Causes of Erythema nodosum
List of causes of Erythema nodosum
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Erythema nodosum)
that could possibly cause Erythema nodosum includes:
Causes of Erythema nodosum (Diseases Database):
The follow list shows some of the possible medical causes of Erythema nodosum
that are listed by the Diseases Database:
Source: Diseases Database
Erythema nodosum Causes: Book Excerpts
Erythema nodosum as a complication of other conditions:
Other conditions that might have
Erythema nodosum as a complication may,
potentially, be an underlying cause of Erythema nodosum.
Our database lists the following as having
Erythema nodosum as a complication of that condition:
Erythema nodosum as a symptom:
Conditions listing Erythema nodosum
as a symptom may also be potential underlying causes of Erythema nodosum.
Our database lists the following as having
Erythema nodosum as a symptom of that condition:
Medications or substances causing Erythema nodosum:
The following drugs, medications, substances or toxins are some of the possible
causes of Erythema nodosum as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
See full list of 6
medications causing Erythema nodosum
Related information on causes of Erythema nodosum:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Erythema nodosum may be found in:
Causes of Erythema nodosum: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Erythema nodosum.
Erythema [Erythroderma]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Allergic reactions
Foods, drugs, chemicals, and other allergens can cause an allergic reaction and erythema. A localized allergic reaction also produces hivelike eruptions and edema.
Anaphylaxis, a life-threatening reaction, produces relatively sudden erythema in the form of urticaria. It also produces flushing; facial edema; diaphoresis; weakness; sneezing; bronchospasm with dyspnea and tachypnea; shock with hypotension and cool, clammy skin; and possibly airway edema with hoarseness and stridor.
Burns
In thermal burns, erythema and swelling appear first, possibly followed by deep or superficial blisters and other signs of damage that vary with the severity of the burn. Burns from ultraviolet rays, such as sunburn, cause delayed erythema and tenderness on exposed areas of the skin.
Candidiasis
When this fungal infection affects the skin, it produces erythema and a scaly, papular rash under the breasts and at the axillae, neck, umbilicus, and groin (intertrigo). Small pustules commonly occur at the periphery of the rash (satellite pustulosis).
Cellulitis
This bacterial infection of the skin and subcutaneous tissue causes erythema, tenderness, and edema.
Dermatitis
Erythema commonly occurs in this family of inflammatory disorders. In atopic dermatitis, erythema and intense pruritus precede the development of small papules that may redden, weep, scale, and lichenify. These occur most commonly at skin folds of the extremities, neck, and eyelids.
Contact dermatitis occurs after exposure to an irritant. It quickly produces erythema and vesicles, blisters, or ulcerations on exposed skin.
In seborrheic dermatitis, erythema appears with dull red or yellow lesions. Sharply marginated, these lesions are sometimes ring shaped and covered with greasy scales. They usually occur on the scalp, eyebrows, ears, and nasolabial folds, but they may form a butterfly rash on the face or move to the chest or to skin folds on the trunk. This disorder is common in patients infected with the human immunodeficiency virus and in infants (cradle cap).
Dermatomyositis
This disorder, most common in women older than age 50, produces a dusky lilac rash on the face, neck, upper torso, and nail beds. Gottron’s papules (violet, flat-topped lesions) may appear on finger joints.
Erysipelas
This skin infection caused by group A beta-hemolytic streptococci is characterized by an abrupt onset of reddish, well-demarcated, tender, warm, sometimes elevated lesions, mainly on the face and neck but sometimes also on the extremities. Flaccid, pus-filled bullae may develop after 2 to 3 days. Extension into deeper tissues is rare. Other signs and symptoms include fever, chills, cervical lymphadenopathy, vomiting, headache, sore throat, warmth and tenderness in the affected area and, possibly, alopecia.
Erythema annulare centrifugum
Small, pink infiltrated papules appear on the trunk, buttocks, and inner thighs, slowly spreading at the margins and clearing in the center. Itching, scaling, and tissue hardening may occur.
Erythema marginatum rheumaticum
Associated with rheumatic fever, this disorder causes erythematous lesions that are superficial, flat, and slightly hardened. They shift, spread rapidly, and may last for hours or days, recurring after a time.
Erythema multiforme
This acute inflammatory skin disease develops as a result of drug sensitivity after an infection (most commonly herpes simplex or a mycoplasmal infection), allergies, or pregnancy. One-half of the cases are of idiopathic origin.
Erythema multiforme minor produces reddish pink iris-shaped, urticarial, localized lesions with little or no mucous membrane involvement. Most lesions occur on flexor surfaces of the extremities. Burning or itching may occur before or in conjunction with lesion development. Lesions appear in crops and last 2 to 3 weeks. After 1 week, they become flat or hyperpigmented. Early signs and symptoms may include a mild fever, cough, and sore throat.
Erythema multiforme major usually occurs as a drug reaction; causes widespread symmetrical, bullous lesions that may become confluent; and includes erosions of the mucous membranes. Erythema is characteristically preceded by blisters on the lips, tongue, and buccal mucosa and a sore throat. Additional early signs and symptoms include cough, vomiting, diarrhea, coryza, and epistaxis. Later signs and symptoms include fever, prostration, difficulty with oral intake because of mouth and lip lesions, conjunctivitis due to ulceration, vulvitis, and balanitis. The most severe form of this disorder is known as Stevens-Johnson syndrome, a multisystem disorder that can occasionally be fatal. In addition to all signs and symptoms mentioned above, patients develop exfoliation of the skin from disruptions of bullae, although less than 10% of the body surface area is affected. These areas resemble second-degree thermal burns and should be cared for as such. Fever may rise to 102 ° F to 104° F (38.9° C to 40° C). The patient may also experience tachypnea; a weak, rapid pulse; chest pain; malaise; and muscle or joint pain.
Erythema nodosum
Sudden bilateral eruption of tender erythematous nodules characterizes this disorder. These firm, round, protruding lesions usually appear in crops on the shins, knees, and ankles but may occur on the buttocks, arms, calves, and trunk as well. Other effects include mild fever, chills, malaise, muscle and joint pain and, possibly, swollen feet and ankles. Erythema nodosum is associated with various diseases, most notably inflammatory bowel disease, sarcoidosis, tuberculosis, and streptococcal and fungal infections.
Frostbite
First-degree frostbite turns the affected body part a lifeless gray color, followed by an intense bluish red flush on rewarming. Blisters, lack of feeling, and tissue necrosis may follow.
Gout
This disease, which generally affects men ages 40 to 60, is characterized by tight and erythematous skin over an inflamed, edematous joint.
Intertrigo
In this superficial fungal infection, skin friction usually causes symmetrical erythema that may be accompanied by soreness and itching. Typically, erythema occurs in skin folds, such as in the groin; in severe cases, the skin may become bright red with erosion and maceration.
Kawasaki syndrome
This acute illness of unknown cause, which primarily affects children younger than age 5, commonly produces a rash or erythema. No test is available for Kawasaki syndrome, which can cause serious heart damage and death if not detected and treated immediately. Additional characteristic signs include fever, conjunctival injection, and lymphadenopathy. Patients are treated with I.V. gamma globulin.
Liver disease (chronic)
Any chronic liver disease, such as cirrhosis, can cause local vasodilation and palmar erythema along with jaundice, pruritus, spider angiomas, xanthomas, and characteristic systemic signs.
Lupus erythematosus
Both discoid and systemic lupus erythematosus (SLE) can produce a characteristic butterfly rash. This erythematous eruption may range from a blush with swelling to a scaly, sharply demarcated, macular rash with plaques that may spread to the forehead, chin, ears, chest, and other sun-exposed parts of the body.
In discoid lupus erythematosus, other signs and symptoms may include telangiectasia, hyperpigmentation, ear and nose deformity, and mouth, tongue, and eyelid lesions.
In SLE, acute onset of erythema may be accompanied by photosensitivity and mucous membrane ulcers, especially in the nose and mouth. Mottled erythema may occur on the hands, with edema around the nails and macular reddish purple lesions on the fingers. Telangiectasia occurs at the base of the nails or eyelids along with purpura, petechiae, ecchymoses, and urticaria. Other findings vary according to the body systems affected but typically include low-grade fever, malaise, weakness, headache, arthralgia, arthritis, depression, lymphadenopathy, fatigue, anorexia, weight loss, nausea, vomiting, diarrhea, and constipation.
Necrotizing fasciitis
This streptococcal infection usually begins with an area of mild erythema at the site of insult, which soon changes from red to purple and then blue. The appearance of fluid-filled blisters and bullae indicates the rapid progression of the necrotizing process. By days 7 to 10, dead skin begins to separate at the margins of the erythema, revealing extensive necrosis of the subcutaneous tissue. Other findings include fever, hypovolemia and, in later stages, hypotension and respiratory insufficiency—signs of overwhelming sepsis that require supportive care.
Polymorphous light eruption
This condition produces erythema, vesicles, plaques, and multiple small papules on sun-exposed areas, which may later eczematize, lichenify, and excoriate. Pruritus may also occur.
Psoriasis
Silvery white scales over a thickened erythematous base usually affect the elbows, knees, chest, scalp, and intergluteal folds. The fingernails may become thick and pitted.
Raynaud’s disease
In this disorder, the skin on the hands and feet typically blanches and cools after exposure to cold and stress and later becomes warm and purplish red.
Rheumatoid arthritis
In a flare-up of this disorder, erythema occurs over the affected joints along with heat, swelling, pain, and stiffness. Earlier symptoms include malaise, fatigue, myalgia, prolonged morning stiffness, and clumsiness. As the disease progresses, muscle atrophy, palmar erythema, generalized edema, mottled skin, and structural deformities occur.
Rosacea
Scattered erythema initially develops across the center of the face, followed by superficial telangiectases, papules, pustules, and nodules. Rhinophyma may occur on the lower half of the nose.
Rubella
Typically, flat solitary lesions join to form a blotchy pink erythematous rash that spreads rapidly to the trunk and extremities in this disorder. Occasionally, small red lesions (Forschheimer spots) occur on the soft palate. Lesions clear in 4 to 5 days. The rash usually follows a fever (up to 102° F [38.9° C]), headache, malaise, sore throat, a gritty eye sensation, lymphadenopathy, pain in the joints, and coryza.
Staphylococcal scalded skin syndrome
This endotoxin-mediated epidermolytic disease is caused by a clinically unapparent Staphylococcus aureus infection and primarily affects infants (Ritter’s disease) and small children. It’s characterized by erythema and widespread exfoliation of superficial epidermal layers, resembling scalded skin. Associated signs and symptoms include low-grade fever and irritability. Care must be taken to maintain hydration and prevent secondary infections of denuded areas; hospitalization is commonly required. Death may occur, especially in infants with extensive disease.
Thrombophlebitis
Although this disorder is sometimes asymptomatic, it can produce erythema over the inflamed vein. Fever, chills, and malaise may accompany severe localized pain, warmth, and induration; distal edema; and a positive Homans’sign.
Toxic shock syndrome
This infectious disorder, which is caused by a toxin-producing S. aureus infection, causes sudden, diffuse erythema in the form of a macular rash. It’s accompanied by a sudden high fever, myalgia, vomiting, severe diarrhea, and sudden hypotension that may lead to shock. Desquamation occurs after 1 to 2 weeks, especially on the palms and soles. This syndrome usually affects young women and has been associated with the use of tampons during menses.
Other causes
Drugs
Many drugs commonly cause erythema. (Drugs associated with erythema.)
Herb Alert
Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema of the mouth and rapid formation of vesicles. St. John’s wort can cause heightened photosensitivity, resulting in erythema or “sunburn.”
Radiation and other treatments
Radiation therapy may produce dull erythema and edema within 24 hours. As the erythema fades, the skin becomes light brown and mildly scaly. Any treatment that causes an allergic reaction can also cause erythema.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
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
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Erythema:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Allergic reactions
Foods, drugs, chemicals, and other allergens can cause an allergic reaction and erythema. A localized allergic reaction also produces hivelike eruptions and edema.
Anaphylaxis, a life-threatening condition, produces relatively sudden erythema in the form of urticaria. It also produces flushing; facial edema; diaphoresis; weakness; sneezing; bronchospasm with dyspnea and tachypnea; shock with hypotension and cool, clammy skin; and possibly airway edema with hoarseness and stridor.
Burns
With thermal burns, erythema and swelling appear first, possibly followed by deep or superficial blisters and other signs of damage that vary with the severity of the burn. Burns from ultraviolet rays, such as sunburn, cause delayed erythema and tenderness on exposed areas of the skin.
Candidiasis
When candidiasis — a fungal infection — affects the skin, it produces erythema and a scaly, papular rash under the breasts and at the axillae, neck, umbilicus, and groin, also known as
intertrigo. Small pustules commonly occur at the periphery of the rash (satellite pustulosis).
Cellulitis
Erythema, tenderness, and edema are a result of a bacterial infection of the skin (most commonly streptococcal and staphylococcal) and subcutaneous tissue.
Dermatitis
Erythema commonly occurs in this family of inflammatory disorders. With atopic dermatitis, erythema and intense pruritus precede the development of small papules that may redden, weep, scale, and lichenify. These occur most commonly at skin folds of the extremities, neck, and eyelids.
Contact dermatitis occurs after exposure to an irritant. It quickly produces inflammation, erythema and vesicles, blisters, or ulcerations on exposed skin.
With seborrheic dermatitis, erythema appears with dull red or yellow lesions. Sharply marginated, these lesions are sometimes ring shaped and covered with greasy scales. They usually occur on the scalp, eyebrows, ears, and nasolabial folds, but they may form a butterfly rash on the face or move to the chest or to skin folds on the trunk. This disorder is common in patients infected with the human immunodeficiency virus and in infants (cradle cap).
Dermatomyositis
Dermatomyositis, most common in females older than age 50, produces a dusky lilac rash on the face, neck, upper torso, and nail beds. Other symptoms include fever, malaise, and weakness. Gottron’s papules (violet, flat-topped lesions) may appear on finger joints.
Erythema annulare centrifugum
Small, pink, ring-shaped infiltrated papules appear on the trunk, buttocks, and inner thighs, slowly spreading at the margins and clearing in the center. Itching, scaling, and tissue hardening may occur.
Erythema marginatum rheumaticum
Associated with rheumatic fever, erythema marginatum rheumaticum causes erythematous lesions that are superficial, flat, and slightly hardened. They shift, spread rapidly, and may last for hours or days, recurring after a time.
Erythema multiforme
Erythema multiforme is an acute inflammatory skin disease that develops as a result of drug sensitivity after infection, most commonly herpes simplex and
Mycoplasma; allergies; and pregnancy. One-half of the cases are of idiopathic origin.
Erythema multiforme minor has typical urticarial, red-pink, iris-shaped, localized lesions with little or no mucous membrane involvement. Most lesions occur on flexor surfaces of the extremities. Burning or itching may occur before or in conjunction with lesion development. Lesions appear in crops and last 2 to 3 weeks. After 1 week individual lesions become flat or hyperpigmented. Early signs and symptoms may include a mild fever, cough, and sore throat.
Erythema multiforme major usually occurs as a drug reaction; has widespread symmetrical, bullous lesions that may become confluent; and includes erosions of the mucous membranes. Erythema is characteristically preceded by blisters on the lips, tongue, and buccal mucosa and a sore throat. Additional signs and symptoms early in the course of the disease include cough, vomiting, diarrhea, coryza, and epistaxis. Later signs and symptoms include fever, prostration, difficulty with oral intake due to mouth and lip lesions, conjunctivitis due to ulceration, vulvitis, and balanitis.
The maximal variant of this disease is considered by many to be Stevens-Johnson syndrome. This is a multisystem disorder and can occasionally be fatal. In addition to all signs and symptoms mentioned above, patients develop exfoliation of the skin from disruptions of bullae, although less than 10% of the body surface area is affected. These areas resemble second-degree thermal burns and should be cared for as such. Fever may rise to 102° to 104°F (38.9° to 40° C). The patient may also experience tachypnea; weak, rapid pulse; chest pain; malaise; and muscle or joint pain.
Erythema nodosum
Sudden bilateral eruption of tender erythematous nodules characterizes erythema nodosum. These firm, round, tender, protruding lesions usually appear in crops on the shins, knees, and ankles but may occur on the buttocks, arms, calves, and trunk as well. Other effects include mild fever, chills, malaise, muscle and joint pain and, possibly, swollen feet and ankles. Erythema nodosum is associated with various diseases, most notably inflammatory bowel disease, sarcoidosis, tuberculosis, and streptococcal and fungal infections.
Gout
Gout, which generally affects males ages 40 to 60, is characterized by tight and erythematous skin over an inflamed, edematous joint.
Lupus erythematosus
Both discoid and systemic lupus erythematosus (SLE) can produce a characteristic butterfly rash. This erythematous eruption may range from a blush with swelling to a scaly, sharply demarcated, macular rash with plaques that may spread to the forehead, chin, ears, chest, and other sun-exposed parts of the body.
With discoid lupus erythematosus, telangiectasia, hyperpigmentation, ear and nose deformity, and mouth, tongue, and eyelid lesions may occur.
With SLE, acute onset of erythema may also be accompanied by photosensitivity and mucous membrane ulcers, especially in the nose and mouth. Mottled erythema may occur on the hands, with edema around the nails and macular reddish purple lesions on the fingers. Telangiectasia occurs at the base of the nails or eyelids, along with purpura, petechiae, ecchymoses, and urticaria. Joint pain and stiffness are common. Other findings vary according to the body systems affected but typically include low-grade fever, malaise, weakness, headache, arthralgias, arthritis, depression, lymphadenopathy, fatigue, weight loss, anorexia, nausea, vomiting, diarrhea, and constipation.
Psoriasis
Silvery white scales over a thickened erythematous base usually affect the elbows, knees, chest, scalp, and intergluteal folds. The fingernails may become thick and pitted.
Raynaud’s disease
Typically, the skin on the hands and feet blanches and cools after exposure to cold and stress. Later, it becomes warm and purplish red.
Rosacea
Scattered erythema initially develops across the center of the face, followed by superficial telangiectases, papules, pustules, and nodules. Rhinophyma may occur on the lower half of the nose.
Rubella
Typically, flat solitary lesions join to form a blotchy pink erythematous rash that spreads rapidly to the trunk and extremities in rubella. Occasionally, small red lesions (Forschheimer spots) occur on the soft palate. Lesions clear in 4 to 5 days. The rash usually follows fever (up to 102° F [38.9°C]), headache, malaise, sore throat, a gritty eye sensation, lymphadenopathy, pain in the joints, and coryza.
Other causes
Drugs
Many drugs commonly cause erythema. (See
Drugs associated with erythema.)
Herbal remedies
Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema of the mouth and rapid formation of vesicles. St. John’s wort can cause heightened sun sensitivity, resulting in erythema or “sunburn.”
Radiation and other treatments
Radiation therapy may produce dull erythema and edema within 24 hours. As the erythema fades, the skin becomes light brown and mildly scaly. Any treatment that causes an allergic reaction can also cause erythema.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Erythema:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Allergic reactions
Foods, drugs, chemicals, and other allergens can cause an allergic reaction and erythema. A localized allergic reaction also produces hivelike eruptions and edema.
Anaphylaxis, a life-threatening condition, produces relatively sudden erythema in the form of urticaria. It also produces flushing; facial edema; diaphoresis; weakness; sneezing; bronchospasm with dyspnea and tachypnea; shock with hypotension and cool, clammy skin; and possibly airway edema with hoarseness and stridor.
Burns
With thermal burns, erythema and swelling appear first, possibly followed by deep or superficial blisters and other signs of damage that vary with the severity of the burn. Burns from ultraviolet rays, such as sunburn, cause delayed erythema and tenderness on exposed areas of the skin.
Candidiasis
When candidiasis, a fungal infection, affects the skin, it produces erythema and a scaly, papular rash under the breasts and at the axillae, neck, umbilicus, and groin, also known as intertrigo. Small pustules commonly occur at the periphery of the rash (satellite pustulosis).
Cellulitis
With cellulitis, erythema, tenderness, and edema are a result of a bacterial infection of the skin and subcutaneous tissue. The patient typically feels pain and a warm sensation at the site of the infection.
Dermatitis
Erythema commonly occurs in dermatitis, a group of inflammatory disorders. With atopic dermatitis, erythema and intense pruritus precede the development of small papules that may redden, weep, scale, and lichenify. These occur most commonly at skin folds of the extremities, neck, and eyelids.
Contact dermatitis occurs after exposure to an irritant. It quickly produces erythema and vesicles, blisters, or ulcerations on exposed skin.
With seborrheic dermatitis, erythema appears with dull-red or yellow lesions. Sharply marginated, these lesions are sometimes ring shaped and covered with greasy scales. They usually occur on the scalp, eyebrows, ears, and nasolabial folds, but they may form a butterfly rash on the face or move to the chest or to skin folds on the trunk.
Erysipelas
Erysipelas — a skin infection caused by group A beta-hemolytic streptococci — is characterized by an abrupt onset on reddish, well-demarcated, tender, warm, sometimes elevated areas most commonly on the face and neck, although it may also occur on the extremities. Flaccid bullae that may be filled with pus may occur after 2 to 3 days. Associated signs and symptoms include fever, chills, local adenopathy, malaise, headache, and sore throat.
Erythema annulare centrifugum
With erythema annulare centrifugum, small, pink infiltrated papules appear on the trunk, buttocks, and inner thighs, slowly spreading at the margins and clearing in the center. Itching, scaling, and tissue hardening may also occur.
Erythema marginatum rheumaticum
Associated with rheumatic fever, erythema marginatum rheumaticum causes erythematous lesions that are superficial, flat, and slightly hardened. They shift, spread rapidly, and may last for hours or days, recurring after a time.
Erythema multiforme
Erythema multiform minor has typical urticarial red-pink, iris-shaped, localized lesions with little or no mucous membrane involvement. Most lesions occur on flexor surfaces of the extremities. Burning or itching may occur before or in conjunction with lesion development. Lesions appear in crops and last 2 to 3 weeks. After 1 week individual lesions become flat or hyperpigmented. Early signs and symptoms may include a mild fever, cough, and sore throat.
Erythema multiforme major usually occurs as a drug reaction; has widespread symmetrical, bullous lesions that may become confluent; and includes erosions of the mucous membranes. Erythema is characteristically preceded by blisters on the lips, tongue, and buccal mucosa and a sore throat. Additional signs and symptoms that occur early in the course of the disease include cough, vomiting, diarrhea, coryza, and epistaxis. Later signs and symptoms include fever, prostration, difficulty with oral intake due to mouth and lip lesions, conjunctivitis due to ulceration, vulvitis, and balanitis.
Erythema nodosum
Sudden bilateral eruption of tender erythematous nodules characterizes erythema nodosum. These firm, round, protruding lesions usually appear in crops on the shins, knees, and ankles but may occur on the buttocks, arms, calves, and trunk as well. Other effects include mild fever, chills, malaise, muscle and joint pain and, possibly, swollen feet and ankles. Erythema nodosum is associated with various diseases, most notably inflammatory bowel disease, sarcoidosis, tuberculosis, and streptococcal and fungal infections.
Frostbite
First-degree frostbite turns the affected body part a lifeless gray color, followed by an intense bluish red flush on rewarming. Blisters, lack of feeling, and tissue necrosis may follow.
Gout
Gout is characterized by tight and erythematous skin over an inflamed, edematous joint. The metatarsophalangeal joint of the great toe usually becomes inflamed first, followed by the instep, ankle, heel, knee, or wrist joints.
Intertrigo
With intertrigo, a superficial fungal infection, skin friction usually causes symmetrical erythema that may be accompanied by soreness or itching. Typically, erythema occurs in skin folds, such as in the groin; in severe cases, the skin may become bright red with erosion and maceration.
Liver disease (chronic)
Any chronic liver disease, such as cirrhosis, can cause local vasodilation and palmar erythema along with jaundice, pruritus, spider angiomas, xanthomas, and characteristic systemic signs.
Lupus erythematosus
Both discoid and systemic lupus erythematosus (SLE) can produce a characteristic butterfly rash. This erythematous eruption may range from a blush with swelling to a scaly, sharply demarcated, macular rash with plaques that may spread to the forehead, chin, ears, chest, and other sun-exposed parts of the body.
Telangiectasia, hyperpigmentation, ear and nose deformity, and mouth, tongue, and eyelid lesions may occur with discoid lupus erythematosus.
With SLE, acute onset of erythema may also be accompanied by photosensitivity and mucous membrane ulcers, especially in the nose and mouth. Mottled erythema may occur on the hands, with edema around the nails and macular reddish purple lesions on the fingers. Telangiectasia occurs at the base of the nails or eyelids, along with purpura, petechiae, ecchymoses, and urticaria. Joint pain and stiffness are common. Other findings vary according to the body systems affected but typically include low-grade fever, malaise, weakness, headache, arthralgias, arthritis, depression, lymphadenopathy, fatigue, weight loss, anorexia, nausea, vomiting, diarrhea, and constipation.
Polymorphous light eruption
Polymorphous light eruption produces erythema, vesicles, plaques, and multiple small papules on sun-exposed areas, which may later eczematize, lichenify, and excoriate. Pruritus may also occur.
Psoriasis
With psoriasis, silvery white scales that occur over a thickened erythematous base usually affect the elbows, knees, chest, scalp, and intergluteal folds. The fingernails may become thick and pitted.
Raynaud’s disease
With Raynaud’s disease, the skin on the hands and feet typically blanches and cools after exposure to cold and stress. Later, it becomes warm and purplish red. Numbness and tingling may also occur.
Rheumatoid arthritis
In a flare-up of rheumatoid arthritis, erythema occurs over the affected joints along with heat, swelling, pain, and stiffness. Earlier symptoms include malaise, fatigue, myalgia, prolonged morning stiffness, and clumsiness. As the disease progresses, muscle atrophy, palmar erythema, generalized edema, mottled skin, and structural deformities occur.
Rosacea
With rosacea, scattered erythema initially develops across the center of the face, followed by superficial telangiectases, papules, pustules, and nodules. Rhinophyma may occur on the lower half of the nose.
Rubella
With rubella, flat solitary lesions join to form a blotchy pink erythematous rash that spreads rapidly to the trunk and extremities. Occasionally, small red lesions (Forschheimer spots) occur on the soft palate. Lesions clear in 4 to 5 days. The rash usually follows fever (up to 102° F [38.9° C]), headache, malaise, sore throat, a gritty eye sensation, lymphadenopathy, pain in the joints, and coryza.
Staphylococcal scalded skin syndrome
Also known as Ritter’s disease, this disease occurs mainly in infants and small children. It’s caused by Staphylococcus aureus and is characterized by erythema and widespread exfoliation of superficial epidermal layers, resembling scalded skin. Associated signs and symptoms include low-grade fever and irritability. Death may occur, especially in infants with extensive disease.
Thrombophlebitis
Although thrombophlebitis sometimes produces no symptoms, it can produce erythema over the inflamed vein. Fever, chills, and malaise may accompany severe, localized pain, warmth, and induration; distal edema; and a positive Homans’sign.
Other causes
Drugs
Many drugs commonly cause erythema. (See Drugs associated with erythema.)
Radiation and other treatments
Radiation therapy may produce dull erythema and edema within 24 hours. As the erythema fades, the skin becomes light brown and mildly scaly. Any treatment that causes an allergic reaction can also cause erythema.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Erythema [Erythroderma]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Allergic reaction.Foods, drugs, chemicals, and other allergens can cause an allergic reaction and erythema. A localized allergic reaction also produces hivelike eruptions and edema.
Anaphylaxis, a life-threatening condition, produces relatively sudden erythema in the form of urticaria. It also produces flushing; facial edema; diaphoresis; weakness; sneezing; bronchospasm with dyspnea and tachypnea; shock with hypotension and cool, clammy skin; and, possibly, airway edema with hoarseness and stridor.
Burns.With thermal burns, erythema and swelling appear first, possibly followed by deep or superficial blisters and other signs of damage that vary with the burn's severity. Burns from ultraviolet rays, such as sunburn, cause delayed erythema and tenderness on exposed areas of the skin.
Candidiasis.When candidiasis—a fungal infection—affects the skin, it produces erythema and a scaly, papular rash under the breasts and at the axillae, neck, umbilicus, and groin, also known as intertrigo. Small pustules commonly occur at the periphery of the rash (satellite pustulosis).
Cellulitis.Erythema, tenderness, and edema are a result of a bacterial infection of the skin and subcutaneous tissue.
Dermatitis.Erythema commonly occurs in this family of inflammatory disorders. With atopic dermatitis, erythema and intense pruritus precede the development of small papules that may redden, weep, scale, and lichenify. These occur most commonly at skin folds of the extremities, neck, and eyelids.
Contact dermatitis occurs after exposure to an irritant. It quickly produces erythema and vesicles, blisters, or ulcerations on exposed skin.
With seborrheic dermatitis, erythema appears with dull red or yellow lesions. Sharply marginated, these lesions are sometimes ring shaped and covered with greasy scales. They usually occur on the scalp, eyebrows, ears, and nasolabial folds, but they may form a butterfly rash on the face or move to the chest or to skin folds on the trunk. This disorder is common in patients infected with human immunodeficiency virus and in infants (cradle cap).
Dermatomyositis.Dermatomyositis produces a dusky lilac rash on the face, neck, upper torso, and nail beds. Gottron's papules (violet, flat-topped lesions) may appear on finger joints.
Erythema annulare centrifugum.Small, pink infiltrated papules appear on the trunk, buttocks, and inner thighs, slowly spreading at the margins and clearing in the center. Itching, scaling, and tissue hardening may occur.
Erythema marginatum rheumaticum.Associated with rheumatic fever, erythema marginatum rheumaticum causes erythematous lesions that are superficial, flat, and slightly hardened. They shift, spread rapidly, and may last for hours or days, recurring after a time.
Erythema multiforme.Erythema multiforme minor has typical urticarial red-pink iris-shaped localized lesions with little or no mucous membrane involvement. Most lesions occur on flexor surfaces of the extremities. Burning or itching may occur before or in conjunction with lesion development. Lesions appear in crops and last 2 or 3 weeks. After 1 week, individual lesions become flat or hyperpigmented. Early signs and symptoms may include a mild fever, cough, and sore throat.
Erythema multiforme major usually occurs as a drug reaction; has widespread symmetrical, bullous lesions that may become confluent; and includes erosions of the mucous membranes. Erythema is characteristically preceded by blisters on the lips, tongue, and buccal mucosa and a sore throat. Additional signs and symptoms that manifest early in the course of the disease include a cough, vomiting, diarrhea, coryza, and epistaxis. Later signs and symptoms include a fever, prostration, difficulty with oral intake due to mouth and lip lesions, conjunctivitis due to ulceration, vulvitis, and balanitis. The maximal variant of this disease is considered by many to be Stevens-Johnson syndrome, a multisystem disorder that can occasionally be fatal. In addition to all signs and symptoms mentioned above, the patient develops exfoliation of the skin from disruptions of bullae, although less than 10% of the body surface area is affected. These areas resemble second-degree thermal burns and should be cared for as such. Fever may rise to 102° F to 104° F (38.9° C to 40° C). The patient may also experience tachypnea; a weak, rapid pulse; chest pain; malaise; and muscle or joint pain.
Erythema nodosum.Sudden bilateral eruption of tender erythematous nodules characterizes erythema nodosum. These firm, round, protruding lesions usually appear in crops on the shins, knees, and ankles, but may occur on the buttocks, arms, calves, and trunk as well. Other effects include a mild fever, chills, malaise, muscle and joint pain and, possibly, swollen feet and ankles. Erythema nodosum is associated with various diseases, most notably inflammatory bowel disease, sarcoidosis, tuberculosis, and streptococcal and fungal infections.
Gout.Gout is characterized by tight and erythematous skin over an inflamed, edematous joint.
Kawasaki syndrome.This acute illness of unknown cause commonly produces a rash or erythema. No test is available for Kawasaki syndrome, which can cause serious heart damage and death if not detected and treated immediately. Additional characteristic signs include fever, conjunctival injection, and lymphadenopathy.
Lupus erythematosus.Discoid and systemic lupus erythematosus (SLE) can produce a characteristic butterfly rash. This erythematous eruption may range from a blush with swelling to a scaly, sharply demarcated, macular rash with plaques that may spread to the forehead, chin, ears, chest, and other sun-exposed parts of the body.
With discoid lupus erythematosus,telangiectasia, hyperpigmentation, ear and nose deformity, and mouth, tongue, and eyelid lesions may occur.
With SLE, an acute onset of erythema may also be accompanied by photosensitivity and mucous membrane ulcers, especially in the nose and mouth. Mottled erythema may occur on the hands, with edema around the nails and macular reddish purple lesions on the fingers. Telangiectasia occurs at the base of the nails or eyelids, along with purpura, petechiae, ecchymoses, and urticaria. Joint pain and stiffness are common. Other findings vary according to the body systems affected, but typically include a low-grade fever, malaise, weakness, a headache, arthralgia, arthritis, depression, lymphadenopathy, fatigue, weight loss, anorexia, nausea, vomiting, diarrhea, and constipation.
Psoriasis.Silvery white scales over a thickened erythematous base usually affect the elbows, knees, chest, scalp, and intergluteal folds. The fingernails may become thick and pitted.
Raynaud's disease.Typically, the skin on the hands and feet blanches and cools after exposure to cold and stress. Later, it becomes warm and purplish red.
Rosacea.Scattered erythema initially develops across the center of the face, followed by superficial telangiectases, papules, pustules, and nodules. Rhinophyma may occur on the lower half of the nose.
Rubella.Typically, flat solitary lesions join to form a blotchy pink erythematous rash that spreads rapidly to the trunk and extremities in this disorder. Occasionally, small red lesions (Forschheimer spots) occur on the soft palate. Lesions clear in 4 or 5 days. The rash usually follows a fever (up to 102° F [38.9° C]), a headache, malaise, a sore throat, a gritty eye sensation, lymphadenopathy, pain in the joints, and coryza.
Other causes
Drugs.Many drugs commonly cause erythema. (See Drugs associated with erythema, page 242.)
Radiation and other treatments.Radiation therapy may produce dull erythema and edema within 24 hours. As the erythema fades, the skin becomes light brown and mildly scaly. Any treatment that causes an allergic reaction can also cause erythema.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Erythema Nodosum:
Erythema Nodosum - pathophysiology
(The 5-Minute Pediatric Consult)
- Septal panniculitis: Lymphocytic perivascular infiltrate in the dermis; lymphocytes and neutrophils in the fibrous septa in the subcutaneous fat
- In older lesions, histiocytes, giant cells, and occasionally plasma cells are seen.
- No fat cell destruction or vasculitis is present.
Erythema Nodosum - etiology
- Thought to be a result of a host hypersensitivity immune response to circulating immune complexes secondary to infectious and/or inflammatory stimuli, which then results in chronic injury to the blood vessels of the reticular dermis and subcutaneous fat
- There are many associated triggering/underlying diseases:
- In children: Streptococcal infection and tubercular infection are the most common causes.
- In older patients: Streptococcal infection and sarcoidosis are most common; drugs (oral contraceptives, sulfonamides, iodides/bromides, phenytoin); infection (streptococcal infection, tuberculosis, psittacosis, histoplasmosis, yersiniosis, lymphogranuloma venereum, catscratch disease, coccidioidomycosis, upper respiratory infection)
- Systemic:
- Sarcoidosis
- Inflammatory bowel disease
- Hodgkin disease
- Behçet disease
- Pregnancy
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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