Erythema marginatum rheumatica

Erythema marginatum rheumatica is a rash that is associated with acute rheumatic fever. Rheumatic fever is a multisystem disease that occurs after infection with a Lancefield group A streptococcus.

The rash represents one of the major Jones' criteria for the diagnosis of rheumatic fever.¹ Die Jones-Kriterien stammen aus dem Jahr 1944, wurden jedoch 1992 geändert,² und erneut im Jahr 2015.³

Der Begriff erythema annulare wird manchmal für Erythema marginatum verwendet, aber erythema annulare centrifugum wird als eines der figurativen oder gyraten Erytheme klassifiziert. Es kann auf eine Überempfindlichkeit, auf Malignität, Infektion, Medikamente oder Chemikalien zurückzuführen sein, oder es kann idiopathisch sein. Erythema marginatum ist per Definition wirklich mit rheumatischem Fieber assoziiert.

Erythema marginatum rheumatica epidemiology

In most developed countries, rheumatic fever has become very rare. Erythema marginatum rheumatica occurs in fewer than 6% of cases of rheumatic fever.⁴ Allerdings bleibt das rheumatische Fieber unter den Aborigines und Torres-Strait-Insulaner-Gemeinschaften in Australien weit verbreitet,⁵ und unter den Māori- und Pazifik-Bevölkerungen in Neuseeland.⁶

In the 1990s there appeared to be a resurgence of rheumatic fever in the USA.⁷ Eine große Serie aus Pittsburgh berichtete, dass Erythema marginatum bei Patienten mit rheumatischem Fieber selten vorkommt.⁸

One of the best descriptions of erythema marginatum was given by Professor Perry of Bristol. It was based on a case series published in Archives of Disease in Childhood.⁹ Dies wird unten unter 'Weiterführende Literatur & Referenzen' ausführlich beschrieben.'

Characteristically the eruption starts as an erythematous macule. It gradually spreads out and, as it does so, the skin in the centre of lesions returns to normal, thus forming the typical spreading marginate or annular eruption. Where the spreading circles of the rash meet they coalesce forming a larger ring, or a serpiginous rash.

The usual sites of its occurrence are on the front of the abdomen and front and back of the chest. It can develop on the limbs but almost never on the face. It may, and usually does, appear at the onset of an acute attack or relapse of rheumatism but it is frequently present when there are no other signs of active infection and the ESR is normal. Once it has occurred it tends to come and go lasting from one or two days to months or years.

Subcutaneous nodules may also appear in rheumatic fever. They are closely associated with carditis.¹⁰

Betrachten Sie Arzneimittelreaktionen. Es könnte aussehen wie Urtikaria das sich auch ziemlich schnell ändern kann, aber bei Erythema marginatum gibt es keinen Juckreiz.

Erythema marginatum is also recognised as the classical skin finding in hereditary angio-oedema.¹¹

Diagnosis is based on presence of additional clinical features suggestive of acute rheumatic fever, using modified Jones' criteria.

Evidence of streptococcal infection is the essential criterion and this can be established by:

• Throat swab which grows Group A beta-haemolytic streptococcus.

• Raised or increasing streptococcal antibody titre.

In uncertain cases, skin biopsy may allow early diagnosis.¹²

Es kann mit Karditis, Arthritis, Fieber und Chorea Sydenham.

Es gibt keine spezifische Behandlung des Ausschlags, aber das rheumatische Fieber muss wie beschrieben behandelt werden in der Rheumatisches Fieber article. If the diagnosis is suspected, it is wise to start a full course of penicillin as for rheumatic fever.

There are no specific complications of the rash but complications such as cardiac disease and Sydenham's chorea may occur as a result of the rheumatic fever.

As for rheumatic fever.

As for rheumatic fever.