Did you notice skin redness or rash on your trunks or inner limbs? Are you worried it can be a symptom of a medical condition that leads to rheumatic heart disorder? Read on to know all about this skin condition, including its causes, symptoms, diagnosis and treatment options.
Erythema Marginatum Definition
Erythema Marginatum is characterized as a skin rash that occurs on the trunk and its proximal extremities. It is associated with acute rheumatic fever and appears as rings, lasting for months. Face, soles of the feet and the palms of the hands are usually unaffected in most of the cases. It is painless and itchy, hence often goes unreported and ignored.
Erythema Marginatum Types
As per doctors and physicians, this rare skin condition in nothing but a symptom that indicates the presence of an underlying disorder. It is divided into two types which include:
Erythema Marginatumm perstans
It is a chronic form of Erythema Marginatum which exhibits skin lesions on both legs and arms. The relapses reoccur quite frequently and hence the eruption seems almost permanent.
Erythema Marginatumm rheumaticum
It is another form of Erythema Marginatum, which is symptomless and is superficial in occurrence. It exhibits skin lesion on the surface of the trunk and limbs.
Erythema Marginatum Epidemiology
This form of Erythema is most common in light skinned individuals. Although it can affect people of all ages, the incidence rate of this medical condition peaks in males than in females. Measuring between 0.5 to 2 centimeters in diameter, this skin condition is so uncommon it is witnessed in only 2-3% of rheumatic fever cases.
Erythema Marginatum Associated Disorders
It is an early characteristic of rheumatic fever and is associated with Jones criterion. As per studies, this medical condition is often linked with arthritis, fever, carditis, polyarthritis, mild myocarditis and Sydenham’s chorea. In few cases of allergic drug reactions, glomerulonephritis and sepsis, traces of this skin condition has been found.
Erythema Marginatum Symptoms
The onset of this skin condition is exhibited by circular rings with a pale center. The macular rings acquire a reddish or pinkish color with time. Such characteristics are similar to other exanthema which may arise due to any viral infection or disease. Below-mentioned are the list of features which differentiate it from other skin eruptions:
- Slightly raised rings
- No rashes on the face
- Rashes turn pale under pressure
- Lasts for minutes to hours or weeks
- Can reoccur
- Occurs on the extensor surfaces
- Pink circular rings
- Non itchy
- Appears like a smoke ring
Erythema Marginatum Causes
Skin specialists consider this type of Erythematic to be idiopathic or triggered by an underlying medical condition. Among all other possible causes, rheumatic fever is the most common reason of all. It is an inflammatory disorder whose incidence is prevalent in children aged between five and 15. Along with it, there are a handful of other factors which may give rise to this condition including:
- Drugs (cimetidine, penicillin, chloroquine)
- Lyme disease
- Infection (Ascaris lumbricoides, Candida albicans, Escherichia coli)
- Malignancy (breast cancer, leukemia, lymphoma and squamous cell carcinoma)
- Hereditary Angioedema
Erythema Marginatum Diagnosis
Diagnosis is focused on the existence of clinical features that indicate acute rheumatic fever, using modified Jones criteria. In a few cases, the diagnosis is confirmed using skin biopsy. The skin rash on the surface of the trunk serves as a diagnostic clue and is prevalent in children than in adults.
Erythema Marginatum Differential Diagnosis
It is generally confused with similar conditions like erythema nodosum, erythema migrans, erythema multiforme.
Difference between Erythema Marginatum and Erythema Migrans (Erythema Marginatum vs Erythema Migrans)
Erthema migrans appears within a month after a tick bite. Erythema migrans looks similar to Erythema Marginatum except the ‘bull’s eye’ appearance in the middle which is missing in the latter. This feature helps to differentiate migrans from marginatum.
Difference between Erythema Marginatum and Erythema Multiforme (Erythema Marginatum vs Erythema Multiforme)
Erthema multiforme is mildy itchy (in some cases it is severe) in nature, on the other hand, erythema marginatum is not itchy. Both of the conditions have different appearance.
Erythema Marginatum Treatment
Treatment of this skin condition centers on the diagnosis of the patient. If the patient is diagnosed with rheumatic fever, the treatment is focused on managing the infectious disease. Cases where the manifestation of Erythema Marginatum is as a result of hereditary Angioedema, the treatment concentrates on curing the said condition.
For symptoms associated with Rheumatic fever, certain treatments are done to lessen the severity of the rashes. Such treatments include:
- Salicylates such as aspirin
- Anti-inflammatory drugs such as corticosteroids
- Regular Penicillin injections
- Digoxin, ACE inhibitors, beta blockers and diuretics if carditis is present
Drugs or any other medication that can worsen the rash should be strictly avoided. Withdrawal from foods that can trigger an allergic reaction is necessary to avert the onset of this uncommon form of Erythema. Antibiotic treatments are recommended to treat reactions caused by an infection.
Erythema Marginatum Complications
The condition itself does not pose any serious complication, even if it may last for weeks or months. Since it is not a disease in its own sense, it presents no complication, however, patients can suffer from Sydenham’s chorea or cardiac disease due to the rheumatic fever.
Erythema Marginatum Prognosis
If rheumatic fever recurs during the first three-five years after the first episode, patients are prescribed to take low-dose antibiotics by doctors. If the heart valves are involved, heart complications may arise.
Erythema Marginatum ICD9 Code
The ICD9 code of this medical condition is 695.8.
Patients with Erythema Marginatum conjointly with fever and joint pain must be diagnosed for rheumatic fever. The quicker the treatment is offered, the more effective it will be for the patient and prevents future complications to arise.
Erythema Marginatum Pictures