengue fever in Florida, and [0:10] you're probably wondering what the heck [0:11] is dengue fever. Dengue fever is a [0:14] mosquito-borne viral illness. Florida [0:17] has recently reported locally acquired [0:19] cases of dengue fever, especially in [0:22] South Florida, and they have declared it [0:24] a local emergency. So, I thought it [0:25] would be a good opportunity to talk [0:28] about the skin warning signs of dengue [0:31] fever, because this is a viral illness [0:33] that has very characteristic rashes that [0:35] can serve as important warning signs [0:37] that that's what you have. Before we get [0:39] into all of that, having a rash that [0:40] looks like what I'm going to show you in [0:42] this video doesn't mean that you have [0:44] dengue infection. It could be any number [0:46] of things. There are actually other skin [0:49] conditions that produce rashes that look [0:51] very similar. There are also many other [0:53] viral infections that you can have, [0:55] run-of-the-mill type colds and flus, if [0:57] you will, especially this time of year, [0:59] that can produce rashes on the skin. So, [1:01] don't just assume if you have a rash [1:03] that you've got dengue fever, okay? So, [1:05] dengue is caused by dengue viruses. It's [1:08] transmitted primarily through the Aedes [1:11] aegypti mosquito. There are actually [1:13] four dengue virus serotypes. Infection [1:16] can range from a mild illness all the [1:18] way to life-threatening dengue. After an [1:20] infected mosquito bites someone, [1:21] symptoms typically begin after around a [1:25] incubation period of about 4 to 10 days. [1:27] The illness commonly causes fever, [1:29] headache, joint pain, muscle aches, bone [1:32] pain. And many people develop pain [1:34] behind the eyes, which is a classic [1:36] symptom of dengue fever. Now, most [1:38] symptomatic dengue infections aren't [1:40] severe, but severe dengue can lead to [1:43] bleeding, shock, and organ damage. And [1:46] the transition from uncomplicated dengue [1:48] infection to complicated it's abrupt. [1:51] So, that's why knowing the warning signs [1:53] matters. The classic rash of dengue [1:55] virus infection is notoriously what is [1:58] described as diffuse, meaning [2:00] widespread, red, flat and raised. In [2:03] other words, it's a maculopapular, [2:05] or we also like to call it morbilloform, [2:08] because we give everything two names. [2:09] Maculopapular or morbilloform rash. Now, [2:12] what's interesting about the rash of [2:14] dengue virus is it notoriously does this [2:16] one thing. It spares random little [2:19] patches of your skin. In other words, [2:21] you're all red, but you've got these [2:23] random little islands, if you will, of [2:26] that's completely normal. We describe [2:28] this as islands of sparing. It's [2:30] basically like you have a sea of red [2:32] with little random white islands [2:33] interspersed throughout. So, instead of [2:35] seeing a uniformly red rash, you might [2:37] notice these like mottled areas where [2:39] you have sort of larger spots of normal [2:42] appearing skin. The rash usually appears [2:44] within a few days of the illness. And [2:45] the rash is usually accompanied by other [2:47] symptoms like fever and a headache. But, [2:49] here's the important caveat. There are [2:51] many viral illnesses that produce [2:53] maculopapular rashes. So, simply having [2:55] a rash that kind of looks like this, or [2:57] looks exactly like this, doesn't [2:58] necessarily mean you have dengue fever. [3:01] In other words, the rash has to be [3:02] interpreted with context of the person's [3:04] symptoms, their travel history, mosquito [3:07] exposures, have they been in an area [3:09] where outbreaks are known to occur, and [3:11] also appropriate lab testing. I also [3:13] want to mention that the rash doesn't [3:14] necessarily look exactly like this in [3:17] all skin tones. On lighter skin tones, [3:19] that red is a lot easier to recognize. [3:22] It's usually very bright pink. But, on a [3:24] deeper skin tone, it can appear more [3:26] violet to gray. Or, sometimes it just [3:28] looks different from the normal [3:31] background skin. The only trace of [3:33] normal background skin are those islands [3:35] of sparing. So, if you don't see that [3:36] bright red or that bright pink in a [3:39] patient with a deeper skin tone, don't [3:40] be surprised. It doesn't mean that their [3:42] rash is not dengue. Another skin finding [3:44] is something called petechiae. Petechiae [3:46] are basically little tiny areas where [3:48] you have bleeding into the skin. They [3:50] look like little small red, purple, [3:52] brownish dots depending on the person's [3:54] skin tone. A useful feature when trying [3:56] to determine if a spot is petechiae, aka [3:59] leakage of blood into the skin, is if [4:01] you press on it, it should not blanch. [4:03] As opposed to if it's redness due to [4:05] blood in a blood vessel, when you press [4:08] on it, you're going to be pressing on a [4:09] blood vessel, compressing it, and that [4:10] redness should disappear. That's known [4:12] as blanching. If that's difficult for [4:14] you to elicit because you're like, "I [4:15] don't know, that's a really tiny spot. [4:17] Every time I put my finger on it, I just [4:18] cover it up and can't see anything." Get [4:20] yourself a a glass microscope slide, um [4:23] and press it down on the skin so you can [4:25] see through it. That's what we do in in [4:27] clinic, and it it's very useful. It's [4:28] called diascopy. We give it a fancy [4:30] name, but it's literally just taking a [4:32] microscope slide and pressing it on the [4:33] skin. But again, petechiae, they can [4:36] occur, of course, in dengue, but they [4:37] can commonly occur with other viral [4:39] infections as well. Also, you can [4:41] develop petechiae like on the face if [4:43] you've been coughing a lot. So, if [4:45] you're sick with some sort of viral [4:46] illness and you're coughing, you can [4:48] develop petechiae on the face if you've [4:50] been vomiting, if you've been blowing up [4:52] a balloon, anything that increases the [4:54] intrathoracic pressure, it temporarily [4:57] uh increases the blood pressure in such [4:58] a way to result in these little bursts [5:01] of leakage of blood into the skin that [5:03] produce uh petechiae. The reason [5:05] identification of petechiae is so [5:07] important with dengue infection is [5:09] because severe cases of dengue infection [5:11] can cause all sorts of bleeding [5:13] complications and affect blood clotting [5:15] in your platelets. When dengue affects [5:17] the blood vessels, the platelets, it can [5:20] lead to bleeding complications that can [5:21] be life-threatening. Low platelet count, [5:23] which is also referred to as [5:25] thrombocytopenia, especially coupled [5:27] with mucosal bleeding, those are [5:30] particularly worrisome findings for more [5:33] severe cases, especially if they're [5:35] coupled with, say, this rash, fever, [5:38] joint pain, and uh the petechiae. You [5:41] know, all those things together, those [5:42] are clues that you need to get moving a [5:44] lot faster when it comes to caring for [5:47] these patients as far as making sure [5:49] that you have everything ready to go if [5:51] more urgent medical care is needed. [5:54] Someone with the history of having been [5:56] exposed to Aedes aegypti mosquitoes or [5:59] have been traveled to an area where [6:01] outbreaks are known to occur. If they [6:02] have bleeding from the nose and gums, [6:04] that is a particularly worrisome warning [6:07] sign for more severe infection [6:09] necessitating more urgent medical care. [6:11] And if the individual is vomiting blood [6:13] or there's blood in their stools, that [6:16] is definitely an emergency warning sign [6:17] for sure. Those are situations where you [6:19] don't want to just wait it out. You want [6:21] to get in to see the doctor urgently. [6:23] And we're talking like emergency room. [6:25] Because if someone with dengue infection [6:28] develops bleeding, they require urgent [6:30] medical care. And something that's [6:31] really important to understand about [6:33] dengue infection is that the most [6:35] dangerous phase of the infection doesn't [6:37] coincide with the highest temperature of [6:40] the fever. Initially, you have a fever [6:42] and flu-like symptoms with dengue. But [6:44] then the fever might start to come down [6:46] and some of those symptoms seem to let [6:48] up a bit and you might think, "Oh, I'm [6:49] getting better." But the more worrisome [6:51] bleeding signs often start to appear 24 [6:54] to 48 hours after the fever has gone [6:56] away. So, if someone has had several [6:57] days of fever, flu-like symptoms, [7:00] especially joint pain, bone pain, muscle [7:02] pain, I would not necessarily say, "Oh, [7:04] you're all clear once the fever goes [7:07] away." You want to be very careful and [7:09] watch them. Now, of course, the skin can [7:11] provide a lot of important clues. I love [7:13] that the skin is so accessible to our [7:15] eyes. We don't have to order any fancy [7:17] tests to see these rashes. They are [7:19] right there in front of our face. There [7:20] are also some other important warning [7:22] signs that you don't want to miss. You [7:23] definitely want to let your health care [7:25] provider know. If you have abdominal [7:26] pain, your stomach feels really tender [7:28] to the touch or any point on your [7:29] stomach does, that is more worrisome, [7:32] especially if you've been having [7:33] persistent vomiting. Persistent vomiting [7:35] and now you're noticing that you're [7:36] vomiting blood. Yeah, these are all very [7:39] urgent. Any bleeding from the nose or [7:41] gums, not anything you want to sleep on [7:43] for sure. And if there's significant [7:44] fatigue, lethargy, um restlessness, [7:47] irritability. If you have a rash and [7:50] these symptoms, regardless of what the [7:51] rash looks like, and you've been [7:53] somewhere where cases are known to [7:55] occur, you've had a recent mosquito [7:57] exposure, yeah, it's definitely not [8:00] something to be like, "Well, I don't [8:01] really see any island sparing, so surely [8:03] it's not dengue." Because the rashes [8:05] don't always follow the textbooks, okay? [8:07] Now, we already talked about the [8:08] petechiae, those little pinpoint dots of [8:10] bleeding into the skin, but some people [8:12] can develop more significant, extensive [8:15] areas of bleeding into the skin that [8:17] look bruise-like. That's referred to as [8:18] purpura. Think of petechiae as like [8:21] pinhead-size bruises, whereas purpura is [8:24] like big bruises, okay? Larger areas. [8:27] And this often will look much different [8:29] depending on the person's background [8:30] skin type. Here's another thing that's [8:32] important to understand. Dengue is not [8:34] the only mosquito-borne viral illness. [8:36] So, another reason diagnosis can be [8:38] challenging is that there are some other [8:40] mosquito-borne viral illnesses that can [8:42] look very similar. Uh Zika and [8:45] chikungunya are two others, for example, [8:47] that cause fever and skin rash. There [8:49] are many other viral infections that can [8:51] produce fever and a rash. Flu, measles, [8:54] which is at an all-time high right now, [8:56] especially currently, as of the filming [8:57] of this video, Pennsylvania is being hit [9:00] with some very critically ill children, [9:02] as a matter of fact. Um also, rubella, [9:04] which is, you know, German measles. Uh [9:07] and then other viral infections, okay? [9:09] So, if you have a young child, uh [9:11] they often times make rashes when they [9:13] get a virus. Not all the rashes that [9:15] they make are going to be, "Oh, this is [9:18] This is dengue, okay?" Especially if you [9:20] have a school-age child, you know, a [9:22] young school-age child. Yeah, they [9:23] commonly make rashes when they get [9:25] certain viral illnesses. But, it's [9:27] really the whole clinical picture that [9:28] really puts somebody in a category of, [9:30] "We really should be thinking about [9:32] dengue here." It's going to be the [9:33] exposure history. Now, how is it [9:35] diagnosed? Um dengue is diagnosed with [9:37] laboratory testing. The timing of the [9:39] testing really matters because different [9:41] tests are useful at different phases of [9:43] the illness. It will depend on how many [9:45] days have passed since you initially [9:46] developed symptoms. The testing might [9:48] include a molecular test or an NS1 [9:50] antigen plus antibody test. How is this [9:53] treated? Well, there's not actually a [9:54] specific dengue virus antiviral that is [9:58] used. Instead, it's treated [10:00] symptomatically. That means rest and [10:02] hydration. By hydration, sometimes uh it [10:05] involves IV fluids. Depending on how ill [10:07] you are, more intensive medical [10:09] monitoring may be needed. But, this is [10:11] something I want everyone to know. You [10:13] want to avoid aspirin and medications [10:15] known as nonsteroidal anti-inflammatory [10:17] drugs. These include ibuprofen, unless [10:20] of course your health care provider [10:21] specifically tells you to take those [10:23] because of the bleeding risk. Now, [10:26] acetaminophen, also referred to as [10:28] paracetamol, that's actually generally [10:30] used for the fever and the pain in this [10:32] case. Um, but if you're unsure about the [10:34] medication, you know, it's all the more [10:36] reason to be talking to your health care [10:38] provider for sure, rather than just [10:40] trying to self-treat your own dengue. [10:41] Another important point is that getting [10:43] infected with dengue doesn't necessarily [10:46] mean that you can't get infected again. [10:48] And in fact, it's kind of surprising [10:50] because you can get another dengue [10:52] infection. Not only can you get sick [10:54] again, but you can get more sick than [10:56] had you never been infected in the first [10:58] place. Why does that happen? Well, as I [10:59] said at the beginning of the video, [11:01] dengue is not just one virus, it's [11:02] actually four different viruses. For [11:04] example, you may have been infected with [11:06] dengue virus serotype one. In which [11:09] case, you will be immune to serotype one [11:13] from here on out. But, you will not be [11:15] immune to types two, three, and four. If [11:17] you are at a later time point bitten by [11:19] the old Aedes aegypti mosquito, and this [11:22] time this time they are bringing another [11:24] dengue virus with them, not just the one [11:26] that you were infected with in the past. [11:28] Not only are you not going to be immune [11:30] to that, but it creates this bizarre [11:31] situation where it actually makes you [11:33] sicker and more likely to have severe [11:35] bleeding complications. So, when should [11:37] you seek urgent medical care? Is this [11:39] something you can just ride out like [11:40] your garden variety cold or flu? I'm [11:43] going to go out on a limb here and say [11:44] that's not really a smart thing to do. [11:46] If you have been somewhere where Aedes [11:48] aegypti mosquitoes are known to, you [11:51] know, occur, there have been outbreaks, [11:53] you think that you may have been exposed [11:55] to a dengue virus, you have a fever, you [11:57] have a rash, you feel unwell, see a [12:00] healthcare provider. Not all cases of [12:02] fever and a rash are serious or [12:04] life-threatening. In many cases of fever [12:06] plus rash will go away on their own with [12:08] no medical care. But there are enough [12:10] reasons to have fever and a rash that [12:13] are serious and are life-threatening [12:15] that it's definitely worth seeing a [12:17] healthcare provider, but you want to get [12:18] in urgently if you have any kind of [12:21] evidence of bleeding. Petechiae, [12:23] purpura, but especially especially if [12:25] you have bleeding gums, a nosebleed, [12:27] you're having blood in your stool, [12:29] you're vomiting up blood, don't [12:31] say I'm going to just going to ride this [12:33] out, okay? Because you can get really [12:34] really really uh critically ill, [12:36] seriously critically ill. How can you [12:38] prevent dengue in the first place? The [12:40] best way to prevent dengue is to avoid [12:42] mosquito bites. Um I don't know about [12:44] you. Fortunately, I've never gotten [12:46] dengue, but I know that mosquitoes they [12:49] love me. Mosquitoes that transmit [12:51] dengue, they can breed in relatively [12:53] small amounts of standing water. So, [12:54] make sure to be really um diligent about [12:57] not letting any standing water collect [13:00] around your property, around your home, [13:01] apartment. So, things like containers, [13:04] flower pots, bird baths, discarded tires [13:07] are a common actual mosquito harbinger [13:11] of doom, if you will. Emptying or [13:12] covering any kind of container that [13:14] could collect like rainwater and and [13:16] serve as a little home for mosquitoes, [13:18] that really goes a long way. Also, um [13:20] for personal protection purposes, make [13:22] sure you're using an insect repellent [13:24] with DEET. Wear long sleeves, long [13:26] pants, good to protect against not only [13:28] mosquitoes, but those damaging UV rays, [13:31] of course. Sleeves and slacks, [13:33] especially now that we're getting into [13:34] the cooler months. If you've ever been [13:36] to like a lake or somewhere where there [13:38] are a lot of mosquitoes, they typically [13:40] come out in droves at night, right? They [13:42] still can bite you and commonly do bite [13:45] during the day. So, don't just reserve [13:47] the DEET use and the covering to night [13:50] time. You want to be doing it during the [13:52] daytime, as well. All right, y'all. So, [13:54] I hope today's video was educational and [13:56] informative with regards to the [13:58] interesting skin findings characteristic [14:00] of dengue infection. Again, having this [14:02] type of a rash does not necessarily mean [14:04] that you have dengue, but if you have [14:06] this and you've been somewhere where [14:08] outbreaks are occurring, where there are [14:09] a lot of Aedes aegypti mosquitoes, [14:12] you've been bit, and you've have other [14:13] symptoms of feeling unwell, it's [14:15] definitely something to be on the [14:16] lookout for and know about. Let me know [14:18] in the comments, have you ever heard of [14:20] dengue? Do you live in Florida? I know a [14:22] lot of you guys do. I actually have a [14:23] lot of videos on my YouTube channel [14:25] about skin warning signs of different [14:28] infections. We've got measles, Ebola, [14:31] we've got Chagas disease on here, we've [14:33] got leprosy. I mean, we've got a lot of [14:36] skin warning signs of different [14:38] infections that you're like, "Oh my [14:39] gosh, what is that?" So, definitely [14:41] check it out, but if you guys enjoyed [14:43] today's video, give it a thumbs up, [14:44] share it with your friends, and as [14:45] always, don't forget, sunscreen and [14:47] subscribe. I'll talk to you guys [14:48] tomorrow. Bye. [14:54] >> [music] [15:09] [music]