Diagnosis of Erythema
Erythema Diagnosis: Book Excerpts
Diagnostic Tests for Erythema: Online Medical Books
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Erythema [Erythroderma]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If erythema isn’t associated with anaphylaxis, obtain a detailed health history. (See Differential diagnosis: Erythema, pages 310 and 311.) Find out how long the patient has had the erythema and where it first began. Has he had any associated pain or itching? Has he recently had a fever, an upper respiratory tract infection, or joint pain? Does he have a history of skin disease or other illness? Does he or anyone in his family have allergies, asthma, or eczema? Find out if he has been exposed to someone who has had a similar rash or who is now ill. Did he have a recent fall or injury in the erythematous area?
Obtain a complete drug history, including recent immunizations. Ask about food intake and exposure to chemicals.
Begin the physical examination by assessing the extent, distribution, and intensity of erythema. Look for edema and other skin lesions, such as urticaria, scales, papules, and purpura. Examine the affected area for warmth, and gently palpate it to check for tenderness or crepitus.
Cultural Cue: Dark-skinned patients may have difficulty recognizing erythema; as a result, they may present with associated diseases in a more advanced state.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Erythema Multiforme:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Were there any prodromal symptoms?
1. Prodromal symptoms occur in one-third of cases, usually in the form of an upper respiratory illness (3).
2. A prodrome is unusual in EM minor, but fever, malaise, and myalgias can precede the more severe varieties (Chapters 2.6 and 13.6).
B. Characteristics of the rash
1. What was the time course of onset and the duration of lesions?
a. An acute onset with enlargement of papules over 24 to 48 hours is typical of EM. New lesions can develop over 10 days or more with a usual duration of 1 to 6 weeks from onset to healing (3). Be aware of late onset lesions as they may also be a recurrence.
2. Where are the lesions?
a. EM lesions usually start on the hands and feet, including palms and soles, and can spread proximally to become generalized.
b. The mouth and lips are involved up to 99% of the time. More extensive mucosal involvement is seen in the more severe cases. Mouth lesions are usually tender.
c. The rash is symmetric.
3. Skin symptoms
a. Are the lesions painful or pruritic? Oral lesions are usually tender. The patient may complain of itching, swelling, and tenderness of the hands and feet.
C. Recent exposures
1. Has the patient been exposed to any drugs 1 to 3 weeks prior to onset (4)? These most often include sulfonamides, penicillin, anticonvulsants, and nonsteroidal antiinflammatory drugs. Drugs often lead to extensive mucosal erosions with large bullae.
2. Has the patient recently been ill?
a. The percent of EM cases precipitated by herpes simplex virus (HSV) is likely greater than 50% (3). HSV usually presents as EM minor, and it is recurrent in one-third of cases.
b. Another well-documented factor is infection with mycoplasma pneumonia (2). In this case, EM generally presents in bullous form or as Stevens–Johnson syndrome (Chapter 13.8).
c. Other bacterial and viral causes have been suggested, including tuberculosis (TB), β-hemolytic streptococci, staphylococcal infections, and the bacillus Calmette-Guérin vaccine.
d. Other factors such as radiation therapy, collagen vascular diseases, pregnancy, and carcinomas have been implicated.
Physical examination
A. Description of lesions
1. The rash begins as a round erythematous papule, which enlarges up to 1 to 2 cm over 24 to 48 hours. The periphery of the lesion is erythematous and raised or edematous. The center becomes more cyanotic looking and can be white/yellow or gray. This is the pathognomonic “target lesion,” but it may not be present in all cases. If a blister forms in the middle, the term “iris lesion” is more appropriate.
2. Lesions are generally symmetrical, with acral to central spread including extensor surfaces, face, palms, and soles. Mucosal lesions indicate a more severe type; bullae with sloughing in large sheets suggests TEN.
B. Systemic signs
1. Systemic signs are present in the more serious Stevens–Johnson syndrome and TEN.
2. Systemic signs include high fever, involvement of eyes with corneal ulceration, pulmonary findings, widespread cutaneous involvement, or pneumonia, indicating higher morbidity and mortality.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Patterned Erythema:
Differential Overview
(Field Guide to Bedside Diagnosis)
Figurate
❑ Tinea corporis
❑ Urticaria
❑ Erysipelas
❑ Erythema migrans
❑ Secondary syphilis
❑ Livedo reticularis
❑ Erythema multiforme
❑ Cutaneous larva migrans
❑ Granuloma annulare
❑ Erythema marginatum
Photodistribution
❑ Sunburn
❑ Drugs
❑ Polymorphous light eruption
❑ Systemic lupus erythematosus
❑ Porphyria cutanea tarda
❑ Pellagra
Differentiate from Cellulitis
❑ Insect bite
❑ Acute gout
❑ Deep vein thrombophlebitis
❑ Erythema migrans
❑ Fixed drug eruption
❑ Pyoderma gangrenosa
❑ Sweet syndrome
❑ Necrotizing fasciitis
Diagnostic Approach
Sun-exposed areas of the face, the “V” of the neck (but not under the chin), and the dorsum of the hands and feet are common distributions for photodermatitis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Erythema:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
If erythema isn’t associated with anaphylaxis, obtain a detailed health history. Find out how long the patient has had the erythema and where it first began. Has he had any associated pain or itching? Has he recently had a fever, upper respiratory tract infection, or joint pain? Does he have a history of skin disease or other illness? Does he or anyone in his family have allergies, asthma, or eczema? Find out if he has been exposed to someone who has had a similar rash or who is now ill. Did he have a recent fall or injury in the area of the erythema?
Obtain a complete drug history, including recent immunizations. Ask about food intake and exposure to chemicals.
Physical examination
Begin the physical examination by assessing the extent, distribution, and intensity of erythema. Look for edema and other skin lesions, such as hives, scales, papules, and purpura. Examine the affected area for warmth, and gently palpate it to check for tenderness or crepitus.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Erythema:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If erythema isn’t associated with anaphylaxis, obtain a detailed health history. Find out how long the patient has had the erythema and where it first began. Has he had any associated pain or itching? Has he recently had a fever, upper respiratory tract infection, or joint pain? Does he have a history of skin disease or other illness? Does he or anyone in his family have allergies, asthma, or eczema? Find out if he has been exposed to someone who has had a similar rash or who’s now ill. Did he have a recent fall or injury in the area of erythema?
Obtain a complete drug history, including recent immunizations. Ask about food intake and exposure to chemicals.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Erythema [Erythroderma]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If erythema isn't associated with anaphylaxis, obtain a detailed health history. Find out how long the patient has had the erythema and where it first began. Has he had associated pain or itching? Has he recently had a fever, upper respiratory tract infection, or joint pain? Does he have a history of skin disease or other illness? Does he or anyone in his family have allergies, asthma, or eczema? Find out if he has been exposed to someone who has had a similar rash or who's now ill. Did he have a recent fall or injury in the area of erythema?
Obtain a complete drug history, including recent immunizations. Ask about food intake and exposure to chemicals.
Begin the physical examination by assessing the extent, distribution, and intensity of erythema. Look for edema and other skin lesions, such as hives, scales, papules, and purpura. Examine the affected area for warmth, and gently palpate it to check for tenderness or crepitus.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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