Erythema

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Erythema

• By
• Dr. Mohamad Nasr
• Lecturer Of Dermatology Venereology

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Erythema

• Erythema is a skin condition characterized by
  redness or rash.

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Types

1. Photosensitivity
2. Erythema multiforme
3. Erythema nodusum.

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Photosensitivity

• Photosensitivity is caused by a reaction to
  sunlight and tends to occur when something, such
  as an infection or a medication, increases your
  sensitivity to ultraviolet radiation.

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Erythema multiforme

• Erythema multiforme is an acute or subacute
  self-limiting disease that involves the skin and
  mucous membranes.
• The etiology is unclear. However, an
  immunologically mediated process triggered by
  herpes simplex or Mycoplasma pneumoniae, drugs,
  radiation or malignancies, is probable.
• Age the ages of 20 and 30 years
• Sex The disease more frequently affects young
  men.

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Clinical Features

• Fatigue, fever, itching (before lesions appear)
• The skin manifestations consist of erythematous,
  flat, round macules, papules, or plaques, usually
  in a symmetrical pattern.
• -The characteristic skin patterns are target- or
  iris-like lesions.
• Skin bullae may occasionally be seen.

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Stevens-Johnson syndrome (SJS) toxic epidermal
necrolysis (TEN)

• The most severe forms of erythema multiforme.
• The oral lesions are always present, and are
  characterized by extensive vesicle formation,
  followed by painful erosions covered by
  grayish-white or hemorrhagic pseudomembranes.
• Drugs usually trigger the disease
• Age young adults
• Sex Male predilection
• A person with TEN will have symptoms of SJS that
  worsen to include peeling and detachment of the
  skin, pus-like infections, fluid loss and even
  death.

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Stevens-Johnson syndrome
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Toxic Epidermal Necrolysis
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Treatment

• Prevention
• Treat any underlying diseases and avoid any known
  triggers (certain medications, for example).

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• 2. Drug Therapies
• Antihistamines for itching
• Antibiotics, if you have an infection
• Antiviral medications such as acyclovir and
  valacyclovir, if you have a virus
• Corticosteroids -- applied to the skin
  (topically) corticosteroids may also be taken
  orally.

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Treatment of TEN SJS

• Management should be in an intensive care unit
• Supportive care (warm environment, fluid
  replacement, correction of electrolyte
  disturbances, prevention of sepsis, suction of
  oropharynx)
• Analgesics
• Intravenous antibiotics for sepsis
• Debridement of frankly necrotic skin
• Non-stick occlusive burns dressings
• Granulocyte colony stimulating factor for
  neutropaenia
• Intravenous immunoglobulins or ciclosporin to
  arrest the cytotoxic process

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Erythema nodosum (EN)

• EN is an acute, nodular, erythematous eruption
  that usually is limited to the extensor aspects
  of the lower legs.
• EN is a hypersensitivity reaction that may occur
  in association with several systemic diseases or
  drug therapies, or it may be idiopathic.
• Age peak 20 - 30 years of age
• Sex Female predilection

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Etiology

1. Streptococcal infections are the most frequent
2. Drugs
3. Sarcoidosis
4. Autoimmune disorders
5. Inflammatory diseases of the bowel

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Clinical features

• EN begins with flulike symptoms of fever and
  generalized aching.
• Lesions begin as red tender nodules . Lesion
  borders are poorly defined and vary from 2-6 cm.
• During the first week, lesions become tense, hard
  and painful.
• During the second week, they may become
  fluctuant, as in an abscess, but do not suppurate
  or ulcerate.
• Individual lesions last approximately 2 weeks,
  but occasionally, new lesions continue to appear
  for 3-6 weeks.

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Treatment

• In most patients, EN is a self-limited disease
  and requires only symptomatic relief using NSAIDs
  (eg, indomethacin) , cool wet compresses,
  elevation and bed rest.
• Corticosteroids are effective but seldom
  necessary in self-limited disease.