Diagnostic Tests for Erythema
Erythema Tests: Book Excerpts
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:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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.
Testing
A. Biopsy. The history and physical examination will be most helpful in making the diagnosis; however, biopsy of an early lesion helps to confirm it and exclude others. The differential diagnosis would include urticaria, vasculitis, fixed drug eruptions, and bullous pemphigoid.
B. Other tests. If underlying infection is suspected, laboratory tests including a complete blood count, throat culture, antistreptolysin-O titer, slide test for infectious mononucleosis, and hepatitis screen may be indicated. A chest x-ray study may be needed if Mycoplasma pneumoniae, histoplasmosis, coccidiomycosis, or TB is suspected. Skin tests or serum complement fixation titers for infectious agents may be needed.
Diagnostic assessment
A. If the history and physical examination are consistent with the diagnosis of EM, a symmetric, fixed, discrete, round, erythematous rash is seen, which lasts 1 to 6 weeks from onset to healing, which is self-limited, acute, or episodic in nature. If biopsy supports the diagnosis, then the clinical criteria for EM have been met.
B. Cause. Then, determine the most likely cause in order to remove the antigenic stimulus, whether this means stopping a drug, treating an infection, or invoking preventative measures such as avoiding a drug or providing prophylaxis for recurrent HSV.
C. Determining which subtype of EM is present helps dictate treatment and anticipate prognosis.
References
1. Fitzpatrick TB, Johnson RA, Polano MK, Suurmond D, Wolff K. Color atlas and synopsis of clinical dermatology, 2nd ed. New York: McGraw-Hill, 1992:474–477.
2. Goldberg GN. Erythema multiforme controversies and recent advances. Adv Dermatol 1987;2:73–90.
3. Huff JC. Erythema multiforme. In: Sams WM, Lynch PJ, eds. Principles and practice of dermatology, 2nd ed. New York: Churchill Livingstone, 1996:483–490.
4. Stampien TM, Schwartz RA. Erythema multiforme. Am Fam Physician 1992;46(4):
1171–1176.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Patterned Erythema:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
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:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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.
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: 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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