Erythema (from Latin erythema), i.e. local reddening of the skin surface, is one of the most common dermatological symptoms. Erythematous changes may be caused by local irritation, and may also be a symptom of inflammation or infection within the skin. In some illnesses with erythema, various accompanying symptoms coexist - in such cases erythema may become an "independent" disease entity. Sometimes the erythematous changes resolve spontaneously, while others require appropriately selected treatment. Find out what the causes of erythema are, which types of erythema are the most common, how to recognize erythema and how to treat it.
Erythema(from Latinerythema ) is a local reddening of the skin that can appear in anyone, at any age, and its the reasons can be very different.
Erythema: causes
Erythematous changes on the skin may occur in the course of many diseases of various origins. The source of their formation is the expansion and inflow of blood to thin vessels (so-called capillaries) located in the superficial layers of the skin.
Common causes of this condition include infections, skin injuries and wounds, as well as inflammation. The erythema is then a symptom of hyperemia arising to increase blood flow. Along with the blood, immune system cells, molecules that convey information about inflammation, and factors that facilitate healing and tissue repair travel to their destination.
Skin damage manifested by erythema also occurs in the course of sunburn or exposure to other types of radiation (for example, during radiotherapy).
Another factor that causes vasodilation (including in the skin) is histamine. It is a substance released in the body, including in the course of allergic reactions. Erythematous changes on the skin can therefore accompany various types of allergies.
Other diseases coexisting with erythema include some diseases of the connective tissue. An interesting example is systemic lupus erythematosus, in the course of which a characteristic butterfly-shaped erythema may appear on the face.
In addition to the above-mentioned causes of erythema, a group of the so-called erythematous dermatoses. These are skin diseases,whose main symptom is erythema, which has special properties. In addition to the characteristic appearance of skin lesions, additional symptoms are also possible. The most important types of erythema are listed below.
Types of blush
- drug erythema (permanent erythema)
Drug erythema and permanent erythema are different names for the same disease entity. As the name suggests, skin lesions - round or oval brown patches - are caused by taking certain medications. Patients often notice the cause of discoloration themselves, as they usually appear in the same place after taking a specific drug. The basis of diagnostics is a carefully collected history of the drugs taken, and the treatment consists in discontinuing the drug causing the changes. Drug erythema can appear on the skin after taking various pharmaceuticals; statistically, it is most often caused by antibiotics, sulfonamides, hormonal agents and antiallergic agents.
- wandering erythema
Wandering erythema is an example of a disease with a well-known cause. It is caused by the multiplication of bacteria of the typeBorrelia burgdorferiin the skin. Migratory erythema is therefore an early symptom of tick-borne Lyme disease. It usually appears at the injection site within a few or several days.
The migratory erythema has a characteristic appearance - it resembles a red ring, spreading circumferentially from the tick injection site. In some cases, it is accompanied by systemic symptoms of infection: fatigue, fever, and muscle aches. The diagnosis of migratory erythema is an indication for the implementation of antibiotic therapy against Lyme disease (the most common are amoxicillin or doxycycline). If it is not certain whether the skin lesion is an erythema migrans, additional laboratory tests can be performed (blood tests for antibodies against bacteriaBorrelia ).
- erythema nodosum
Erythema nodosum (Latinerythema nodosum ) is an inflammatory disease. Its characteristic symptom is painful, several centimeter-long red bumps, changing their color to a blue-brown color over time. The lesions are typically located on the front surface of the lower leg. The inflammation causing erythema nodosum develops in the subcutaneous tissue. The most common accompanying symptoms include joint pain and fever.
The exact mechanism behind the formation of erythema nodosum remains unclear. Most often it is associated with another infection within the body (bacterial, viral or fungal), sometimes it can also accompany diseasesautoimmune diseases (Crohn's disease, sarcoidosis), cancer or pregnancy. Skin lesions in erythema nodosum usually resolve spontaneously and heal without leaving any visible traces. In the case of a known background, causal treatment (e.g. antibiotic therapy for an established bacterial cause) can be used.
- erythema sclerotic
Sclerotic erythema (Latinerythema induratum ) is another example of an erythema with a probable infectious origin. It is most commonly associated with tuberculosis infection, as most patients with erythema sclerosis test positive for tuberculosis. Skin lesions, as in erythema nodosum, usually appear on the lower legs ( although indurated erythema is much more common on the back of the calves). The healing process differentiating tumors in both diseases is much worse in erythema. After an initial, painful phase, the disease usually takes a chronic course. The severity of the pain decreases, but deep sores appear in the area of the tumors and permanent marks may remain on the surface of the skin.
- Erythema multiforme
Erythema multiforme (from Latinerythema multiforme ) is basically a group of diseases of varying severity and appearance of skin lesions. They are based on the reaction of the immune system to various stimuli: medications, a history of infection, or other (often unidentified) factors.
Skin lesions are most often located on the limbs, although their characteristic feature is the possibility of appearing on the oral mucosa.
The mild form of erythema multiforme usually does not cause serious ailments, and does not require specialist treatment. The severe form, which in dermatology is divided into two separate disease entities, is completely different:
- Stevens-Johnson syndrome
- TEN syndrome (toxic epidermal necrolysis)
Erythematous changes occupy very large areas and are also accompanied by a much more serious general condition of the patients. The most dangerous form of erythema multiforme is TEN syndrome, in which the epidermis separates from the remaining layers of the skin. The loss of the natural protective barrier exposes patients to water loss, which is evaporated uncontrollably from the surface of their body. This leads to electrolyte disturbances and infections that can be life-threatening. Due to the different and much more severe course of Stevens-Johnson syndromes and TEN, some scientific publications currently exclude them beyond the spectrumerythema multiforme.
- wandering necrolytic erythema
Wandering necrolytic erythema is an example of cutaneous paraneoplastic syndrome, i.e. a condition that coexists with neoplastic disease. This type of erythema is the result of metabolic changes, caused in most cases by the so-called glucagonoma. This is a special type of cancer of the pancreas that produces large amounts of glucagon - a hormone that works opposite to insulin.
Excess glucagon, in addition to skin changes such as wandering necrolytic erythema, affects the metabolism of the whole organism. Diabetes is the most common accompanying symptom. Wandering necrolytic erythema may resemble the TEN syndrome (see above) due to the depletion of the epidermis within the erythematous lesions. The treatment of migratory necrolytic erythema, like the treatment of other paraneoplastic syndromes, is based on the treatment of the underlying disease - in this case, pancreatic cancer.
- palmar erythema
Palmar erythema (Latinerythema palmarum ), i.e. reddening of the skin on the hands, is a symptom accompanying many diseases. It is typically associated with liver conditions such as cirrhosis, portal hypertension, or chronic liver failure.
Another group of comorbidities are rheumatological diseases (eg RA). Its formation may also be influenced by hormonal changes, in particular, increased estrogen levels during pregnancy. In many cases, palmar erythema does not necessarily indicate any disease, and sometimes it can also be a genetically inherited trait.
Erythema in children
Although most of the erythematous diseases described above can occur in both adults and children, some are unique to the pediatric population. There are two types of erythema: infectious and sudden. These are infectious diseases of childhood caused by viral infection.
- infectious erythema (the so-called fifth disease)
Infectious erythema is an infectious disease that occurs most often in preschool and school-age children. The causative agent is a virus (specifically parvovirus B19). The initial symptoms resemble a cold - low-grade fever, runny nose, sometimes joint pain.
After a few days, the main symptom of the disease appears - intense red erythema on the face (hence the common name - "slapped baby syndrome"), spreading to the child's torso, buttocks and limbs. Skin lesions may alternately resolve and recur over a period of several weeks, and typically worsen due to overheating.
Since the background of infectious erythema is viral, there is no causal treatment available (antibiotics should also not be used). Infectious erythema in children in the vast majority of cases is mild. Its feature is that it is easy to spread, with the greatest infectivity occurring before the appearance of typical skin lesions. Pregnant women must be especially alert to the contact with parvovirus B19, because infection during pregnancy can destroy fetal blood cells and cause serious complications.
- sudden erythema (three-day fever)
Sudden erythema, also called three-day fever or disease six, is a disease that affects younger children (usually under the age of 3). It is caused by viruses from the groupHerpes(HHV-6 and HHV-7). The course of the disease is very characteristic: the child has a sudden fever (even up to 40 ° C), usually without accompanying symptoms.
After a few (usually - three) days, the temperature returns to normal, and an erythematous rash appears on the skin of the body and face. The overall condition of the baby remains good. There is a certain risk associated with a high fever which, in some cases, can cause febrile seizures. As with infectious erythema, there is no causal treatment for blushing erythema.
"Trzydniówka" is treated only symptomatically, by monitoring the child's temperature (non-steroidal anti-inflammatory drugs and / or paracetamol may be administered), and by ensuring adequate hydration during fever.
About the author
Krzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.
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