Erythema

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Erythema is redness of the skin caused by capillary congestion. It can be caused by infection, massage, electrical treatments, acne medication, allergies, exercise or solar radiation (sunburn), and waxing and plucking of the hairs any of which can cause the capillaries to dilate, resulting in redness. Erythema is a common side effect of radiotherapy treatment due to patient exposure to ionizing radiation.

Causes

It can be caused by infection, massage, electrical treatment, acne medication, allergies, exercise, solar radiation (sunburn), cutaneous radiation syndrome, niacin administration, vitamin A toxicity, or waxing and tweezing of the hairs—any of which can cause the capillaries to dilate, resulting in redness. Erythema is a common side effect of radiotherapy treatment due to patient exposure to ionizing radiation. Circumoral erythema has been described as a typical sign of acute oleander poisoning by ingestion.

Common Causes

Causes by Organ System

Cardiovascular Kawasaki disease, Lomotil, Necrotising microvasculitis, Phlebitis
Chemical/Poisoning 1-Amino-2-propanol, 1-Pentanethiol, 1,2-Dibromoethane, 2-Amino-2-methylpropanol, 2,4,6-Trinitrotoluene, 3-Aminopyridine, 4-Aminopyridine, Abalone poisoning, Acetic acid, Acrolein, Acute pesticide poisoning, Adverse reaction to chemical, Alclometasone, Alcohol flush reaction, Alcohol tolerance, Alcoholism, Allyl Glycidyl Ether, Allylamines, Aluminum Phosphide, Aminopterin, Ammonium bituminosulfonate, Ammonium nitrate ingestion, Ammonium Nitrate, Ammonium Sulfamate, Amylcinnamic alcohol, Anisole, Anisyl alcohol, Asparagus Fern poisoning, Australian Umbrella Tree poisoning, Benaldehyde, Benomyl, Benyl alcohol, Benyl salicylate, Benzanthrone, Biphenyl, Bleeding heart (plant) poisoning, Boxwood poisoning, Bromates, Bromides, Butyl Alcohol, Candelabra cactus poisoning, Caper spruge poisoning, Carbon Tetrachloride, Caterpillar complication poisoning, Celgene, Chemical allergy, Chemical burn, Chemical poisoning, Chlordecone, Chlormezanone, Chloromethane, Churee poisoning, Cinnamic alcohol, Cinnamic aldehyde, Clematis poisoning, Clobetasol propionate, Crown of Thorns poisoning, Cyclohexanol, Cyclohexanone, Cypress spurge poisoning, Devil's trumpet poisoning, Eflornithine, Elephant's-ear poisoning, Epidemic dropsy, Ethotoin, Eucalyptus poisoning, Eugenol, Euphorbium poisoning, False cactus poisoning, Fishtail palm poisoning, Flax poisoning, Flowering spurge poisoning, Garden chrysanthemum poisoning, Geraniol, Geranium poisoning, Ginger lily poisoning, Gold salts, Heliotrope poisoning, High Melting Explosive, Hops poisoning, Houseleek poisoning, Hydroid poisoning, Hydroxycitronellal,Hydroquinone, Hydroxocobalamin, Isoeugenol, Japanese Boxwood poisoning, Jimsonweed poisoning, Leatherwood poisoning, Lewisite, Lidocaine (cream), Maidenhair tree poisoning, Maprotiline, Merbromin, Mercury poisoning, Methamidophos, Methyl Isocyanate, Methyl Tert-Butyl Ether, Methylene Chloride, Milkbush poisoning, Morpholine, Musk ambrette, N-Butyl Chloride, N-Methyl-2-Pyrrolidone, Nitric Acid, Nitroethane, Nitrofen, Nitrogen Dioxide, Nitromethane, Oak moss absolute, Orf, Oyster plant poisoning, Paraphenylenediamine, Pazopanib, Pentaborane, Pentachlorophenol, Peplomycin, Pepper Spray, Perazine, Peruvian lily poisoning, Phenolphthalein, Phenylbutazone, Phthalthrin, Piggyback plant poisoning, Pineapple sap poisoning, Plant poisoning (Datura stramonium), Plant poisoning (Datura suaveolans), Plant poisoning (Euphorbiaceae), Plumbago poisoning, Poinsettia poisoning, Potassium iodide, Primidone, Primrose poisoning, Pyrethrin, Pyridine, Saddleback caterpillar poisoning, Sandalwood oil, Sassafras Oil (herbal agent) , Sea onion poisoning, Sea wasp poisoning (Chironex fleckeri), Sea wasp poisoning (Chiropsalmus quadrigatus), Sea wasp poisoning, Selenium Dioxide, Senecio poisoning, Snake plant poisoning, Streptozocin, Tavaborole
Dental No underlying causes
Dermatologic Acne rosasea, Acne, Acrodermatitis chronica atrophicans, Angioedema, Aphthous ulcer, Bazin disease, Bedsores, Brazilian pemphigus foliaceus, Bronchial adenomata syndrome, Bullous palmoplantar erythrodysesthesia, Bullous Pemphigoid, Chloasma, Chrome contact allergy, Contact dermatitis, Dandruff, Dermatitis ab igne, Dermatitis, Dermatosis, Diaper rash, Duhring-Brocq disease, Ecthyma gangrenosum, Eczema, Eicosanoid, Enfuvirtide, Erysipelas, Erythema ab igne, Erythema annulare centrifugum, Erythema annulare, Erythema chronicum migrans, Erythema craquele, Erythema elevatum diutinum, Erythema induratum, Erythema infectiosum, Erythema marginatum, Erythema migrans, Erythema multiforme, Erythema neonatorum, Erythema nodosum, Erythema toxicum, Erythrokeratodermia variabilis et progressiva, Erythrokeratodermia variabilis, Erythromelalgia, Erythropoietic protoporphyria, Exfoliative erythroderma syndrome, Flushing, Granulosis rubra nasi, Harlequin-type ichthyosis, Histrelin, Ichthyosis, Impetigo herpetiformis, Impetigo, Incontinentia pigmenti, Intertrigo, Lamellar ichthyosis, Majocchi disease, Melasma, Millian erythema, Mucositis, Palmar erythema, Papular mucinosis, Peeling skin syndrome, Phytophotodermatitis, Pityriasis rubra pilaris, Pityriasis rubra, Prosector's wart, Rhinophyma, Rosacea, Roseola infantum, Rowell syndrome, Seborrheic dermatitis, Seborrheic keratosis
Drug Side Effect Acetazolamide, Acetylcysteine, Acyclovir, Allopurinol, Amifostine, Antibiotics, Anticonvulsants, Antihypertensive drug allergy, Aspirin, Axitinib, Barbiturates, Barium nitrate, Benoxaprofen, Benzodiazepines, Beta-lactam antibiotic, Betamethasone dipropionate, Betamethasone valerate, Bezafibrate, Bleomycin, Brentuximab vedotin, Cabozantinib, Calcium hypochlorite, Capecitabine, Carbamazepine, Cetrorelix, Chlorambucil, Chloroquine, Chlorpromazine, Chlorpropamide, Clindamycin, Clofazimine, Clofibrate, Cold panniculitis of Haxthausen, Coumarin, Cytosine arabinoside, caspofungin acetate, capsaicin, Dabrafenib, D-Aminolevulinic acid,

Dapsone, Degarelix, Desmopressin, Dexamethasone, Diclofenac, Diltiazem, Diphenhydramine, Docetaxel, Doxorubicin, Drug Allergies, Erlotinib, Etravirine, Everolimus, Floxuridine, Flucytosine, Fluorouracil, Fosamprenavir, Gallium Citrate Ga 67, Herbal Agent, Hydraine, Hydralazine, Hydroxycarbamide, Hydrocortisone butyrate, Hyoscine, Ibritumomab tiuxetan, Ibuprofen, Idarubicin, Imiquimod, Ipilimumab, Isoniazid, Ixabepilone, Ketoprofen, Lamotrigine, Lapatinib ditosylate, Leflunomide, Luliconazole, Maté (herbal agent) adverse reaction, Meprobamate, Methscopolamine, Methyl Bromide, Methyldopa, Methyldopate, Methylphenidate, Metronidazole, Modafinil, Muromonab-CD3, Netupitant and palonosetron, Nevirapine, Oral contraceptives,Oxytetracycline, Paracetamol, Penicillamine, Penicillin, Peppermint Oil (herbal agent) , Phenobarbital, Phenytoin, Pipothiazine, Pomalidomide, Procainamide, permethrin, Procarbazine, prednisolone, Retinol, Quinine, Regorafenib, Sertaconazole, Sinecatechins, Sezary syndrome, Spinosad, Tazarotene, Tretinoin, Tolbutamide

Ear Nose Throat No underlying causes
Endocrine Glucagonoma Syndrome, Glucagonoma, Hyperoestrogenic states, Hyperthyroidism, Hypothyroidism
Environmental Chilblains, Environmental factors, Heat rash, Heatstroke, Photosensitivity, Radiation burn
Gastroenterologic Alcoholic Hepatitis, Cirrhosis, Colitis, Hepatic failure, Hepatitis B, Hepatitis C, Liver cirrhosis, Obstructive biliary disease, Palmar erythema
Genetic Bloom syndrome, C1 esterase inhibitor deficiency, CHILD syndrome, Chondrodystrophia calcificans congenita, Chondrodystrophia punctata, Chromosome 9q deletion syndrome, Chronic recurrent multifocal osteomyelitis, Complement 5 deficiency, Conradi-Hunermann Syndrome, Davis syndrome, Familial cold urticaria, Giroux-Barbeau syndrome, Gitelman syndrome, Gottron syndrome, Hereditary C2 deficiency, Hereditary C4 deficiency, Hyper-IgE syndrome, Immunodeficiency with short limb dwarfism, Majeed syndrome, Microphthalmia-dermal aplasia-sclerocornea syndrome, Nephroblastomatosis, fetal ascites, macrosomia and Wilms tumor, Nephroblastomatosis, Nonbullous congenital ichthyosiform erythroderma, Omenn syndrome, Oudsthoorn disease, Recurrent hereditary polyserositis, Roberts syndrome, Sjogren-Larsson syndrome
Hematologic No underlying causes
Iatrogenic Bacillus Calmette–Guérin vaccine, Radiotherapy
Infectious Disease Arcanobacterium haemolyticum, Athlete's foot, Atypical measles syndrome, Bannwarrth syndrome, Blastomyces dermatitidis, Blastomycosis, Borrelia burgdorferi, Boutonneuse fever, Candida paronychia, Candidiasis, Cat scratch disease, Cellulitis, Chancroid, Chickenpox, Chikungunya, Chlamydia infection, Chlamydia psittaci, Chlamydia trachomatis, Coccidioides immitis, Coccidioidomycosis, Coxsackie, Cutaneous larva migrans, Cutaneous leishmaniasis, Dengue, Dermatophytids, Disseminated gonococcal infection, Edwardsiella tarda infection, Ehrlichiosis, Epstein Barr virus, Erythrovirus, Escherichia coli O157:H7, Fifth disease, Gnathostomiasis, Granuloma inguinale, Hand foot syndrome, Haverhill fever, Herpes simplex, Hibernian fever, Histoplasmosis, Human immunodeficiency virus, Infection, Infectious mononucleosis, Latent tuberculosis, Leishmaniasis, Lenalidomide, Leprosy, Leptospirosis, Levomepromazine, Loiasis, Lyme disease, Lymphogranuloma venereum, Measles, Mycobacterium leprae, Mycobacterium marinum, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Mycoplasma, Neisseria meningitidis, Onchocerciasis, Orthopoxvirus, Parvovirus B19, Perinatal infection, Protothecosis, Psittacosis, Rat-bite fever, Relapsing fever, Rheumatic fever, Rickettsia conorii, Rickettsia orientalis, Rickettsia prowazekii, Rickettsia tsutsugamushi, Rickettsia typhi, Rickettsialpox, Rocky Mountain spotted fever, Rubella, Rubeola, Salmonella typhi, Sarcoptes scabiei, Scabies, Scarlet fever, Shingles
Musculoskeletal/Orthopedic Myositis, Necrotising fascitis
Neurologic Autonomic dysreflexia, Burning Feet Syndrome, Glioblastoma multiforme, Morton's neuroma, Peripheral neuropathy
Nutritional/Metabolic Pellagra
Obstetric/Gynecologic Pruritic Urticarial Papules and Plaques of Pregnancy
Oncologic Cutaneous T-cell lymphoma, Hypertrophic pulmonary osteoarthropthy, Lymphomatoid granulomatosis, Non-Hodgkin lymphoma, Paraneoplastic syndrome, Sezary syndrome
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Gitelman syndrome
Rheumatology/Immunology/Allergy Allergic contact dermatitis, Allergies, Autoimmune disorders, Behcet's Disease, Blau syndrome, Chronic necrotizing vasculitis, Crohn disease, Dermatomyositis, Discoid lupus erythematosus, Ethylenediamine dihydrochloride mix allergy, Graft versus host disease, Hypersensitivity, IgE mediated gastrointestinal food allergy, Inflammatory bowel disease, Insect allergy, Interleukin-2, Isothiazolinone allergy, Lupus erythematosus, Mercaptobenzothiazole allergy, Mixed Connective Tissue Disorder, Morphine allergy, Neonatal lupus syndrome, Non-Food Allergy, Novacaine drug allergy, P-Phenylenediamine allergy, Penicillin allergy, Polychondritis, Psoriasis, Pyoderma gangrenosum, Reiter's syndrome, Rheumatoid arthritis, Scleredema adultorum, Scleroderma, Senear-Usher syndrome, Skin allergy
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Brachioradial pruritus, Burns, Cyanea sting, Excess friction and sweating, Injury, Insect bite, Mosquito, Necrolytic migratory erythema, Palmar plantar erythrodysesthesia, Panniculitis, Reflex sympathetic osteodystrophy, Sarcoidosis

Causes in Alphabetical Order


Associated conditions

In about 30-50% of cases, the cause of Erythema is unknown.

Differentiating Erythema from Other Diseases

Different rash-like conditions can be confused with erythema and are thus included in its differential diagnosis. The various conditions that should be differentiated from erythema include:[1][2][3][4][5][6][7]

Disease Features
Impetigo 
  • It commonly presents with pimple-like lesions surrounded by erythematous skin. Lesions are pustules, filled with pus, which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of trauma to the skin.
Insect bites
  • The insect injects formic acid, which can cause an immediate skin reaction often resulting in a rash and swelling in the injured area, often with formation of vesicles.
Kawasaki disease
Measles
Monkeypox
  • The presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash, often first on the face. The lesions usually develop through several stages before crusting and falling off.
Rubella
Atypical measles
Coxsackievirus
  • The most commonly caused disease is the Coxsackie A disease, presenting as hand, foot and mouth disease. It may be asymptomatic or cause mild symptoms, or it may produce fever and painful blisters in the mouth (herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
Acne
Syphilis It commonly presents with gneralized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic It is classically described as:
Molluscum contagiosum
  • The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections.
Mononucleosis
Toxic erythema
  • It is a common rash in infants, with clustered and vesicular appearance.
Rat-bite fever
  • It commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques.
Parvovirus B19
  • The rash of fifth disease is typically described as "slapped cheeks," with erythema across the cheeks and sparing the nasolabial folds, forehead, and mouth.
Cytomegalovirus
Scarlet fever
Rocky Mountain spotted fever
Stevens-Johnson syndrome
  • The symptoms may include fever, sore throat and fatigue. Commonly presents ulcers and other lesions in the mucous membranes, almost always in the mouth and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. Conjunctivitis of the eyes occurs in about 30% of children. A rash of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
Varicella-zoster virus
  • It commonly starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
Chickenpox
  • It commonly starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a chickenpox blister can also spread the disease.
Meningococcemia
Rickettsial pox
Meningitis

See also

Pathological Findings


Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

External links


  1. Hartman-Adams H, Banvard C, Juckett G (2014). "Impetigo: diagnosis and treatment". Am Fam Physician. 90 (4): 229–35. PMID 25250996.
  2. Mehta N, Chen KK, Kroumpouzos G (2016). "Skin disease in pregnancy: The approach of the obstetric medicine physician". Clin Dermatol. 34 (3): 320–6. doi:10.1016/j.clindermatol.2016.02.003. PMID 27265069.
  3. Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
  4. Ibrahim F, Khan T, Pujalte GG (2015). "Bacterial Skin Infections". Prim Care. 42 (4): 485–99. doi:10.1016/j.pop.2015.08.001. PMID 26612370.
  5. Ramoni S, Boneschi V, Cusini M (2016). "Syphilis as "the great imitator": a case of impetiginoid syphiloderm". Int J Dermatol. 55 (3): e162–3. doi:10.1111/ijd.13072. PMID 26566601.
  6. Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y (2015). "Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan". Med Mycol J. 56 (1): E1–5. doi:10.3314/mmj.56.E1. PMID 25855021.
  7. CEDEF (2012). "[Item 87--Mucocutaneous bacterial infections]". Ann Dermatol Venereol. 139 (11 Suppl): A32–9. doi:10.1016/j.annder.2012.01.002. PMID 23176858.

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