Erythema marginatum

The rings are barely raised and are non-itchy. The face is generally spared.{{citation needed|date=May 2021}}

The condition is characterised by circular, non-pruritic, erythematous rashes which form on the trunk and extremities of the body. The rash has a known serpiginous edge, and often appears and disappears spontaneously over time.{{Cite book |last=Kliegman |first=R.M. |title=Group A streptococcus. In: Nelson textbook of pediatrics |last2=Stanton |first2=B.F |last3=Gerne |first3=J.W. |last4=Schor |first4=N.F. |last5=Behrman |first5=R.E. |publisher=Elsevier Saunders |year=2011 |edition=9}} Histological examination of the rash identifies infiltration of mononuclear cells and neutrophils in the papillary and upper half of the reticular dermis layer.{{Cite journal |last=Vijayan |first=Vini |last2=Sukumaran |first2=Sukesh |date=July 2023 |title=Erythema Marginatum |url= |journal=The Journal of Pediatrics |volume=258 |pages=113330 |doi=10.1016/j.jpeds.2022.12.038 |issn=0022-3476|doi-access=free }}

It occurs in less than 10% of patients with acute rheumatic fever (ARF),{{Cite journal |last=Sharma |first=Shreya |last2=Biswal |first2=Niranjan |date=December 2015 |title=Erythema Marginatum |url= |journal=Indian Pediatrics |volume=52 |issue=12 |pages=1100 |issn=0974-7559}} but is considered a major Jones criterion when it does occur.{{Cite journal |last=Tani |first=L.T. |last2=Veasy |first2=L.G. |last3=Minich |first3=L.L.A. |last4=Shaddy |first4=R.E. |date=2003 |title=Rheumatic fever in children younger than 5 years: is the presentation different? |journal=Pediatrics |volume=112 |pages=1065–8}}{{Cite book |last=Wolfson |first=Allan B. |title=Harwood-Nuss' Clinical Practice of Emergency Medicine |last2=Hendey |first2=Gregory W. |last3=Ling |first3=Louis J. |last4=Rosen |first4=Carlo L. |last5=Schaider |first5=Jeffrey J |last6=Sharieff |first6=Ghazala Q. |publisher=Wolters Kluwer Health |year=2012 |isbn=9781451153453 |pages=1302}} The four other major criteria include carditis, polyarthritis, Sydenham's chorea, and subcutaneous nodules. In this case, it is often associated with Group A streptococcal infection, otherwise known as Streptococcus pyogenes infection, which can be detected with an ASO titer.{{citation needed|date=May 2020}}

It is an early feature of acute rheumatic fever though not pathognomonic of it.[http://www.japi.org/january2007/PC-45.pdf Erythema Marginatum Pictorial CME] It some cases it may be associated with mild myocarditis (inflammation of heart muscle).

The condition is also seen as a precursor to or accompany an attack of angioedema, and is seen in conditions like allergic drug reactions, sepsis and glomerulonephritis.

It often occurs as a harbinger of attacks in hereditary angioedema. In this case it may occur several hours or up to a day before an attack.{{citation needed|date=May 2020}}

Some sources distinguish between the following:{{citation needed|date=May 2020}}

• "Erythema marginatum rheumaticum"
• "Erythema marginatum perstans"

The diagnosis of erythema marginatum can be made during examination of skin appearance. A skin biopsy may be performed if needed, to confirm the diagnosis. Medical history and family history may also be taken into account.

{{Expand section|date=January 2020}}

Erythema marginatum can be treated with hydrocortisone and adrenocorticotropc hormone (ACTH).{{Cite journal|last=Burke|first=J. B.|date=1955-08-01|title=Erythema Marginatum|url= |journal=Archives of Disease in Childhood|language=en|volume=30|issue=152|pages=359–365|doi=10.1136/adc.30.152.359|issn=0003-9888|pmc=2011784|pmid=13249623}}

In cases where the condition is associated with ARF and severe carditis, corticosteroids are indicated{{Cite book |title=Oski's Essential Pediatrics |publisher=Lippincott Williams & Wilkins |year=2004 |isbn=9780781737708 |editor-last=Oski |editor-first=Frank A. |pages=298 |editor-last2=Barone |editor-first2=Michael A. |editor-last3=Crocetti |editor-first3=Michael}} alongside the classic treatment protocol for ARF which is a 10-day course of oral Penicillin. Alternatively, one dosage of Penicillin G benzathine may be injected intramuscularly followed with a daily course of oral Amoxicillin for a total of 10 days. In cases of Penicillin allergy, a Cephalosporin or Macrolide may be considered. To avoid recurrences of ARF, secondary prevention is called for. This may include a period of antibiotic prophylaxis determined by the presence of carditis and the amount of remaining heart damage.{{Cite book |title=Group A Streptococcal Infections. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases |publisher=American Academy of Pediatrics |year=2021 |isbn=978-1-61002-521-8 |editor-last=Kimberlin |editor-first=David W. |edition=32 |pages=694–707 |editor-last2=Barnett |editor-first2=Elizabeth D. |editor-last3=Lynfield |editor-first3=Ruth |editor-last4=Sawyer |editor-first4=Mark H.}}

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| ICD10 = {{ICD10|L|53|2|2|50}}

| ICD9 = {{ICD9|695.8}}

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{{Urticaria and erythema}}

Category:Bacterium-related cutaneous conditions

Category:Erythemas

Category:Pediatrics