Skin Redness (Erythema): Causes

Pathogenesis (development of disease)

The pathogenesis of erythema is diverse.

Etiology (Causes)

Disease-related causes.

Endocrine, nutritional, and metabolic diseases (E00-E90).

Skin and subcutaneous (L00-L99)

  • Acrodermatitis chronica atrophicans – skin disease that may occur as a result of Lyme disease.
  • Erythema exsudativum multiforme (of various causes).
  • Livedo reticularis (marbled skin)
  • Rosacea (copper rose) – chronic inflammatory, non-contagious skin disease that manifests on the face; papules (nodules) and pustules (pustules) and telangiectasias (dilation of small, superficial skin vessels) are typical.
  • Diaper rash
  • Cellulitis – acute skin infection caused by bacteria.

Infectious and parasitic diseases (A00-B99).

  • Lyme disease (here: erythema chronicum migrans).
  • Dengue fever – infectious disease that occurs mainly in tropical and subtropical regions. It is caused by dengue viruses (DENV); here: Erythema, especially on the face and chest, often with white dermographism.
  • Erythema infectiosum (ringworm; here: toxic erythema).
  • Helminthiasis (worm disease); here for: Spiruridae
  • HIV (seroconversion rash; maculopapular (blotchy and with papules, i.e., vesicles); occurs mainly on the face and trunk, more rarely on the extremities).
  • Measles (morbilli; here: toxic erythema).
  • Rheumatic fever (synonym: streptococcal rheumatism) – reactive disease that usually occurs after infection with group A streptococci (Lancefield classification); here: Erythema nodosum
  • Scarlet fever (Scarlatina; here: toxic erythema).
  • Streptococcal infections (here: erythema nodosum).
  • Tuberculosis (consumption; here: Erythema induratum, nodular tuberculid; erythema nodosum).

Liver, gallbladder, and bile ducts-pancreas (pancreas) (K70-K77; K80-K87).

  • Liver disease, unspecified (palmar erythema).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum); involvement is usually continuous and originates from the rectum; here: Erythema nodosum
  • Crohn’s disease – chronic inflammatory bowel disease; it usually progresses in episodes and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal segments may be affected, which are separated by healthy sections; here: Erythema nodosum

Musculoskeletal system and connective tissue (M00-M99).

  • Dermatomyositis – disease belonging to the collagenoses, affecting the skin and muscles and associated mainly with diffuse pain on movement.
  • Reactive arthritis (synonym: postinfectious arthritis / joint inflammation) – secondary disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; refers to an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
  • Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of a “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); can manifest as arthritis (inflammation of the joints), conjunctivitis (inflammation of the conjunctiva), urethritis (inflammation of the urethra) and sometimes with typical skin changes (here: Erythema nodosum)
  • Sarcoidosis (synonyms: Boeck’s disease; Schaumann-Besnier’s disease) – systemic disease of connective tissue with granuloma formation (skin, lungs and lymph nodes); here: Erythema nodosum
  • Systemic lupus erythematosus (SLE) – systemic disease affecting the skin and connective tissue of the vessels.

Pregnancy, childbirth and puerperium (O00-O99).

  • Pregnancy (palmar erythema)

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Sunburn
  • Burns, thermal or chemical

Other

  • Acute graft-versus-host reaction – rejection reaction in post-transplant state.
  • Fixed drug exanthema (it owes its name to the fact that erythema reappears at the same skin site after new administration of the drug)
  • Phototoxic drug reaction
  • Prolonged immobility with drooping legs.

Medication

  • Alpha-2-adrenergic receptor agonist (brimonidine).
  • Antibiotics:
    • Gyrase inhibitors → fixed drug exanthem.
    • Sulfonamides → fixed drug exanthem
    • Tetracyclines → toxic erythema (areal redness of the skin).
    • Trimethoprim → fixed drug exanthema.
  • Antipsychotics (neuroleptics).
  • Diuretics (dehydrating drugs)
  • Hormones
    • Antiestrogens (clomiphene)
  • Ingenol mebutate (cytostatic).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – anti-inflammatory drugs not derived from steroids → toxic erythema.