STUDY - Technical - New Dacian's Medicine
Erythema
(Classical / Allopathic Medicine)
Dilated or
congested blood vessels produce red skin, or erythema, the
most common sign of skin inflammation or irritation. Erythema
may be localized or generalized and may occur suddenly or
gradually. Skin color can range from bright red (in someone
with an acute condition) to pale violet or brown (in someone
with a chronic condition). Erythema must be differentiated
from purpura, which causes redness from bleeding into the
skin. When pressure is applied directly to the skin, erythema
blanches momentarily, but purpura doesn't.
Erythema usually
results from changes in the arteries, veins, and small vessels
that lead to increased small-vessel perfusion. Drugs and
neurogenic mechanisms can also allow extra blood to enter the
small vessels. In addition, erythema can result from trauma
and tissue damage as well as from changes in supporting
tissues, which increase vessel visibility. Many rare disorders
can also cause this sign. (See Rare causes of erythema.)
ALERT:
If the patient has sudden progressive erythema:
- quickly take his vital signs
- assess him for a rapid pulse, dyspnea, hoarseness, and agitation, all of which may indicate anaphylactic shock
- initiate emergency measures, if necessary.
If the patient's erythema isn't associated with anaphylaxis, perform a focused assessment.
If the patient has sudden progressive erythema:
- quickly take his vital signs
- assess him for a rapid pulse, dyspnea, hoarseness, and agitation, all of which may indicate anaphylactic shock
- initiate emergency measures, if necessary.
If the patient's erythema isn't associated with anaphylaxis, perform a focused assessment.
HISTORY:
Ask the patient how long he has had the erythema and where it first began.
Ask the patient if the erythema is associated with pain or itching.
Ask the patient if he recently had a fever, upper respiratory tract infection, or joint pain.
Review the patient's medical history for skin disease and other illnesses. Also, ask the patient about a family history of allergies, asthma, or eczema.
Ask the patient if he has been exposed to someone who has had a similar rash or is now ill.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake and recent immunizations.
Ask the patient about food intake and exposure to chemicals.
Ask the patient how long he has had the erythema and where it first began.
Ask the patient if the erythema is associated with pain or itching.
Ask the patient if he recently had a fever, upper respiratory tract infection, or joint pain.
Review the patient's medical history for skin disease and other illnesses. Also, ask the patient about a family history of allergies, asthma, or eczema.
Ask the patient if he has been exposed to someone who has had a similar rash or is now ill.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake and recent immunizations.
Ask the patient about food intake and exposure to chemicals.
Rare causes of
erythema
In exceptional cases, the patient's erythema may be caused by one of these rare disorders:
- acute febrile neutrophilic dermatosis, which produces erythematous lesions on the face, neck, and extremities after a high fever
- erythema ab igne, which produces lacy erythema and telangiectases after exposure to radiant heat
- erythema chronicum migrans, which produces erythematous macules and papules on the trunk, upper arms, or thighs after a tick bite
- erythema gyratum repens, which produces wavy bands of erythema and is commonly associated with internal malignancy
- toxic epidermal necrolysis, which causes severe, widespread erythema, tenderness, and skin loss as a result of staphylococci or, possibly, the use of certain drugs.
In exceptional cases, the patient's erythema may be caused by one of these rare disorders:
- acute febrile neutrophilic dermatosis, which produces erythematous lesions on the face, neck, and extremities after a high fever
- erythema ab igne, which produces lacy erythema and telangiectases after exposure to radiant heat
- erythema chronicum migrans, which produces erythematous macules and papules on the trunk, upper arms, or thighs after a tick bite
- erythema gyratum repens, which produces wavy bands of erythema and is commonly associated with internal malignancy
- toxic epidermal necrolysis, which causes severe, widespread erythema, tenderness, and skin loss as a result of staphylococci or, possibly, the use of certain drugs.
PHYSICAL
ASSESSMENT:
Assess the extent, distribution, and intensity of the 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.
Assess the extent, distribution, and intensity of the 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.
SPECIAL
CONSIDERATIONS:
Because erythema can cause fluid loss, closely monitor and replace fluids and electrolytes, especially if the patient has burns or widespread erythema. Be sure to withhold all medication until the cause of erythema has been identified.
Because erythema can cause fluid loss, closely monitor and replace fluids and electrolytes, especially if the patient has burns or widespread erythema. Be sure to withhold all medication until the cause of erythema has been identified.
PEDIATRIC
POINTERS:
Erythema toxicum neonatorum (newborn rash), a pink papular rash, normally develops during the first 4 days after birth and spontaneously disappears by the 10th day.
Neonates and infants can develop erythema from infections and other disorders. For instance, candidiasis can produce thick, white lesions over an erythematous base on the oral mucosa as well as diaper rash with beefy red erythema.
Roseola, rubeola, scarlet fever, granuloma annulare, and cutis marmorata may all cause erythema in children.
Erythema toxicum neonatorum (newborn rash), a pink papular rash, normally develops during the first 4 days after birth and spontaneously disappears by the 10th day.
Neonates and infants can develop erythema from infections and other disorders. For instance, candidiasis can produce thick, white lesions over an erythematous base on the oral mucosa as well as diaper rash with beefy red erythema.
Roseola, rubeola, scarlet fever, granuloma annulare, and cutis marmorata may all cause erythema in children.
AGING ISSUES:
Elderly patients commonly have well-demarcated purple macules or patches, usually on the back of the hands and on the forearms. Known as actinic purpura, this condition results from blood leaking through fragile capillaries. The lesions disappear spontaneously.
Elderly patients commonly have well-demarcated purple macules or patches, usually on the back of the hands and on the forearms. Known as actinic purpura, this condition results from blood leaking through fragile capillaries. The lesions disappear spontaneously.
PATIENT
COUNSELING:
If the patient has a chronic disorder that causes erythema, teach him about the character of a typical rash so he can be alert to flare-ups. Also, advise him to avoid sun exposure and to use sunblock when appropriate.
If the patient has a chronic disorder that causes erythema, teach him about the character of a typical rash so he can be alert to flare-ups. Also, advise him to avoid sun exposure and to use sunblock when appropriate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)