Skin problems are usually of the least importance to most of the people. Issues of skin including rashes, blisters, etc. are often ignored hoping they will be treated naturally. But some of these skin issues might lead to a bigger problem including Rheumatic heart disease.
The question is how do you know when a simple skin rash might lead to rheumatic heart disease? Here in this article, we will discuss Erythema Marginatum – a skin rash that plays a major role in rheumatic fever.
What Is Erythema Marginatum?
Erythema Marginatum is a rare, non-painful dermatological disorder that is marked by the presence of a number of pink rings around the trunk and inner regions of the limbs and arms.
This rare condition of the skin affects many children and adults across the globe. Often, it goes unnoticed.
The pink rings are usually found on the surfaces that lie beneath the extensor muscles which are used to straighten or extend a limb or any other part of the body. During the condition, these rashes will appear and disappear periodically.
This transition can continue for months. The disorder mostly affects the light-skinned population. It is responsible for about 2 to 5 percent of the rheumatic fever cases. It affects males twice as often as females.
Types Of Erythema Marginatum
This rare, dermatological condition is categorized into two types:
1. Erythema Marginatum Rheumatic
This form of Erythema Marginatum is asymptomatic. It is associated with Rheumatic fever. This causes multiple eruptions scattered over the upper area of legs and arms. The causes of this condition still remain unknown.
2. Erythema Marginatum Perstans
This form of Erythema Marginatum is usually seen in feet and the arms. Caused by some underlying medical conditions, this rash spreads to other parts of the body except for the soles of the feet and palms of the body.
The lesions grow at a considerably higher rate and can be deep or superficial.
Symptoms Of Erythema Marginatum
a. Erythema Marginatum causes the doughnut-shaped rashes.
b. In the case of some of the patients, the rashes might appear as serpiginous where these lesions have a wavy shape similar to the shape of a snake. This type of growth pattern is because of the slow development of the condition.
c. The rings are not elevated. They can be either open or close.
d. The disorder affects multiple parts of the body. However, no circular rings appear on the face of the patient.
e. In the condition, the rashes have pink, macular rings with pale centers. These circles are small, flat, and have distinct and visible circumscribed changes in the skin color. These rings are neither depressed nor elevated. They have sharp and well-demarcated edges.
f. The rings are connected to each other adjacently. This gives rise to a polycyclic configuration that consists of many cyclic configurations. This is the reason why the skin condition spreads peripherally.
g. The rashes do not cause the irritation or any itchy sensations in the skin because the circular areas are non-pruritic. If the body is subjected to an increase in temperature, these macules might get worse.
So, if you are taking a hot shower, relax if your rings get worse because they will reduce after attaining the normal temperature.
h. The lesions’ diameter can vary from small centimeters to few inches. In most cases, these lesions start on the lower trunk and then slowly make their way in the upward direction. As the upper lesions start becoming visible, the lower lesions start to disappear.
i. In the case of some patients, there is a development of rashes that can be either dull red or violet or brown in color. This is due to the residual hyperpigmentation.
Causes Of Erythema Marginatum
During the Erythema Marginatum, both the deep as well as superficial dermal vessels have acute lymphohistiocytic thickening.Histiocytes cells, including the lymphocytes and the phagocytic, are the main cause for triggering the blood vessels’ inflammation.
This inflammation is responsible for the sudden transformation of the skin’s epidermal layer.The exact reason for this skin disorder is still unknown. Many believe that the disorder might even arise spontaneously.However, we can list a number of factors that possibly produce these macular skin rashes. Some of this includes:
1. Rheumatic Fever
Streptococcus pyrogenes is the bacterium responsible for this inflammatory disorder. This disorder can affect skin, joints, brain and even heart.
The most common symptom of this disease is the eruption of ring-shaped rashes on the skin.High ever worsen the situation by intensifying the rashes turning them more severe. When a number of such rings aggregate, the macules start taking an appearance like a snake.
Many people have sensitive skin. They show reactivity or excess intolerance towards a certain spectrum of stimuli or agents.
These agents might generate an allergic reaction to the skin in the form of these rashes.Food allergy is one of the most frequent causes of Erythema Marginatum. Tomatoes and Blue cheese are one of the most common food allergens.
Malignancy is considered a serious symptom in Erythema Marginatum. It is also present as a symptom in many life-threatening diseases including leukemia, breast cancer, squamous cell carcinoma, and lymphoma.
Sometimes, due to an array of infections caused by Ascaris Lumbricoid, Candida Albicans or Escherichia coli, small reddish eruptions can occur.
5. Drugs Or Chemicals
People, who take regular dosage of Antimalarial chloroquine or hydroxychloroquine, penicillin, cimetidine, and gold, can be linked directly to this dermatological condition.
6. Lyme Disease
Lyme disease is caused by the infection with a bacterium, Borrelia Burgdorferi. The damaging pathogen finds its way inside the human body through bites from infected ticks. The symptom of Lyme disease is the occurrence of Erythema Marginatum.
A hormonal change in a pregnant woman is another factor considered responsible for the occurrence of Erythema Marginatum.
However, the pink rashes are usually resolved right after the delivery. The onset of Erythema Marginatum can be seen in children of age 15 years, starting to hit puberty because the start of puberty in teenagers is activated by hormonal changes.
Diagnosis Of Erythema Marginatum
The diagnosis or Erythema Marginatum is completely based on the observation and the examination of the patients’ skin.
A thorough study of the medical history of the patient is very important to the doctor to check the presence of any other associated disorder or usage of any drug.
A skin biopsy is important to check for the presence of any associated cutaneous disorder. For this, a small section of the outermost layer of the macular skin is taken for examination.
If there is an infection, the swab culture is taken to the labs to detect the presence of the causative microorganism.
To diagnose Rheumatic fever, there are a number of tests including:
- The complete blood count evaluation by a blood test
- To check for the presence of Streptococcus Pyogenes, a throat swab is examined in the lab.
- To check the proper functioning of the chambers and valves of the heart, an Electrocardiogram (ECG) is needed.
The symptoms of Erythema Marginatum is similar to that of Urticaria or Hives, the condition that is marked by the red, itchy and raised areas of skin of different shapes and sizes.
This kind of eruption on the skin is mostly because of a drug reaction.
Unlike Hives, the rashes in Erythema Marginatum are neither elevated nor pruritic. These few points might come in handy when the physician needs to distinguish Erythema Marginatum from ordinary Hives.
Treatment Of Erythema Marginatum
1. Erythema Marginatum is not a disease condition. Basically, it is just a symptom of another underlying condition. So, the treatment of the dermal condition should be directed towards the cause of that rash.
2. Once, the cause of the rash is identified and treated, the rash starts to disappear on its own. It takes no time and no specific treatment to recover from this rash.
3. Rheumatic fever is one of the most common causes of Erythema Marginatum. So, the treatment of these rashes generally focuses on eliminating the bacteria responsible for the fever.
The patient undergoes a full course of antibiotic treatment. It’s time length depends on the severity of the fever. Once the fever is treated, the rash starts to disappear automatically.
4. For the rash, what we can do is, we should not aggravate it. Any medication that increases the body temperature needs to be changed immediately. Stay away from all the food that might increase the heat in the body.
This might worsen the rashes. Also, if you are allergic to certain medications or food, stay away from it as it will worsen Erythema Marginatum.
5. So basically, the condition’s management requires treatment of the underlying disorder as well as removal of any medication or food that aggravates the rash. Avoid the food that evokes allergic reactions.
6. Rheumatic fever is the most common cause of this condition. It is important that it is treated by appropriate means. The bacterium needs to be eradicated. This can be accomplished using penicillin or Benzathine Benzylpenicillin.
This prevents the throat from another bacterial infection. Patients that show inflammatory response might require corticosteroids. If there is too much pain, you can use salicylates. This will also reduce the fever.
7. If there is some serious heart damage, heart surgery is performed by replacing the damaged valves.
After the surgery, make sure to take a follow-up visit to the doctor to prevent any damage to the heart due to the strep infection.
Bed rest is suggested to the patient for at least one week or till the symptoms including the inflammation and rashes disappear.
Complications Of Erythema Marginatum
Usually, this dermal condition does not involve any serious consequences. However, conditions like Rheumatic fever might raise certain conditions including Myocarditis, Subcutaneous nodules, Polyarthritis and Sydenham’s chorea.
Prevention Of Erythema Marginatum
a. The best way to prevent Erythema Marginatum is through timely recognition and diagnosing the bacterial infection causing the rheumatic fever. This dermal condition is not contagious or fatal. It can easily recover on its own.
b. The long-term antibiotic treatment can help prevent the occurrence of rheumatic fever. Medical experts are attempting to develop a vaccine for completely eliminating the rheumatic fever, which would prevent the formation of the macular rings.
c. If you have cold, strep doctor and pink rashes, consult your doctor immediately. If you delay in approaching your doctor, your chance of getting thematic fever will increase.
d. So, the point is that Erythema Marginatum is not a disease condition. It is just a symptom of other underlying conditions of the skin. They heal themselves after the bacterium responsible for the underlying condition is removed.
However, if the rashes get worse, it is suggested to consult your doctor regarding Erythema Marginatum.