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Erythema is redness of the skin caused by increased blood flow to the capillaries. There are many causes and manifestations of erythema, including photosensitivity, erythema multiforme, and erythema nodusum. Photosensitivity refers to a skin reaction in response to the sun; it tends to occur when something, such as an infection or a medication, increases a person's sensitivity to ultraviolet radiation. Erythema multiforme is characterized by spots, blisters, or other lesions on the skin and usually results from a reaction to medications, infections, or illness. Erythema nodosum is a form of erythema that is accompanied by nodules, small round masses, typically on the arms and legs.
half of all cases of either erythema multiforme or erythema nodosum, the exact
cause is not identified. The following are examples of what may precipitate
these skin reactions.
herpes simplex virus (HSV) and pneumonia caused by a particular type of
organism called mycoplasma; influenza A and Epstein–Barr virus (the
organism that causes mononucleosis) may also lead to erythema multiforme
and other antibiotics such as a class containing sulfa; anticonvulsant
medications; 5-fluorouracil used for certain forms of cancer
tuberculosis and HSV
tissue disorders such as lupus
contraceptives; a class of antibiotics containing sulfa.
on the other hand, are at greater risk for erythema nodosum.
sun exposure increases the risk for erythema multiforme.
with a family history of skin conditions have a greater chance of developing
either erythema multiforme or erythema nodosum.
fever, itching of skin (before lesions appear)
outbreak of spots, bumps, and lesions (typically on knees, elbows, palms,
hands, feet, and mouth; trunk in severe cases)
lesions (central lesion surrounded by concentric rings of normal and red
infectiosum (caused by a virus and known as fifth disease)—facial rash and
rash on arms lasting about two weeks
fatigue, flu-like symptoms (before lesions appear)
of nodules (small round masses)?and lesions on shins, forearms, thighs, and
hard, painful lesions become soft and bluish, and fade to yellow and brown
syndrome (SJS) and toxic epidermal necrolysis (TEN), perhaps the most severe
forms of erythema multiforme, are characterized by 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 eventually
worsen to include peeling and detachment of the skin, pus-like infections,
fluid loss, and even death.
any underlying diseases and avoid any known triggers (certain medications, for
example); it is also important to avoid being outside in the sun when taking
certain medications that contribute to photosensitivity.
providers will treat any underlying diseases, eliminate drugs that may
contribute to symptoms, and take steps to control current symptoms. While mild
cases may not require treatment, bed rest and medication may be necessary for
more severe cases.
providers may prescribe various medications in the appropriate clinical setting,
to treat particular infections
medications such as acyclovir and valacyclovir
compresses—a solution used to soothe skin conditions, particularly
drugs, such as azathioprine, have shown mixed results
immunoglobulin has been used experimentally for SJS and TEN
for particular skin lesions; oral prednisone to reduce symptoms of erythema
nodosum and to prevent recurrence of erythema multiforme, although this use
order to heal any type of erythema, the underlying cause of the skin condition
must be treated. Certain complementary and alternative therapies, though, help
the immune system
found in some dietary supplements and topical preparations such as gels,
ointments, or lotions may protect against skin damage caused by ultraviolet
(UV) sun rays when used prior to exposure. Antioxidants are molecules that
scavenge free radicals (highly active molecules that can injure cells and
contribute to disease, including skin damage).
following substances with antioxidant activity were found in studies to have
benefit in protecting the skin in the circumstances described:
appear to be effective at preventing skin damage when taken orally with or
without vitamin E prior to sun exposure. Carotenoids can be found in fruits
and vegetables as well as supplement form; beta-carotene is one common type.
such as quercetin, may help reduce the likelihood of developing erythema
because they prevent inflammation and strengthen connective tissue; this,
however, is only a theoretical benefit that has not been studied
appears to have a protective effect when used topically in a gel, lotion, or
ointment, either alone or in combination with topical vitamin E prior to
exposure to UV radiation from the sun
C seems to be protective against developing erythema when used prior to sun
exposure in either topical or oral form, although only when used in
combination with topical or oral vitamin E
E seems to be protective when used prior to sun exposure in combination with
either vitamin C or melatonin
was used in a study as adjunctive treatment for a severe form of erythema
multiforme similar to TEN; five out of eight people treated with zinc in
addition to standard medical treatment had added benefit from this oral
tea (Camellia sinensis) may also protect against erythema caused by UV light
because it contains antioxidants, like the micronutrients described in the
section entitled Nutrition; this protection, when taken prior to exposure to
UV radiation, has been suggested by animal studies as well as a recent
preliminary human study.
traditionally used to heal damaged skin, promote lymph circulation, and
possibly treat the underlying cause of various skin conditions may be
helpful. Although these have not been tested scientifically for erythema
specifically, some examples include:
root (Arctium lappa) has been used topically for skin inflammation and wound
(Calendula officinalis) has been used topically for burns, wounds, and other
skin conditions; may be used as homeopathic remedy for these purposes as
(Hydrastis canadensis) has been used for infections, including those causing
balm (Melissa officinalis) can be applied to HSV lesions in the form of a
cream or a wash
root (Glycyrrhiza glabra) has been used topically for viruses and connective
tissue disorders; should not be used orally in the case of high blood
(Filipendula ulmaria) has been used for painful joints (as may be seen with
thistle (Silybum marianum) for chemical causes of skin lesions
elm (Ulmus fulva) in combination with goldenseal root has been applied
topically for treatment of open wounds
(Achillea millefolium) has been applied topically for skin inflammation and
is best and safest to see a trained, experienced herbalist for guidance
about the use of herbs to treat erythema.
studies suggest that homeopathic treatment with Apis may protect the skin
against the damaging effects of radiation. Although few other studies have
examined the effectiveness of specific homeopathic remedies in the treatment
of erythema, professional homeopaths may recommend the following treatments
based on their knowledge and clinical experience. Before prescribing a
remedy, homeopaths take into account a person's constitutional type. In
homeopathic terms, a person's constitution is his or her physical,
emotional, and intellectual makeup. An experienced homeopath assesses all of
these factors when determining the most appropriate remedy for a particular
mellifica?—for skin rashes that feel hot and dry and are sensitive to
touch; may be accompanied by sore throat; symptoms are relieved by cool
drinks and baths and worsened by heat and warm liquids; this remedy is most
appropriate for individuals who often feel sad, disappointed, or even
depressed; they tend to cry easily but may also be irritable and envious by
nature; they're also distinctly not thirsty but may crave milk
– for burns and skin lesions that are fairly superficial; often used after
the acute phase of the skin condition has subsided to aid in complete
toxicodendron — used for blisters and vesicles accompanied by intense
itching that worsens at night and improves with the application of heat;
this remedy is most appropriate for individuals who are generally restless
and unable to get comfortable at night
skin disorders that are accompanied by fever and intense itching; this
remedy is most appropriate for individuals who are thirsty, irritable while
sick, lazy and messy under ordinary circumstances, and who describe a
sensation of internal heat and burning; symptoms tend to improve with open,
cold air and worsen with warmth.
should be avoided in cases of erythema because it may make any inflammation
treated properly, signs and symptoms of erythema multiforme usually disappear in
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. Ten percent may die
from more severe forms of SJS. Up to 40 percent of those with TEN may die of the
condition. If the drug causing either SJS or TEN is identified and discontinued
quickly, a person's chance of survival significantly improves.
providers will monitor fluid and electrolyte levels, protein loss, and any organ
damage. Persons with erythema multiforme may need treatment in a hospital burn
unit if 20% or more of their body is affected.
raises special issues related to pregnancy. If a pregnant woman develops
erythema infectiosum (fifth disease), the virus can infect the fetus and cause
fetal anemia, heart failure, hydrops (collection of watery fluid), and even
death. Studies have also shown that pregnancy may trigger erythema nodosum.
Finally, certain medications must be avoided during pregnancy; your healthcare
provider will be able to direct your care appropriately.