What are the other Names for this Condition? (Also known as/Synonyms)

• Erythema Marginatum Rheumatica

What is Erythema Marginatum? (Definition/Background Information)

• Erythema Marginatum is described as a transient skin rash that occur as red rings on the body and limbs. It is an uncommon condition that is generally associated with rheumatic fever during its early stages
• Erythema Marginatum is seen in both children and adults. It is believed that the rash develops secondary to an underlying condition, or even due to an adverse drug reaction
• In a majority, the skin lesions do not present any pain or itchy sensation. However, they may present cosmetic concerns in some individuals
• Adequate treatment of the underlying condition can help resolve Erythema Marginatum. However, the skin condition can return, since it is dependent on the underlying/associated condition, which may recur
• The prognosis of Erythema Marginatum is good in a majority of cases. It is known to resolve once the underlying condition is managed appropriately

Who gets Erythema Marginatum? (Age and Sex Distribution)

• Erythema Marginatum may occur at any age; both children and adults may be affected
• Both males and females may be affected
• Individuals of all racial and ethnic background can be affected

What are the Risk Factors for Erythema Marginatum? (Predisposing Factors)

The risk factors for Erythema Marginatum may include a variety of factors such as:

• Rheumatic fever: Erythema Marginatum is seen in nearly 5% of the individuals with rheumatic fever
• Allergic reaction to certain antibiotics such as a combination of amoxicillin and clavulanate
• Lyme disease
• Hereditary angioedema
• Renal conditions such as glomerulonephritis
• Sepsis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erythema Marginatum? (Etiology)

• It is widely considered that Erythema Marginatum is not a disorder by itself rather, a manifestation of other systemic conditions
• Rheumatic fever caused by streptococcal infection is associated with Erythema Marginatum in many cases
• The skin rash is also seen with many other health conditions, such as allergic drug reactions, Lyme disease, and in the inherited form of angioedema

It is important to note that Erythema Marginatum is non-contagious and it cannot be transmitted from one individual to another. However, the underlying condition causing Erythema Marginatum may or may not be transmissible.

What are the Signs and Symptoms of Erythema Marginatum?

The signs and symptoms of Erythema Marginatum include:

• The rash occurs as red rings on any part of the body skin; the rashes are usually round or ring-like
• The rashes are well-defined macules that are slightly elevated with irregular borders
• Itching and pain are not associated with Erythema Marginatum rashes
• The rashes are described as being ‘evanescent’, meaning they disappear quickly (sometimes, within hours). However, newer rashes may form at other sites, which makes it seem like the rashes are migrating
• The size of the rash is typically less than 5 mm, but many rashes may coalesce to become larger lesions
• Blanching of the rashes on application of pressure may be observed
• Usually, the chest, back, and upper and lower limbs are involved. On the limbs, it is the extensor surfaces that are affected
• Rashes are typically not noted on the face
• The skin rashes may ‘come and go’ over a period of many months
• Occasionally, it may precede the symptoms of hereditary angioedema
• Erythema Marginatum is often difficult to detect on dark-skinned individuals

How is Erythema Marginatum Diagnosed?

A diagnosis of Erythema Marginatum may involve the following:

• A thorough medical history assessment and complete physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests to diagnose underlying disorders, including rheumatic fever
• Culture studies to rule out any infection
• Imaging studies to diagnose underlying conditions, if any
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erythema Marginatum?

The complications of Erythema Marginatum are typically from the presence of the underlying disorder/condition. In general, the complications may include:

• Cosmetic issues that result in emotional stress
• Recurrence of the red skin rashes

How is Erythema Marginatum Treated?

The treatment of Erythema Marginatum depends on the underlying condition. Treating the underlying condition successfully can result in a cure, and this may include:

• Administration of antibiotics for rheumatic fever, Lyme disease, and sepsis
• Use of medications to treat inherited angioedema
• Treatment of any other symptoms

How can Erythema Marginatum be Prevented?

Currently, there are no known methods to prevent the occurrence of Erythema Marginatum. However, one may lower the risk for the skin condition by considering the following factors:

• Treating any underlying infections/conditions early and adequately
• Informing one’s physician about any medication allergies

What is the Prognosis of Erythema Marginatum? (Outcomes/Resolutions)

• The prognosis for Erythema Marginatum is usually good, in many cases, since it is a benign skin condition
• However, the overall prognosis is also dependent on the underlying cause and severity of the symptoms presented

Additional and Relevant Useful Information for Erythema Marginatum:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse