Erythema: Types, Symptoms, Causes, Diagnosis, Treatment, Prevention and Prognosis


Erythema is a skin condition causing skin redness or rash

September 21, 2018

Erythema is a skin condition causing skin redness or rash. UV-induced erythema, erythema nodusum, photosensitivity, and erythema multiforme are different types of erythema.

Types of Erythema:

UV-induced erythema:

This is the most common type of erythema which is caused by sunburn. Sunburn can be developed from ultraviolet radiation of sunlight resulting in irritation, redness and inflammation of the skin. It occurs when an individual is exposed to sunlight often.

Erythema nodusum :

This is inflammation of the skin that tends to center around the fatty layers of the skin. EN results in reddish, painful, tender lumps most commonly located in the front of the legs. The tender lumps, or nodules, of erythema nodosum range in size from 1 to 5 centimeters. The nodular swelling is caused by inflammation in the fatty layer of skin. Usually it gets resolved by its own in 3 to 6 weeks. It may leave only a temporary bruised appearance or leave a chronic indentation in the skin where the fatty layer was injured after resolution.

Photosensitivity from medication:

This condition occurs when an individual is taking medication or has some type of infection that creates sensitivity to the sun and UV rays and results in redness or rash.

Erythema multiforme:

It is caused by various medications, illness, or infection and is characterized by lesions or raised red spots on the skin.

Other types of erythema:

Some of the less common types of erythema include Erythema chronicum migrans, Erythema infectiosum , Erythema toxicum, Erythema ab igne, Erythema induratum, Erythema elevatum diutinum, Palmar erythema, Erythema gyratum repens, and Keratolytic winter erythema.

Symptoms of Erythema:

The signs and symptoms vary for the different types of erythema.

UV-Induced Erythema:

  • Red, stinging skin that is hot to the touch
  • Inflammation
  • Pain
  • Irritation

Erythema Nodosum:

  • Pain in the joints
  • Arthritis pain
  • Flu-like symptoms before the onset of the lesions, general fatigue
  • Painful, reddish lesions that soften to a bluish color and then finally fade to brown and yellow
  • Nodule clusters and lesions on various parts of the body such as the trunk, forearms, shins, and thighs

Erythema Multiforme:

  • Outbreak of bumps, lesions and red spots on palms, feet, hands, knees and elbows. All of these usually appears suddenly
  • An individual may experience itching, fever, and fatigue before lesions appear
  • Lesions that break out resemble targets which means spots surrounded by rings of red

The most acute forms of erythema multiforme are Stevens-Johnsons Syndrome (SJS)and toxic epidermal necrolysis(TEN). Symptoms of SJS include target lesions on the lower half of the body with fever, cough, and blisters that appear around the nostrils, mouth, eyes, and groin area. Symptoms of TEN are the same as SJS. In addition it  will continue into skin peeling and detachment, infection, loss of fluids which could be fatal sometime.

Risk factor:

  • Individual of any age who spends a lot of time in the sun is at risk of developing erythema, especially UV-induced erythema.
  • People between the ages of 20 and 30 are at a higher risk of developing erythema nodosum.
  • Men tend to develop erythema multiforme more frequently than women
  • Women are at a higher risk of developing erythema nodosum than men.
  • A family history of the disease is associated with all forms of erythema.

Causes of Erythema:

When the surface capillaries of the skin dilate due to any reason, that can result in some type of erythema. Erythema may occur as an isolated condition or in association with other conditions. However many of the cases of erythema nodosum and erythema multiforme are unknown.
Causes and conditions that are associated with erythema include:

  • Sunburn from solar radiation particularly UV radiation
  • Allergies
  • Pregnancy
  • inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease
  • Exercise
  • Massage
  • Ulcerative colitis
  • Infection including mononucleosis and herpes simplex virus
  • Mercury toxicity
  • Niacin administration
  • Hair tweezing and waxing
  • Acne medication as well as anti-seizure medications, penicillin and sulfa drugs, and NSAID's (nonsteroidal anti-inflammatory drugs), birth control pills, and estrogens
  • Behcet's disease
  • Electrical treatments
  • Cutaneous radiation syndrome
  • Cat scratch disease
  • Fungal diseases
  • Strep throat
  • Sarcoidosis

Diagnosis of Erythema:

A physical examination of the rash by your doctor is enough to diagnose erythema most of the time. As erythema disappears with finger pressure, it is easy to distinguish this skin condition from other types of pigmentation issues or bleeding inside the skin. The nodules or red patches are usually firm and raised, and depending on the age of the lesions they may have a bruise-like appearance. It does not typically require other investigative tests.
However, a throat culture, blood test, skin biopsy, or x-ray can also be done to find out the underlying cause. These tests will reveal medications or infections that may be contributing to or causing your symptoms.
If diagnosis can not be done based on its appearance, a biopsy is usually required to confirm a diagnosis of erythema. This is a procedure in which a small section of affected skin is taken to examine more thoroughly under a microscope. The nodules of erythema nodosum are sometimes confused with insect bites. When the inflammation of erythema nodosum is more widespread that can mimic skin infection or cellulitis.

Treatment of Erythema:

Mild cases of erythema may not require any treatment at all. Herbal supplements including aloe vera, lemon balm, flavonoids, sage extract, calendula, goldenseal, yarrow, and others may provide some help in getting relief from the symptoms.
Nutritional supplements, antioxidants, and vitamins and minerals such as Vitamins B6, C, D, E, lycopene, beta-carotenes, selenium, zinc, and others can also help manage the symptoms in some cases.
Preventative therapy such as boosting your immune system by eating healthy food, getting plenty of sleep, and exercising may also help. Preventing infections, and reducing general inflammation within the body can also be one of the treatment in many cases.
If all of these does not work then drug therapies such as antibiotics, antihistamines, Burrow's compresses, antiviral medications, NSAIDs, photomodulation therapy, and intravenous immunoglobulin (for SJS and TEN) can be tried. For severe cases, prescription drugs along with bed rest is recommended. Any suspected medications that are causing or contributing to your erythema should be discontinued, but only after the consultaion of doctor.
Several treatment options can be taken in to consideration depending on the type of erythema. These include:

Treating UV-Induced Erythema:

Over the counter medications such as corticosteroid cream or aloe vera gel that can reduce the inflammation and cool your skin can be used. Moisturizers, ice packs wrapped in a damp cloth and staying hydrated will help treat the burn. Preventing sun damage before it happens is the best thing to do. Taking a daily Sunsafe Rx pill or applying sunscreen lotion before sun exposure can help your body prevent the damaging effects of the UV rays that cause erythema.

Treating Erythema Nodosum:

Erythema nodosum is initially managed by identifying and treating any underlying condition, along with the skin lesions. Treatments for erythema nodosum include anti-inflammatory drugs, and cortisone or corticosteroids by mouth or injection. Colchicine is sometime used effectively to reduce inflammation. Treatment must be customized for the particular patient and his or her symptoms such as the existence of any associated diseases.
If certain medications are suspected of causing erythema they should probably be discontinued as soon as possible. But talk to your doctor before stopping these medications.

Treating Erythema Multiforme:

Topical steroids, analgesics, oral antihistamines, localized skin care, and various soothing mouthwashes can be used for treating erythema multiforme. Wound care and astringents can be used directly for more severe cases. Again, if it is suspected that a prescription drug is causing the issue, it may need to be discontinued. But this can only be done after consulting the doctor.

Treating Erythema Photosensitivity:

If solar or UV radiation is the cause of your erythema, certain steps must be taken to prevent future cases of erythema. These include:

  • staying out of the sun at least during peak solar radiation hours in the middle of the day
  • wearing a hat and protective clothing covering the sun exposed area
  • using sunscreen lotion
  • taking Sunsafe Rx capsules for increased protection against sun damage.

Prevention of Erythema:

Prevention of Erythema can be achieved by preventing the cause. Preventing sun damage before it happens is the best thing you can do to prevent Erythema Photosensitivity.
  • Taking a daily Sunsafe Rx pill or applying sunscreen lotion before sun exposure can help your body prevent the damaging effects of the UV rays that cause erythema. Erythema Photosensitivity can be prevented by avoiding triggers that cause the disease to develop which include limiting sun exposure. Attempt to avoid the intense rays of sun between 10 a.m. and 2 p.m.
  • Apply sunscreen frequently. Use a sunscreen with sun protection factor (SPF) of at least 15 both before and during sun exposure. Select products that block both UVA and UVB light. Check the label before purchasing the product.
  • Wear long sleeves and a wide-brimmed hat if you are likely to sunburn.
  • Preventative therapy such as boosting your immune system by eating healthy food, getting plenty of sleep, and exercising is recommended for maximizing immune health. Practicing good hygiene habits can preventing possible secondary infections.

Prognosis:

UV-Induced Erythema:

Excessive sun exposure especially during peak hours can damage and ages your skin. Over time it can also increases your risk of developing sunburns and skin cancer. By decreasing your sun exposure and taking active steps to prevent damage while you are in the sun, you can both decrease the appearance of aging to your skin and decrease your risk of future UV radiation related skin complications.

Erythema Multiforme:

It disappear after 4 to 6 weeks of starting the treatment for erythema multiforme.

Erythema Nodosum:

The symptoms of erythema nodosum may recur up to two years after treatment has started.

Stevens Johnsons Syndrome (SJS):

This more severe form of erythema usually disappears within a month after starting the treatment. However, untreated SJS can lead to blindness and even death.

Toxic Epidermal Necrolysis (TEN):

TEN can be fatal if not treated properly. Quickly identifying the medication that is causing the TEN or SJS greatly increases the chance for survival.