Erythema
By Dr. Donna Barsky, PharmD
Erythema is a skin condition characterized by redness or rash. There are many types, including photosensitivity, erythema multiforme, and erythema nodosum.
What Causes It?
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 is characterized by raised spots or other lesions on the skin. It is usually caused by a reaction to medications, infections (especially herpes simplex virus), or illness. Erythema nodosum is a form of erythema that’s accompanied by tender lumps, usually on the legs below the knees, and may be caused by certain medications or diseases.
In half of all cases of either erythema multiforme or erythema nodosum, the exact cause is not known. In other cases, a variety of causes may result in erythema.
Erythema multiforme:
- Infection, primarily from the herpes simplex virus (HSV)
- Medications, such as penicillin and sulfa drugs; antiseizure medications; nonsteroidal anti-inflammatory drugs (NSAIDs)
Erythema nodosum:
- Infections, including mononucleosis
- Connective tissue disorders, such as lupus
- Pregnancy
- Ulcerative colitis
- Bechet disease
- Crohn disease
- Medications, such as birth control pills; sulfa drugs
Who is Most at Risk?
Men are at greater risk than women for erythema multiforme, while women are at greater risk than men for erythema nodosum. Frequent or excessive sun exposure increases the risk for erythema multiforme. People aged between 20 to 30 years of age are at greater risk of erythema nodosum, while people with a family history of skin conditions have a greater chance of developing either erythema multiforme or erythema nodosum. If a pregnant woman develops erythema infectiosum (fifth disease), the virus can infect the fetus and cause fetal anemia, heart failure, hydrops, and even death.
Signs and Symptoms
Erythema multiforme:
- Fatigue, fever, and itching (before lesions appear)
- Sudden outbreak of spots, bumps, and lesions (usually on knees, elbows, palms, hands, and feet)
- Target lesions (spots surrounded by rings of normal and red skin, looking like a target)
- Erythema infectiosum (caused by a virus and known as fifth disease), rash on face and arms lasting about two weeks
Erythema nodosum:
- Fatigue, flu-like symptoms (before lesions appear)
- Clusters of nodules (small round masses) and lesions on shins, forearms, thighs, and trunk
- Red, painful lesions become soft and bluish, and fade to yellow and brown
- Joint pain
- Arthritis
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), the most severe forms of erythema multiforme, have a different set of symptoms. Target lesions on the trunk, hacking cough, fever, and blisters around the mouth, eyes, nostrils, and anal and vaginal areas are the key symptoms of SJS. 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.
Treatment Options
Your doctor will perform a physical exam and may order a skin biopsy, throat culture, blood test, or x-ray to determine the type of erythema. These tests also may reveal any infections or medications that are contributing to symptoms.
Your doctor will treat any underlying diseases, stop any drugs that may contribute to symptoms, and take steps to control your current symptoms. Mild cases may not require treatment. Bed rest and medication may be necessary for more severe cases.
Drug Therapies
- Antihistaminesfor itching
- If you have an infection, though research suggests many cases of erythema can be resolved without antibiotics
- Antiviral medicationssuch as acyclovir and valacyclovir, if you have a virus
- Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Burrow’s compresses, a solution used to soothe skin conditions, particularly blisters
- Corticosteroids, applied to the skin (topically); corticosteroids may also be taken orally to reduce symptoms of erythema nodosum
- Intravenous immunoglobulin, used experimentally for SJS and TEN
- Photomodulation therapy, use of a light-emitting diode to accelerate the resolution of erythema
Complementary and Alternative Therapies
To treat erythema, you must treat the underlying cause. It is important to get a proper diagnosis from your doctor before using complementary and alternative therapies (CAM). Not all CAM therapies are appropriate for all people, and some may interact with conventional medicines or therapies. You should use CAM therapies only under the guidance of a physician. Some CAM therapies may be used to reduce inflammation, boost the immune system and prevent infections.
Nutrition
Antioxidants are molecules that scavenge free radicals (chemicals that can damage cells). Antioxidants also may protect skin against damage caused by ultraviolet (UV) sun rays. The following antioxidants have been shown to protect skin against damage in scientific studies. Because some of these can interact with some medications which could have a negative impact on some health conditions, speak with your physician before taking them.
- Beta-carotene and other carotenoids
- Vitamin B6
- Vitamin C
- Vitamin D
- Melatonin
- Zinc
Herbs – Flavonoids: Some plant-based antioxidants may protect skin from sun damage in healthy people. In one study, German researchers found that drinking high flavonol cocoa offered protection from the sun (the cocoa used was a special formulation that is not available commercially). In another study, pomegranate fruit extract helped protect skin cells in a test tube from UV light. It is not yet known whether taking the extract would provide any benefit. However, adding fruits and vegetables to your diet to eat more flavonoids may help. You can also take these flavonoids in dried extract form. Speak with your physician first, since certain flavonoids can interact with prescription medications.
Homeopathy
An experienced homeopath assesses all of the factors when determining the most appropriate treatment for an individual such as:
- Apis mellifica: For skin rashes that feel hot and dry and are sensitive to touch; may be accompanied by sore throat. Calendula: For burns and skin lesions that are fairly superficial.
- Rhus toxicodendron: Used for blisters and vesicles accompanied by intense itching that worsens at night and improves with the application of heat.
- Sulphur: For skin disorders that are accompanied by fever and intense itching.
Prognosis/Possible Complications
When treated properly, signs and symptoms of erythema multiforme usually disappear within four to six weeks. Symptoms of erythema nodosum, however, may reappear for up to two years. Symptoms of SJS typically disappear in a month, but when the condition is not treated properly it may lead to blindness. Both SJS and TEN can cause death. If the drug causing either SJS or TEN is identified quickly, a person’s chance of survival significantly improves.
Follow up
Your doctor will monitor fluid and electrolyte levels, protein loss, and any organ damage. People with erythema multiforme may need treatment in a hospital burn unit if 20% or more of their body is affected.
If you have any questions or concerns, please, contact Texas Star Pharmacy @3033 W Parker Rd #100, Plano, TX 75023, 972-519-8475.
