Erythema

By

Dr. Mohamad Nasr Lecturer Of

Dermatology & Venereology

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

TypesTypes

1.1. Photosensitivity Photosensitivity

2.2. Erythema multiforme Erythema multiforme

3.3. Erythema nodusum. Erythema nodusum.

PhotosensitivityPhotosensitivity

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

Erythema Erythema multiformemultiforme

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.

Clinical Features

Fatigue, fever, itching (before lesions Fatigue, fever, itching (before lesions appear)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.

Stevens-Johnson syndrome Stevens-Johnson syndrome (SJS) & toxic epidermal (SJS) & toxic epidermal

necrolysis (TEN)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 A person with TEN will have symptoms of SJS

that worsen to include peeling and detachment that worsen to include peeling and detachment of the skin, pus-like infections, fluid loss and of the skin, pus-like infections, fluid loss and even death.even death.

Stevens-Johnson Stevens-Johnson syndromesyndrome

Toxic Epidermal Toxic Epidermal NecrolysisNecrolysis

TreatmentTreatment

1.1. Prevention;Prevention; Treat any underlying diseases and Treat any underlying diseases and

avoid any known triggers (certain avoid any known triggers (certain medications, for example). medications, for example).

2. Drug Therapies;2. Drug Therapies; Antihistamines for itchingAntihistamines for itching Antibiotics, if you have an infectionAntibiotics, if you have an infection Antiviral medications such as Antiviral medications such as

acyclovir and valacyclovir, if you have acyclovir and valacyclovir, if you have a virusa virus

Corticosteroids -- applied to the skin Corticosteroids -- applied to the skin (topically); corticosteroids may also be (topically); corticosteroids may also be taken orally. taken orally.

Treatment of TEN & SJS;Treatment of TEN & SJS;

Management should be in an intensive care Management should be in an intensive care unitunit: :

Supportive care (warm environment, fluid Supportive care (warm environment, fluid replacement, correction of electrolyte replacement, correction of electrolyte disturbances, prevention of sepsis, suction of disturbances, prevention of sepsis, suction of oropharynx) oropharynx)

Analgesics Analgesics Intravenous antibiotics for sepsis Intravenous antibiotics for sepsis Debridement of frankly necrotic skin Debridement of frankly necrotic skin Non-stick occlusive burns dressings Non-stick occlusive burns dressings Granulocyte colony stimulating factor for Granulocyte colony stimulating factor for

neutropaenia neutropaenia Intravenous immunoglobulins or ciclosporin to Intravenous immunoglobulins or ciclosporin to

arrest the cytotoxic process arrest the cytotoxic process

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

Etiology1. Streptococcal infections are the

most frequent2. Drugs 3. Sarcoidosis 4. Autoimmune disorders 5. Inflammatory diseases of the bowel

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.

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.