Erythema is redness or inflammation of the skin which occurs in the fatty layer of the skin. It is a common form of the inflammatory disease called panniculitis, which is rare. It can be caused due to sunburn, allergic reaction to drugs etc. Reddish, painful lumps or nodules are formed in the affected area which ranges in size from 1 to 5 centimetres. Erythema nodosum most commonly occur in the front part of the legs and disappear on their own in a span of three to six weeks. However, it leaves behind a bruised appearance on the affected area.
Many people develop erythema without any symptom and warning. There are very slight symptoms of Erythema which include barely raised, tender and reddish nodules, which commonly occur below the knee. Sometimes ankles, knees, thighs and forearms may be affected. The nodules are red and painful and sometimes feel hot. They appear and heal on their own over a period of time. A patient may see anywhere between 2 to 50 of the nodules/ bumps. However, they may reappear after a certain period of time and again disappear. In case of chronic erythema, the nodules may last for years. Chronic erythema with intermittent recurrences is believed to occur in the presence or absence of an underlying disease. Other symptoms of Erythema include:
- Lung infection
- Muscle pain and weakness
- Joint pain
- Pain in the legs
- Ankle swelling
- Enlarged lymph nodes in the chest
- Sore throat
- Weight loss
- Stomach pain
Symptoms of Erythema may vary from one individual to another. However, most EN sores are very painful, hot to touch bright red in appearance for a week and then purple or blue, shiny in appearance, non-ulcerating; do not cause breaks or tears on the surface of the skin.
In more than half cases of erythema that arise have no specific causes. Erythema is said to occur with or without any medical history or condition. Other causes include
- Strep throat- It is a contagious disease, caused by a streptococcal infection which causes inflammation of the throat and tonsils. Other symptoms include painful swallowing, fever, headache, rash, body aches, nausea or vomiting. The Streptococcal bacteria are said to be highly contagious. It spreads through airborne droplets when the infected person sneezes or coughs and if food and drinks are shared by such infected persons.
- Cat scratch disease- it is a common and benign infectious disease caused by Bartonella henselae bacteria, which is caused by biting/scratch from a cat. They appear as tender swollen lymph nodes near the affected area or on the neck and is mostly limited to one side. The symptoms occur after a period of 1-3 weeks.
- Allergic reaction to drugs such as antibiotics like sulfonamides and forms of penicillin, salicylates, iodides, bromides and birth control pills.
- Sarcoidosis- It refers to the growth of a small collection of inflammatory cells in various parts of the body like-lungs, eyes, lymph nodes and skin. Medicine experts believe it is a result of the reaction of the body’s immune system to an unknown substance like something inhaled from the air. There are no specific treatments for this disease. Sarcoidosis goes away on its own with modest treatment and care.
- Coccidioidomycosis- This disease is caused by a fungus called Coccidioides immitis. It is also known as a desert fever, valley fever and Posadas’s disease. Out of the total, 40 % of the infected patients develop symptoms. They are influenza-like illness along with fever, cough, rash, and headache with muscle pain. Some patients may have severe lung disease and some may develop a disseminated infection. Two species of Coccidioidomycosis fungi cause valley fever. These fungi are commonly found in soils of specific regions. Mild cases of this disease recover on its own. In case of severity, doctors prescribe antifungal medications to treat the disease.
- Infectious mononucleosis- This is also referred as “mono”, “kissing disease” and “glandular fever”. It refers to a group of symptoms caused by Epstein - Barr virus. The symptoms of this disease include fever, fatigue, malaise and sore throat. Mononucleosis means an increase in the number of mononuclear white blood cells in the blood. Only 10% of children with the disease develop the illness. Most cases of this disease occur in the age group of 15-24.
- Behcet’s disease- It is a type of inflammatory disease which is said to affect multiple parts of the body. Most common symptoms include mouth ulcers, genital sores, inflammation of parts of the eye etc. The inflammation is said to last a few days. Although the cause of this disease is unknown, it is believed to be genetic and non-contagious.
- Fungal diseases- Fungi are found everywhere and there are millions of its species on the earth. However, only 300 of them are said to cause illness in people. Fungal disease/infections are caused by the fungi that are in the environment both indoors and outdoors and on human skin. Some of the types of fungal infections are Aspergillosis, Blastomycosis, Candidiasis, Fungal eye infection, Fungal Nail infection, Mycetoma, Ringworm etc.
- Inflammatory bowel disease- Inflammatory Bowel disease includes Ulcerative colitis and Crohn’s disease. These diseases are said to be caused by a combination of genetic, non-genetic and environmental factors which interact with the body’s immune system. Complications occur when the intestinal inflammation is severe, extend beyond the inner lining of the intestine.
- Cancer (rarely)
- Viral infections
Erythema is said to affect people in the age group of 20-40 years. Some studies indicate that women are six times more prone to develop it than men. However, in general, both the sexes and people of any age can develop it.
One theory says that Erythema may develop as a result of the buildup of immune complexes in blood vessels and connections in the subcutaneous fat. This leads to inflammation.
1.2% of people develop a type of Erythema Nodule called erythema nodosum leprosum or type 2 lepra reaction.
The diagnosis of erythema is very straightforward and simple. The doctor can just physically examine the patient and note the typical firm area of tenderness which is red and shows bruise-like appearance. It does not require any other test or special investigation as such. Some tests may be conducted in certain circumstances like:
- A biopsy of the deeper layer of the skin tissue helps to prove if it is erythema or not
- Throat culture to see if there are chances of strep infection
- Chest x-ray is done to rule out the occurrence of tuberculosis and sarcoidosis
- General/ basic Blood test is conducted to prove any underlying infection or disease.
The first step in treating erythema is to identify and treat any underlying condition, along with the skin lesions. Erythema treatment includes anti-inflammatory drugs, cortisone (orally or injection). Doctors may make use of Colchicine for reducing the inflammation effectively. Taking appropriate rest resolves most of the cases within one or two months. Erythema treatment is customized as per the symptom and the patient. Some other treatments include
- Hot or cold compressions to reduce discomfort
- Keeping the sore area elevated. For instance, if the leg is affected then it may be raised using a pillow or such other support.
- Pain Medicines
- Taking appropriate rest
- Potassium Iodide is often added to juices etc. and given as drops
- Other oral medicines that the doctor may deem fit for the body’s immune system
- Wear compression stockings or supportive bandages and wraps while the bumps heal
- Wearing tight clothes will only itch and irritate the bumps more. So opt for comfortable and loose clothing.
- Over the counter pain and anti-inflammatory medicines
- Changing the medicine which is sometimes the cause of erythema
- Steroid Creams
An important thing to remember is that erythema though painful does not affect or endanger the internal organ and the long-term health of the patient. Seek immediate medical care for a few serious symptoms like high fever (101 degrees and more), chest pain, shortness of breath, difficulty breathing, pain with breathing, choking or coughing up blood. Also if you notice swollen glands or lymph nodes in your neck under the chin, in the armpits or in the groin then it is best to seek medical advice at the earliest.
What is Erythema during pregnancy? Due to the increased levels of estrogens, about 5% of the women develop erythema. The same line of treatment is used for normal women. However, some medicines like NSAIDs which are normally prescribed by doctors for most patients may not be used for pregnant women. In such cases, the obstetrician would be the best to advise appropriately.
Once you find out the cause of the disease it is easier to prevent it. If there are underlying medical conditions which have given rise to erythema then one should take proper treatments for those conditions. In case of allergic actions to certain medication, one should carefully observe the body’s reaction to such medicines and inform the doctor about your problem. This would help him to prescribe some other medicine or reduce the dosage of medicines causing allergy. Maintaining good hygiene and taking care of one’s nutrition helps to maintain the body’s immune system and hence prevent occurrences of secondary infections. It is rightly said that prevention is better than cure!
As it is important to diagnose a disease, it is equally important to get the facts right. There are various myths surrounding the medical world and Erythema is no exception. The most common misconception about this disease is that “if erythema occurs then there is an infection”. However, the fact is: erythema is a skin condition which leads to the formation of lumps/nodules on the body and there is swelling as well. Because both of these conditions also appear in case of infections, the myth (erythema being an infection) has taken birth. The myth is busted by the Wound Care Education Institute which explains that the following conditions should be met in case of an infection: drainage, foul odour, extreme pain, heat emanating from the wound and an edema. All these conditions are not found in the case of erythema and hence, it is not an infection.
Most of the patients with erythema make a complete recovery within a few weeks’ time. The skin that was previously affected heals normally without any scarring. However, there are chances that the condition could come back at some point. Complications arising due to erythema include:
- Severe eye complication (20%) like purulent conjunctivitis, anterior uveitis, scarring of the conjunctivae and may result in permanent blindness.
- Patchy appearance of the skin or Inflammation might occur.
- It might result in acute respiratory distress and might even lead to pneumonia
- Due to erythema, a person might get dehydrated.
- Other complications such as Gastrointestinal inconvenience, haemorrhage, and renal failure too might result in case of erythema
- You also need to be careful of any scars and strictures of the oesophagal that might occur in the urethral, vaginal, and anal mucosa. This condition though might occur rarely, however, cannot be overruled.
As you see, it’s best to get a proper vaccination for erythema to get protection against the virus and safeguard yourself and your family. One can ward off the evils of this disease by maintaining good hygiene and taking care of one’s nutrition helps. There is no need to worry about the infection once you are cured as the body’s immune system will prevent occurrences of secondary infections. There is no way you can prevent the occurrence of this disease, however, once the disease is identified you can be sure that you will easily recover within few weeks and lead a normal life without any long-term complications. there are chances that the condition could come back at some point.
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