Erythema Marginatum
What is Erythema Marginatum?
Erythema marginatum is a rare skin condition characterized by the onset of distinctive rash which is being associated with rheumatic fever. Erythema marginatum is marked by the presence of pink rings in the torso or upper portion of the body and the inside surface of the extremities and usually spares the face and the outward portion of the extremities. Erythema marginatum is also marked by a distinct rash that appears and disappears over the course of several months.
Erythema marginatum is more common among children than in adults, but may affect people from all age levels. It affects both the male and female gender, although there is a slight prevalence among the male gender. The color of the rash is usually pinkish to reddish, which is more obvious among fair skinned individuals, but rather difficult to spot among dark skinned individuals. The rash also neither itches nor creates a burning sensation. A few numbers of cases of rheumatic disease are being associated with the onset of erythema marginatum.
Erythema marginatum is more of a symptom signifying an underlying condition and it is not considered a disease or a disorder. It is a rare skin condition that seldom causes discomfort and is neither a life-threatening condition. It is believed to be triggered by several factors including an infection and allergic reaction.
Erythema Marginatum Symptoms
Erythema marginatum is marked by the development of macular rings that has a pale core or more like the appearance of a doughnut. The macula has irregular borders which are due to the gradual development of the macula. The rash or the lesion itself is rather elevated while the center of the ring is rather flat and small and is usually clear. The color of the ring is pinkish to reddish while the core of the ring is pale or clear.
The rash of erythema marginatum generally occurs in the torso and the inner surface of the extremities. It usually spares the face and the outside portion of the extremities. The size of the rings varies ranging from 0.5 cm to 8 cm in diameter. Overtime, these rings will increase in size and eventually spread and which will later assume an irregular shape or may have a displaced margin. The rash initially develops in the lower portion of the trunk then gradually disappears as it moves upward towards the upper portion of the trunk where it will become more visible.
Erythema marginatum causes no discomfort and often does not cause itchiness and burning sensation. The rash is however getting worse when aggravated by heat, such as in hot showers or extreme heat in temperature and in hot climates. The aggravated rash assumes a reddish discoloration which usually lightens up as soon as room temperature is achieved.
Erythema marginatum is also divided into two types which are based on the characteristics of the rash and the location of their onset.
Erythema marginatum rheumaticum
Erythema marginatum rheumaticum occurs in the superficial layer and is often asymptomatic. This type of erythema marginatum is being associated with rheumatic fever. The rash is usually seen all over the skin of the trunk and the inner surface of the limbs. The exact cause of erythema marginatum rheumaticum is unknown and is also deemed a type of gyrate erythema.
Erythema marginatum perstans
Erythema marginatum perstans is presented with lesion distributed on the entire surface of the skin of the arms and the legs. It can also extend to the other areas of the body with the palms of the hands and soles of the feet spared from the rash distribution. The deep layer of the skin may also get affected by the rash. The incidence of erythema marginatum perstans is being linked to an existing underlying condition which triggered the eruption of the rashes.
Erythema Marginatum Causes
The onset of erythema marginatum is implicated on the inflammation of the blood vessels as triggered by the lymphocytes histiocytes. The mechanism in the alteration of the epidermal layer of the skin resulting to erythema marginatum is not clearly understood. The exact cause of erythema marginatum therefore remains vague.
Rheumatic fever
This is the most associated disease to the onset of erythema marginatum and basically involving Group A streptococcus that causes the complication of rheumatic fever.
Although erythema marginatum has no identified cause, several factors are being considered that triggered the onset and such factors include the following:
Rheumatic fever is the most associated with the incidence of erythema marginatum. The disease is a bacterial infection particularly of Group A streptococcus. The onset of erythema marginatum is deemed a complication of rheumatic fever and is also considered as among the clinical presentation of the disease. Most cases of erythema marginatum are found to be associated with rheumatic fever.
Allergies
Allergy is another consideration in erythema marginatum where the allergic reaction from various stimuli is believed to trigger the inflammation of the blood vessels that later causes the rashes in erythema marginatum.
Lyme disease
This is a disease caused by an infection with Borrelia burgdorferi. The harmful pathogen is transmitted to humans through bites from infected ticks. Erythema marginatum is present as part of the symptoms of Lyme disease.
Infections
Infection from various causative agents can result to eruptions of rashes which may include erythema marginatum. Candida albicans and Escherichia coli are among the infectious agents that can trigger erythema marginatum.
Adverse reaction
Adverse reaction from certain medications can trigger the eruption of rashes including erythema marginatum.
Malignancy
Malignancy such as breast cancer, leukemia and other life-threatening diseases are believed to activate erythema marginatum where in some cases it is part of the symptoms.
Erythema Marginatum Pictures
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Erythema Marginatum Treatment
Erythema marginatum is deemed a symptom rather than a disease or disorder. The incidence is believed as part of the symptoms of an underlying condition. The treatment therefore, is not directed towards erythema marginatum but rather in the underlying condition that influenced the eruption of rashes in erythema marginatum.
Erythema marginatum usually resolve without treatment although the rash may appear or disappear for several months to several years. Erythema marginatum involved in rheumatic fever is basically addressed with antibiotic treatment which is intended for rheumatic fever and not directly to erythema marginatum.