Causes of Exfoliative dermatitis
List of causes of Exfoliative dermatitis
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Exfoliative dermatitis)
that could possibly cause Exfoliative dermatitis includes:
Causes of Exfoliative dermatitis (Diseases Database):
The follow list shows some of the possible medical causes of Exfoliative dermatitis
that are listed by the Diseases Database:
Source: Diseases Database
Exfoliative dermatitis Causes: Book Excerpts
Medications or substances causing Exfoliative dermatitis:
The following drugs, medications, substances or toxins are some of the possible
causes of Exfoliative dermatitis 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 10
medications causing Exfoliative dermatitis
Related information on causes of Exfoliative dermatitis:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Exfoliative dermatitis may be found in:
Causes of Exfoliative dermatitis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Exfoliative dermatitis.
Atopic dermatitis:
Causes
(Professional Guide to Diseases (Eighth Edition))
The cause of atopic dermatitis is still unknown. However, several theories attempt to explain its pathogenesis. One theory suggests an underlying metabolically or biochemically induced skin disorder that’s genetically linked to elevated serum immunoglobulin (Ig) E levels. Another theory suggests defective T-cell function.
Exacerbating factors of atopic dermatitis include irritants, infections (commonly caused by Staphylococcus aureus), and some allergens. Although no reliable link exists between atopic dermatitis and exposure to inhalant allergens (such as house dust and animal dander), exposure to food allergens (such as soybeans, fish, or nuts) may coincide with flare-ups of atopic dermatitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dermatitis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The cause of atopic dermatitis is unknown, but a genetic predisposition may be exacerbated by such factors as food allergies, infections, irritating chemicals, temperature and humidity, and emotions. Approximately 10% of childhood cases are due to allergy to certain foods, particularly eggs, peanuts, milk, fish, soy, and wheat. Atopic dermatitis tends to flare up in response to extremes in temperature and humidity. Other causes of flare-ups are sweating and psychological stress.
An important secondary cause of atopic dermatitis is irritation, which seems to change the epidermal structure, allowing immunoglobulin (Ig) E activity to increase. Consequently, chronic skin irritation usually continues even after exposure to the allergen has ended or after the irritation has been systemically controlled.
Atopic dermatitis is most common in infants, usually developing between ages 1 month and 1 year, commonly in those with strong family histories of atopic disease. At least half of those cases clear by age 36 months. These children often acquire other atopic disorders as they grow older. Typically, this form of dermatitis flares and subsides repeatedly before finally resolving during adolescence. However, it can persist into adulthood. In adults, it’s generally chronic or recurring.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Wilson's disease:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Wilson’s disease is inherited as an autosomal recessive trait only when both parents carry the abnormal gene. There is a 25% chance that carrier parents will transmit Wilson’s disease (and a 50% chance that they will transmit the carrier state) to each of their offspring. The disease usually occurs among eastern Europeans, Sicilians, and other southern Italians.
Wilson’s disease causes excessive intestinal absorption of copper and subsequent decreased excretion of copper in the stool. Copper accumulates first in the liver. As liver cells die, they release copper into the bloodstream, which carries it to other tissues. For example, in the kidneys, excretion of excessive amounts of unbound copper in urine (hypercupriuria) results from ceruloplasmin deficiency, a serum enzyme normally bound to copper. The deposit of copper in the tissue decreases serum copper (hypocupremia).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
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
Arthritis/Dermatitis:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑Lyme disease
❑Erythema nodosum
❑Rheumatoid arthritis
❑Systemic lupus erythematosus
❑Psoriatic arthritis
❑Disseminated gonococcemia
❑Sarcoidosis
❑Scleroderma
❑Dermatomyositis
❑Reiter syndrome
❑Rheumatic fever
❑Behçet syndrome
❑Still disease
❑Hypersensitivity vasculitis
Clinical Findings
Lyme disease Erythema migrans, a rapidly expanding annular rash with a clearing center, is the key early finding. The site of the ixodid tick bite at the center of the lesion is usually intensely indurated, vesicular, or necrotic. The arthritis is an asymmetric oligoarthritis that usually occurs after the rash has resolved.
Erythema nodosum A prodromal syndrome of fever, chills, malaise, and polyarthralgia is followed by the development of lesions that are discrete, tender, slightly raised subcutaneous nodules on the shins or ankles. They represent a hypersensitivity reaction to group A streptococcal infection, tuberculosis, sarcoidosis, inflammatory bowel disease, or drugs such as oral contraceptives and sulfonamides.
Rheumatoid arthritis Symmetric polyarticular arthritis with synovial proliferation, especially of the wrist, and morning stiffness lasting more than 1 hour characterize the early joint involvement. Rheumatoid nodules appear over extensor surfaces. Vasculitic lesions are frequently found on the digits, appearing as small red or purpuric macules that progress to painful nodules or ulcers.
Systemic lupus erythematosus A classic butterfly rash occurs in 40% and is exacerbated by sun exposure. A diffuse maculopapular rash in areas exposed to the sun heralds disease flares. Discoid lesions and scaling plaques that range in color from red to violaceous, with central atrophy and telangiectasias, occur in 20%. Vasculitis, in the form of painful ulcers on the extremities, palpable purpura, or lupus profundus (firm nodules in the subcutaneous fat on the forehead, cheeks, buttocks, and upper arms) are found. The arthritis is typically one of symmetric fusiform swelling of the proximal interphalangeal and metacarpophalangeal joints, diffuse puffiness of the hands, and tenosynovitis.
Psoriatic arthritis Psoriatic plaques, erythematous with a silvery scale, are critical to diagnosis, but may be hidden in the scalp, umbilicus, or gluteal folds. Nail changes such as pitting or yellow discoloration of the nail plate are other clues. The arthritis typically involves the proximal interphalangeal and distal interphalangeal joints, creating sausage digits. The arthritis may become erosive, leading to telescoping of the hands. One-fourth of patients have axial skeletal arthritis.
Disseminated gonococcemia Acral lesions are typically hemorrhagic pustules, but petechiae, hemorrhagic papules, or hemorrhagic bullae can occur. Fever, rigor, tenosynovitis, and polyarthritis are other findings.
Sarcoidosis Transient maculopapular eruptions of the trunk, face, and extremities are often accompanied by uveitis, adenopathy, and parotid enlargement. Translucent reddish-brown to purple indolent plaques may develop on the face (lupus pernio), buttocks, or extremities. Joint symptoms consist of migratory transient arthralgias.
Scleroderma Early findings are primarily Raynaud phenomenon and puffy fingers. Later findings include sclerodactyly (smooth, shiny, tapered fingers with taut, bound-down skin); contractures with “claw hand” deformity; expressionless face (with thin lips, a beak-like nose, and sunken cheeks); microstomia; mat telangiectasias on the nail folds, face, lips, oral mucosa, or trunk; and calcinosis with leathery crepitation over the joints.
Dermatomyositis The classic skin manifestation is a lilac-colored heliotrope rash on the eyelids and in a butterfly distribution. Gottron papules are violaceous, scaly, flat lesions on the extensor aspect of the interphalangeal joints, elbows, knees, and medial malleoli; these occur as a late manifestation. Proximal muscle aching/weakness, not arthritis, is prominent. The patient is unable to reach overhead or arise from a chair. Neck flexors are more involved than extensors.
Reiter syndrome Arthritis, urethritis, conjunctivitis, and mucocutaneous ulcers are found. The arthritis is asymmetric, usually involving the lower extremity joints. Solitary sausage digits may be seen. Tendinitis and fasciitis are common. The mucocutaneous lesions are eroded red vesicles or papules of the corona and glans, which when confluent are called circinate balanitis. Pustules may change into thick hyperkeratotic plaques on the palms and soles, keratoderma blennorrhagicum.
Rheumatic fever There is an acute migratory polyarthritis with fever. Subcutaneous nodules appear over the bony prominences of the elbows, knuckles, ankles, scapulae, and occiput. They are associated with carditis. Erythema marginatum, appearing as evanescent pink lesions with serpiginous borders, is also associated with carditis.
Behçet syndrome The classic triad is arthritis, iritis, and oral and genital ulcerations. Recurrent aphthous ulcers are a sine qua non. They begin as macular erythema that develops into superficial gray ulcers. Scrotal or labial ulcerations are also found. Hypopyon uveitis, a hallmark, is a rare finding. The arthritis is primarily of the knees and ankles.
Still disease Skin lesions are red, flat, and less than 1 cm in diameter. Lesions are evanescent, occurring with fever spikes. A migratory polyarthralgia occurs.
Hypersensitivity vasculitis After an upper respiratory infection, young adults may develop palpable purpura over the extensor surfaces and buttocks. Arthritis, edema, and colicky abdominal pain, followed by bloody stools, suggests the diagnosis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Dermatitis:
Causes
(Handbook of Diseases)
The cause of atopic dermatitis is unknown, but there is a genetic predisposition exacerbated by such factors as food allergies, infections, irritating chemicals, temperature and humidity, and emotions. Approximately 10% of childhood cases are caused by allergy to certain foods, particularly eggs, peanuts, milk, and wheat.
Atopic dermatitis tends to flare up in response to extremes in temperature and humidity. Other causes of flare-ups are sweating and psychological stress.
An important secondary cause of atopic dermatitis is irritation, which seems to change the epidermal structure, allowing immunoglobulin (Ig) E activity to increase. Consequently, chronic skin irritation usually continues even after exposure to the allergen has ended or after the irritation has been systemically controlled.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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