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Erythema
By
Dr. Mohamad Nasr
Lecturer Of
Dermatology & Venereology
Erythema
Erythema
is a skin condition
characterized by redness or
rash.
Types
1.
2.
3.
Photosensitivity
Erythema multiforme
Erythema nodusum.
Photosensitivity
 Photosensitivity
is caused by a reaction
to sunlight and tends to occur when
something, such as an infection or a
medication, increases your sensitivity
to ultraviolet radiation.
Erythema multiforme

Erythema multiforme is an acute or subacute selflimiting disease that involves the skin and mucous
membranes.

The


etiology
is
unclear.
However, an
immunologically mediated process triggered by herpes
simplex or Mycoplasma pneumoniae, drugs, radiation
or malignancies, is probable.
Age: the ages of 20 and 30 years
Sex: The disease more frequently affects young men.
Clinical Features




Fatigue, fever, itching (before lesions appear)
The
skin
manifestations
consist
of
erythematous, flat, round macules, papules, or
plaques, usually in a symmetrical pattern.
-The characteristic skin patterns are target- or
iris-like lesions.
Skin bullae may occasionally be seen.
Stevens-Johnson syndrome (SJS) &
toxic epidermal necrolysis (TEN)






The most severe forms of erythema multiforme.
The oral lesions are always present, and are
characterized by extensive vesicle formation, followed
by painful erosions covered by grayish-white or
hemorrhagic pseudomembranes.
Drugs usually trigger the disease
Age: young adults
Sex: Male predilection
A person with TEN will have symptoms of SJS that
worsen to include peeling and detachment of the skin,
pus-like infections, fluid loss and even death.
Stevens-Johnson syndrome
Toxic Epidermal Necrolysis
Treatment
1.

Prevention;
Treat any underlying diseases and avoid any
known triggers (certain medications, for
example).
2. Drug Therapies;
 Antihistamines for itching
 Antibiotics, if you have an infection
 Antiviral medications such as acyclovir and
valacyclovir, if you have a virus
 Corticosteroids -- applied to the skin (topically);
corticosteroids may also be taken orally.
Treatment of TEN & SJS;
Management should be in an intensive care unit:
 Supportive care (warm environment, fluid replacement,
correction of electrolyte disturbances, prevention of
sepsis, suction of oropharynx)
 Analgesics
 Intravenous antibiotics for sepsis
 Debridement of frankly necrotic skin
 Non-stick occlusive burns dressings
 Granulocyte colony stimulating factor for neutropaenia
 Intravenous immunoglobulins or ciclosporin to arrest
the cytotoxic process
Erythema nodosum (EN)




EN is an acute, nodular, erythematous eruption
that usually is limited to the extensor aspects of
the lower legs.
EN is a hypersensitivity reaction that may occur
in association with several systemic diseases or
drug therapies, or it may be idiopathic.
Age: peak 20 - 30 years of age
Sex: Female predilection
Etiology
1.
2.
3.
4.
5.
Streptococcal infections are the most frequent
Drugs
Sarcoidosis
Autoimmune disorders
Inflammatory diseases of the bowel
Clinical features





EN begins with flulike symptoms of fever and
generalized aching.
Lesions begin as red tender nodules . Lesion borders
are poorly defined and vary from 2-6 cm.
During the first week, lesions become tense, hard and
painful.
During the second week, they may become fluctuant,
as in an abscess, but do not suppurate or ulcerate.
Individual lesions last approximately 2 weeks, but
occasionally, new lesions continue to appear for 3-6
weeks.
Treatment


In most patients, EN is a self-limited
disease and requires only symptomatic
relief using NSAIDs (eg, indomethacin) ,
cool wet compresses, elevation and bed rest.
Corticosteroids are effective but seldom
necessary in self-limited disease.