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ULY CLINIC

9 Septemba 2025, 05:23:25

Erythema

Erythema, characterized by dilated or congested blood vessels resulting in red, scaly skin, is the most common sign of skin inflammation or irritation. It may present as localized or generalized, sudden or gradual, and its color can range from bright red in acute conditions to violet or brown in chronic cases. Differentiation from purpura is critical: erythema blanches under pressure, whereas purpura does not.

Pathophysiology

Erythema primarily results from increased perfusion in the dermal small vessels. Mechanisms include drug reactions, neurogenic changes, trauma, tissue damage, or disorders affecting vascular support structures. Rare causes include acute febrile neutrophilic dermatosis, erythema ab igne, erythema chronicum migrans, erythema gyratum repens, and toxic epidermal necrolysis.

Clinical Assessment

History Taking:

Onset, duration, and progression of erythema
Associated symptoms: pain, itching, fever, malaise, joint pain
Recent infections, trauma, or drug exposure
Family history of skin disorders or allergic conditions
Exposure to chemicals, UV light, or infectious contacts

Physical Examination:

Distribution, extent, and intensity of erythema
Presence of hair loss, edema, or secondary skin lesions (hives, scales, vesicles, purpura)
Palpation for warmth, tenderness, or crepitus
Special attention to skin changes in darker-skinned patients, which may appear bluish or purple

Medical Causes

Table 1: Causes of Erythema – Distinguishing Features and Key Clinical Information

Cause	Clinical Features / Distinguishing Signs	Distribution / Pattern	Other Key Information / Considerations
Allergic Reactions / Anaphylaxis	Sudden erythema, urticaria, flushing, facial edema, diaphoresis, hypotension, airway compromise	Generalized; may involve face and trunk	Life-threatening if anaphylaxis; requires epinephrine, airway management
Burns (Thermal / UV)	Redness, swelling, tenderness, possible blisters; delayed erythema for sunburn	Exposed skin areas	Assess burn depth; manage pain, fluids, infection risk
Candidiasis (Intertrigo)	Erythema with satellite pustules, scaly papular rash	Skin folds: axillae, under breasts, groin, neck, umbilicus	Common in immunocompromised or diabetic patients
Cellulitis	Red, warm, tender, swollen skin; may have systemic signs (fever)	Localized, often unilateral	Bacterial infection; risk of sepsis; treat with antibiotics
Atopic Dermatitis	Erythema with pruritus, small papules, scaling, lichenification	Flexural areas: neck, antecubital, popliteal fossa	Chronic, recurrent; may precede secondary infections
Contact Dermatitis	Acute erythema, vesicles, blisters, or ulceration after exposure	Exposed areas corresponding to irritant	Identify and remove trigger; topical steroids often required
Seborrheic Dermatitis	Dull red or yellow erythema with greasy scales	Scalp, eyebrows, nasolabial folds, chest; butterfly rash on face possible	Common in HIV patients and infants (cradle cap)
Dermatomyositis	Dusky lilac rash, Gottron’s papules over joints, heliotrope rash on eyelids	Face, neck, upper torso, nail beds	Associated with muscle weakness; often autoimmune; may require systemic steroids
Erythema Multiforme Minor	Target-like lesions, urticarial, minimal mucosal involvement	Flexor surfaces of extremities; crops	Often post-infection (HSV, Mycoplasma); self-limited
Erythema Multiforme Major / Stevens-Johnson Syndrome	Widespread symmetrical bullous lesions, mucosal erosions, fever, malaise	Generalized, often trunk and extremities	Drug reaction common; life-threatening; manage like severe burn
Erythema Nodosum	Tender, firm nodules; may be accompanied by fever, malaise, joint pain	Bilateral shins, sometimes knees, ankles, arms, buttocks	Associated with IBD, sarcoidosis, infections (strep, TB); self-limited or treat underlying cause
Gout	Tight, erythematous skin over inflamed joint	Usually first MTP joint, knees, elbows	Acute monoarthritis; treat with NSAIDs, colchicine
Lupus Erythematosus	Butterfly rash, photosensitivity, telangiectasia, purpura, mucosal ulcers	Face, sun-exposed areas	Systemic symptoms possible (fever, fatigue, arthralgia); autoimmune management
Psoriasis	Silvery-white scales over erythematous plaques, pitting nails	Elbows, knees, scalp, chest, intergluteal folds	Chronic, recurrent; systemic therapy if extensive
Rosacea	Central facial erythema, telangiectasia, papules, pustules; rhinophyma possible	Nose, cheeks, forehead, chin	Chronic, may be triggered by alcohol, heat, sun
Radiation / Drug-Induced	Dull erythema, edema; may be symmetric; timing related to exposure	Localized or generalized	Assess drug history; may require discontinuation and supportive care
Neonatal / Pediatric Rashes	Erythema toxicum neonatorum: pink papular rash, resolves spontaneously; Roseola, rubella: erythematous maculopapular rashes with fever	Trunk, extremities, face	Consider infectious causes; hospitalization if neonate has fever
Actinic Purpura (Elderly)	Well-demarcated purple macules or patches, mainly dorsal hands and forearms	Hands, forearms	Result of fragile capillaries; usually self-limited

Notes for Healthcare Professionals:

Always assess systemic signs such as fever, hypotension, dyspnea, and mucosal involvement.
Pediatric and geriatric patients may present differently; consider developmental and skin aging factors.
Rapid identification of life-threatening causes (anaphylaxis, SJS, severe burns) is critical.
Document drug history, exposures, and underlying diseases to guide management.

Emergency interventions and supportive care

Table 2: Emergency Interventions & Supportive Care for Erythema

Cause / Condition	Emergency Interventions	Supportive Care / Monitoring
Anaphylaxis / Severe Allergic Reaction	Immediate epinephrine IM; maintain airway; supplemental oxygen; IV fluids for hypotension	Monitor vitals, respiratory status, and mental status; antihistamines and corticosteroids as adjuncts
Severe Burns (Thermal / UV)	Stop burning process; assess airway if inhalation injury suspected	Cool affected area; analgesics; fluid replacement; monitor for infection and shock
Erythema Multiforme Major / SJS	Hospitalization; discontinue offending drug; supportive care similar to burn management	Fluid and electrolyte replacement; wound care; pain control; monitor for secondary infection
Cellulitis	Assess for sepsis; hemodynamic support if hypotensive	IV or oral antibiotics; monitor for progression, fever, systemic symptoms
Erythema Nodosum	Rule out systemic infection; supportive only unless underlying cause severe	NSAIDs for pain and inflammation; elevate affected limbs; treat underlying disease
Gout with Erythema	NSAIDs or colchicine for acute flare	Rest joint; apply ice; educate on diet and medications to prevent recurrence
Severe Lupus Erythematosus Flare	Hospitalization if systemic involvement; corticosteroids or immunosuppressants	Monitor renal, hematologic, and cardiac function; supportive skin care; avoid sun exposure
Neonatal / Pediatric Erythema with Fever	Assess airway, breathing, circulation; admit if sepsis suspected	Hydration; treat underlying infection; monitor vitals and perfusion
Drug-Induced Erythema	Discontinue offending agent; treat anaphylaxis if present	Symptomatic relief with antihistamines, topical corticosteroids; monitor for systemic reaction
Radiation-Induced Erythema	Usually non-emergent unless widespread skin breakdown	Topical emollients, corticosteroids; avoid further exposure; monitor for infection

Special Considerations

Monitor fluid and electrolyte balance in patients with extensive erythema or burns.
Withhold potential causative medications until the etiology is identified.
Consider topical or systemic corticosteroids and antibiotics as clinically indicated.

Diagnostic Workup

Skin biopsy for atypical lesions or suspected malignancy
Culture and sensitivity for infectious causes
Laboratory studies for systemic involvement: CBC, inflammatory markers, autoantibodies

Patient Counseling

Educate patients to recognize early signs of flare-ups.
Advise sun protection and avoidance of triggering substances.
Recommend skin care strategies: soothing baths, wet dressings, antihistamines, and analgesics.

Pediatric Considerations

Neonatal erythema (toxicum neonatorum) is self-limited.
Infants may develop erythema from infections, candidiasis, or dermatologic conditions.
Hospitalization may be warranted for neonates with fever and erythema.

Geriatric Considerations

Elderly patients often present with actinic purpura: well-demarcated purple macules on the hands and forearms.
Lesions usually resolve spontaneously.

References:

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