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Erythema is a red area of skin caused by local widening of blood vessels. The erythema may appear intermittently, depending on the presence of the causative agent of the reaction.
Skin erythema
This is the general medical name for redness on the skin, which is characterized by a very prominent edge at the edges. The causes of erythema on the skin are very different, it may be the result of strong emotions or stress, and on the other hand, it may be due to a serious disease or infection / inflammation of the skin. The shape of skin lesions can also be varied: ring-shaped, butterfly, irregular, in the form of a round spot. The most characteristic erythema is migratory erythema, which is a symptom of a tick bite. Treatment of erythema depends on its type and determination of the cause of ailments.
The occurrence of erythema is observed on smooth skin:
- contagious – the ailment is viral and manifests itself in the appearance of a skin lesion in the form of a butterfly on the face; the development of the disease leads to the spread of skin lesions throughout the body; infectious erythema is most common in children;
- multiform – it occurs as a consequence of the consumption of certain drugs or chemicals; a characteristic symptom is the presence of erythema (erosions, bleeding, blisters) that merge with each other; erythema multiforme can be diagnosed as Lyell’s syndrome or Stevens-Johnson syndrome;
- lumpy – the ailment is caused by a certain hypersensitivity to drugs; manifested by painful bumps, swelling and high temperature;
- permanent – erythema appears as a result of consumed food and medications;
- hardened – it is otherwise known as hardened tuberculosis; the symptoms include lumpy skin lesions which appear as ulcers that heal over time; non-ulcerative erythema leaves unsightly depressions, and the symptoms of the disease worsen in spring and autumn;
- Lombard – the disease is caused by vitamin B3 (PP) deficiency; the skin lesion (erythema) most often affects the face and hands; accompanying symptoms such as weakness, diarrhea, insomnia and problems with coordination may occur.
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Serotonin erythema
Serotonin erythema occurs due to the presence of a carcinoid tumor that secretes vasoactive substances (serotonin and others). It is caused by tumors of the gastrointestinal tract, mainly in the small intestine, ovaries, testes and bronchi, which secrete serotonin and other vasoactive amines. Other malignant tumors have a similar effect: oat cell carcinoma, medullary diarrhea and abdominal pain, sometimes malabsorption syndrome or pellagra; tachycardia.
Complications after serotinic erythema:
- right-sided pericardial fibrosis,
- sometimes pulmonary artery stenosis,
- tricuspid valve regurgitation,
- right ventricular failure.
Diagnostics and treatment of serotonin erythema
The diagnosis uses the importance of the daily excretion of 5-HIAA (5-hydroxyindole acid – a serotonin metabolite) in the urine after excluding the consumption of foods rich in serotonin (bananas, avocados, walnuts and others). Excretion of 5-HIAA increases above 50 mg / day (N <10 mg / day).
Treatment of serotonin erythema: When the syndrome is diagnosed, primary tumors are usually inoperable. Metastatic tumors, on the other hand, may be treatable. Treatment of erythema is most often performed with streptozocin in combination with 5-fl uorouracil, beta-adrenergic blockers and corticosteroids are helpful.
Erythema multiforme
It is an ailment that is a frequent consequence of the organism’s hypersensitivity to chemical, viral factors and medications. Erythema occurs in all age groups, also regardless of gender, although the most severe forms of the disease are usually seen in women. Erythema multiforme is diagnosed in most cases in young people under the age of 20. The onset of erythema and symptoms are quite rapid and appear immediately after taking certain medications or as an infection develops. The most dangerous form of erythema multiforme is epidermal necrolysis, which in consequence may even lead to the patient’s death.
Factors that increase the risk of exudative erythema multiforme:
- viral infection (e.g. flu-like infections),
- bacterial infection,
- pneumonia,
- Herpes simplex virus infection in the labial or genital area,
- chemical,
- medications taken (e.g. sulfonamides, anticonvulsants, antibiotics, diuretics, non-steroidal anti-inflammatory drugs).
The symptoms of erythema vary depending on its form. In the course of the mild form of the disease, the symptoms are erythematous-edema changes of varying severity. They are symmetrical and have the shape of rings directed inwards. Sometimes, in addition, vesicles and hemorrhagic changes appear. It is worth mentioning that stress often intensifies the symptoms of erythema. What is it caused by? Long-term stress weakens the body, so herpes often appears, which leads to the rapid multiplication of the virus and the development of the body’s reaction characteristic of erythema.
Forms of exudative erythema multiforme: mild, Stevens-Johnson syndrome, epidermal necrolysis.
Treatment is causal. So if the reaction was caused by a specific drug – it should be discontinued, and if the infection – it should be cured. Among the preparations most often used in the course of the disease are:
- antiviral preparations,
- antipyretic drugs,
- painkillers,
- antifungal agents,
- antiseptic drugs,
- antibiotics
- glucocorticoids,
- antihistamines (prescribed by a dermatologist).
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Erythema gyrus creeping (Fig. 10.1)
Erythema gyratum repens is a paraneoplastic syndrome characterized by a rapidly spreading concentric peripheral erythema. The disease occurs very rarely – usually between the ages of 40 and 60, more often in men, before the diagnosis of a malignant tumor or at various times in its duration. The causes of the disease are unknown, possibly due to immunological reasons. Erythema gyratum repens occurs in 82% of cases together with tumors of internal organs: lungs, digestive tract, nipple. It disappears after surgery to remove the neoplasm; in 10% of cases, no association with neoplasma changes was demonstrated.
This type of erythema is most common on the trunk and limbs. It usually doesn’t show up on the face, hands or feet. The symptoms are very characteristic: the erythema peeling around the perimeter spreads very quickly (about 1 cm / day), forming the so-called tree rings. The eruptions are often accompanied by itching.
This type of erythema has a non-specific image. Perivascular lymphocytic infiltrates, more intense in the upper layer of the skin. Must be differentiated with glucagonomy.
Treatment: Searching for an accompanying neoplastic process.
Centrifugal annular erythema (Fig. 10.2)
Centrifugal annular erythema is a rare condition that affects mainly adults. The cause is not entirely known. There are many triggers:
- fungal infections – Candida albicans, viral – herpes, bacterial,
- connection with the presence of neoplastic tumors of the breast, gastrointestinal tract, lungs, in the course of lymphocytic leukemia; changes disappear after tumor removal,
- helminths,
- food allergies to fish, peanuts, cheese (mainly mold),
- medications, incl. penicillin, phi nesteride.
Centrifugal annular erythema affects all areas of the body, most often the torso. Initially, the erythematous eruptions resemble urticaria, they spread slowly peripherally, asymmetrically, disappear in the central part, forming erythematous rings with collars-shaped exfoliation and spot ecchymoses. They develop within a few days and disappear within a few weeks or months. The changes do not hurt; sometimes a slight itching.
The histopathological image shows a characteristic, significant degree of perivascular infiltration from lymphocytes in the dermis.
Treatment: Search for the etiological factor.
Figure 10.2. Centrifugal annular erythema
Creeping necrolytic erythema
Creeping necrolytic erythema is a paraneoplastic skin disorder associated with a tumor of islet cells in the pancreas that secrete glucagon. The condition is a marker of cancer. It is three times more common in postmenopausal women.
Erythema is found in almost all patients with tumors, mainly pancreatic alpha cells. Rarely in patients with other diseases of the gastrointestinal tract (chronic pancreatitis, chronic hepatitis, colorectal cancer). The skin lesions are thought to be caused by glucagon and other metabolic products. The first symptom of crawling necrolytic erythema is redness around the mouth or dark brown spots in the groin. The eruptions are covered with scabs over time. Sometimes symptoms of glossitis appear. In the area of the erythema, vesicles, spreading circumferentially, and collar-shaped scales form.
It is noted in people with this type of ailment very high level of glucagon in the serum – up to 3000 pg / ml (normal 0,1-0,3 pg / ml), diabetes and anemia often appear, and the presence of a tumor is detected by angiography.
Erythema should be differentiated from:
- zinc deficiency,
- Hailey-Hailey pemphigus
- pustular psoriasis,
- deciduous pemphigus.
Treatment: Removal of the tumor by surgery; topically: antibacterial agents. Most patients are treated surgically. In case of relapses, the survival time is 10-15 years. Skin lesions after surgery are a sensitive indicator of recurrence of the neoplastic disease.
Infectious erythema
Infectious erythema is a disease typical of childhood (usually occurs between 2 and 12 years of age) and is caused by infection with parvovirus 19. Infectious erythema usually occurs in children who are still attending nursery or kindergarten. Paravirus infection is transmitted by airborne droplets and sometimes from contaminated blood or plasma products. The source of the infection is a sick child or a carrier who has no symptoms of the disease. The infectious erythema is generally mild and self-limiting, giving life-long immunity.
The hatching period of the infectious erythema is about 14 days.
The precursors of infectious erythema are usually absent. The disease is fever-free or with a low temperature, runny nose, sore throat and sometimes muscle pain. These symptoms are flu-like in nature and usually appear before a characteristic rash. Accurate diagnosis is not easy because the signs of the disease do not always appear simultaneously, and neither of them is specific. Not infrequently, one characteristic symptom of erythema is a rash with a specific garland-like appearance. At first, the erythema appears on the face, then it goes down to the arms, torso and limbs. The resulting changes form characteristic erythematous rings. Important! The rash does not affect the soles of the feet and hands!
To confirm the presence of infectious erythema, it is necessary to perform serological research. They are designed to detect antibodies that are created by the human body as a defense against infection. Another method is direct determination of genetic material. It is used in patients for whom a final diagnosis cannot be made solely on the basis of serological tests, i.e. patients with ailments disturbing the functioning of the immune system.
It is impossible to cure the causes of infectious erythema, therefore prescribing antiallergic preparations and antibiotics will not bring any effect. Patients who have a normal immune system fight erythema spontaneously. Radical therapy is implemented in people with reduced immunity.
Acute febrile neutrophilic dermatosis
Acute febrile neutrophilic dermatosis is a febrile disease accompanied by the appearance of erythematous-edematous-infiltrative foci. Mainly middle-aged women are sick, five times more often than men. The disease can occur after an infection with bacteria of the genus Yersinia. Only in some cases is the presence of immune complexes found. Erythema appears on the trunk, face, and extensor parts of the limbs.
A symptom of a medical condition there are erythematous-oedematous-infiltrative foci with an intense red color; vesicles, rarely pustular eruptions, may form on their periphery. The general symptoms are: joint and muscle pain, iritis, sometimes an increase in temperature. The changes disappear on their own within a few weeks. The condition may recur. The image shows the predominance of polynuclear leukocytes in infiltrates with signs of leukocytoclasia.
It is seen in people with acute fever accelerated ESR, elevated neutrophil count (up to 70-90%), very high left shift, total leukocyte count may exceed 20 / mm000.
It is necessary to differentiate the disease with the following ailments:
- gassy erythema,
- lymphoma.
Treatment: Topical: corticosteroid creams in early lesions. In general: corticosteroids (prednisone 60 mg / day, with gradual reduction), antipyretics.
LITERATURE:
- Amblowd P., Rachail M., Reymond I.L.: Cutaneous symptoms of carcinoid tumours of the small bowel, Ann Dermatol Venereol 1979, 106 (2), 103-107.
- Eubanks L.E., McBurney E., Reed R.: Erythema gyratum repens, Am J Med Sci 2001, 321 (5), 302-5.
- Gantcheva M.L., Brosthilova V.K., Lalova A.J.: Necrolystic migratory erythema: the outermost marker for glucagonoma syndrome, Arch Dermatol 2007, 143 (9), 122.
- Kim K.J. i wsp.: Clinicopathologic analysis of 66 cases of erytema annulare centrifugum, J Dermatol 2002, 29 (2), 61-67.
- Kurzrock R., Cohen P.R.: Cutaneous paraneoplastic syndromes in solid tumors, Am J Med 1995, 99 (6), 662-671.
- Stone S.P., Buescher L.S.: Life — threatening paraneoplastic cutaneous syndromes, Clin Dermatol 2005, 23 (3), 301-306.
- Uhara H. i wsp.: Neurophilic dermatoses with acute myeloid leukemia associated with an increase of serum colony — stimulating factor, J Am Acad Dermatol 2008, 59 (2 supl), 510-512.
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