Erythema marginatum

Erythema marginatum Description: A variant of erythema multiforme seen in rheumatic fever; occasionally has a configuration to suggest the designation erythema migrans (geographic tongue). Erythema marginatum (EM) is the disease in which pink rash is obtain on the trunk and insides of the arms and legs and also go for as long as for few months. But never occur on the face. Erythema marginatum is the symptom of rheumatic fever. Rheumatic fever is the disorder mediated through the immune system and also is a throat infection with strep bacteria. It mostly found in children between five and fifteen years and occurs in fall, winter, and early spring. EM is an evanescent, erythematous rash occur during rheumatic fever. There are two types of Erythema Marginatum: Erythema marginatum rheumaticum.
  1. Erythema marginatum perstans.
It occurs in less than 5% of patients with rheumatic fever, but is considered a major Jones criterion when it does occur. The four other major criteria include carditis, polyarthritis, Sydenham's Chorea, and subcutaneous nodules. It is an early feature of rheumatic fever and may be associated with mild carditis (inflammation of heart muscle). In developed countries, rheumatic fever has become very rare and this rash occurs in no more than 2 to 5% of cases of rheumatic fever. However, rheumatic fever has become as common in New Zealand as in some developing countries, especially amongst the Maori children. Most doctors in general practice in Great Britain will never see a case of rheumatic fever and the likelihood of seeing a case of erythema marginatum is even less. Symptoms:Erythema marginatum There are light pink macules spreading outwards with a serpiginous, well-demarcated edge and clearing central portion. The rash changes from hour to hour and may seem to appear, disappear or move so rapidly that it can almost be seen doing so. It often involves multiple areas, usually on the trunk and occasionally over the proximal parts of the limbs. It is exacerbated by heat and fades when the patient is cool. There are usually other symptoms of acute rheumatic fever but it can recur intermittently over weeks or even months. It may appear with subcutaneous nodules which are firm, painless lumps, mainly on the hands, feet, occiput and back.They are usually 0.5 to 2-cm in diameter and often found in crops of 3, appearing 2 to 3 weeks after the onset of fever. The rash occurs early in the disease and remains long past the resolution of other symptoms. Causes and Risk factors: Viral:
  • Herpes simplex I & II,
  • Adenovirus.
  • Coxsackievirus B5.
  • Echoviruses.
  • Enteroviruses.
  • Epstein-Barr.
  • Hepatitis A.
  • Hepatitis B.
  • Measles.
  • Vaccinia.
  • Varicella.
  • Influenza.
  • Mumps.
  • Poliovirus.
Bacterial:
  • Mycoplasma pneumoniae.
  • Proteus species.
  • Salmonella species.
  • Tuberculosis.
  • Vibrio parahaemolyticus.
  • Psittacosis.
  • Catscratch disease.
  • Brucella species.
  • Tularemia.
  • Gonorrhea.
  • Typhoid fever.
  • Diphtheria.
  • Lymphogranuloma venereum.
  • Cholera.
  • Yersinia enterocolitica.
Fungal:
  • Histoplasmosis.
  • Coccidioides species.
Drugs:
  • Sulfonamides, including hypoglycemics.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Anticonvulsants.
  • Barbiturates.
  • Antituberculous drugs.
  • Antibiotics.
  • Pyrazolones.
  • Phenylbutazone, oxyphenbutazone, and phenazone.
  • Salicylates.
Diagnosis: Diagnosis of Erythema marginatum is based on the assumption that other likely diagnoses have been excluded.Many of the clinical features of Erythema marginatum are non-specific, so wide range of differential diagnoses should be considered.The patient who is suspected Erythema marginatum should undergo echocardiography to confirm or refute the diagnosis of rheumatic carditis. Because this disease has different forms, there is no specific test that can firmly diagnose it. Your doctor will perform a careful exam, which includes checking your heart sounds, skin, and joints. Your doctor may also do an electrocardiogram while testing your heart. You may have blood samples taken to test for recurrent strep infection (such as ASO test), complete blood counts, and sedimentation rate (ESR). Treatment: Penicillin injection is the first step of treatment of Erythema marginatum and it must be regular. Also there is use of an anti-inflammatory agents like ibuprofen. Some medications like diazepam and haloperidol are also used for Erythema marginatum treatment. Medicine and medications: Penicillin.
  • Erythromycin.
  • Amoxicillin.
  • Clindamycin.
  • Ampicillin.
Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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