ERYTHEMA (erythema; Greek erythema redness) — the site of a dermahemia (or a mucous membrane) in the form of a spot, usually inflammatory character. The term «erythema» is used also for designation of a number of skin diseases, for to-rykh rashes in the form of inflammatory spots are characteristic.
AA. it is caused by expansion of blood vessels of a papillary layer of a derma. Allocate active E., characterized by dominance of an arterial hyperemia, and passive
E., resulting from a venous staz. Active E. usually develops as a result of ostrovospalitelny reaction of skin, is followed by hypostasis of fabrics. Skin in the field of active E. hot to the touch, bright red color; form E. more often roundish, at merge of several inflammatory spots E. can get girlyandopodobny outlines. Gistol. a picture at active E. it is characterized, in addition to vasodilatation, by hypostasis and perivascular infiltration of a papillary layer of a derma. At the same time the cellular composition of infiltrate depends on a disease, at Krom the erythema developed. Active E. it is observed at the dermatitis (see) caused chemical, physical and, in particular, by beam factors (a beam, infrared thermal, ultra-violet erythema); and also at eczema (see), toxidermias (see), a toxic erythema of newborns (see the Erythema toxic newborns), etc. In some cases active E., having the reflex nature, differs in instability (quickly arises and disappears) — so-called E. shame, anger.
Passive E. it is characterized by a cyanotic (tsianotichesky) shade, has diffusion character, indistinct borders as, e.g., at a Crocq's disease (see), perfigeration (see). In nek-ry cases, napr, at a livedo (see), passive E. has the mesh or treelike drawing.
The group erity as nosological units is diverse and includes diseases of various genesis. The exudative erythema of Gebra of multiforms-iaya, Stephens's syndrome — Johnson concern to her (see the Erythema exudative mnogoformny, the Erythema infectious); a krugovidny erythema to Scale of la, or Belisario the serpigi-nozny migrating erythema (see. Paraoncological dermatosis); AA. fixed sulfanamide (see Toxidermias); centrifugal ring-shaped erythema to Darya; the migrating chronic erythema of Aftse-lius — Lipshyuttsa; ring-shaped rheumatic E., or Lendorffa — Leynera a disease (see Rheumatism); resistant figured erythema; hereditary erythema of palms and soles, or Lane disease; a skarlatinoformny recurrent erythema of Fereol — Benye.
Are presented in this article but - it is evil. forms erity, not described in the published independent articles.
Centrifugal ring-shaped erythema to Darya. The etiology is not established. The nature of a disease is supposed infektsionnoallergichesky or toksiko-aller-gicheskaya what development of a disease against the background of persistent infection testifies to (tonsillitis, gyamorit, etc.), and also diseases went. - kish. path (colitis, gastritis, etc.). At this form E. in a papillary layer of a derma focal lymphocytic infiltrate around expanded blood vessels and appendages of skin, intercellular and intracellular hypostasis of epidermis is noted. The disease develops sharply, got further hron. current; a recurrence is possible. More often men of middle age are ill. The wedge, a picture is characterized by emergence on skin of a trunk, proximal departments of extremities of the not shelled flesh-colored edematous roundish spots turning due to eccentric growth into the raised dense ring-shaped elements, in the center to-rykh skin has normal color or is slightly pigmented. The Pyatyaa quickly increase in a size (in day by several millimeters what definition «centrifugal» is connected with), reaching 4 — 5 cm in the diameter. Being broken off, ring-shaped spots form arches and garlands. In the central part of the old centers sometimes there are new. Subjective feelings usually are absent. To atypical versions centrifugal ring-shaped E. carry shelled
324 ERYTHEMA INFECTIOUS
E., edges differs in emergence of a peeling in the form of a thin white border in a zone of the outer edge of the centers; vesicular E., edges it is characterized by periodic emergence of quickly passing vesicles on edge of ring-shaped elements; the simple girlyandoobrazny erythema of Yadas-son differing in short terms of existence of spots (from bore - how many hours up to several days); a resistant mikrogirlyandoobrazny erythema, at a cut elements do not exceed 1 cm in the diameter. The diagnosis is based on a wedge, a picture. Differential diagnosis is carried out with other types erity, a small tortoiseshell (see) and a leprosy (see). Treatment by means of the hyposensibilizing means (drugs of calcium, sodium thiosulphate, sulfate magnesia, antihistaminic drugs), is appointed also by redoxons, groups B; outwardly — corticosteroid ointments. Forecast favorable. Prevention consists in sanitation of the centers hron. infections and normalization of function went. - kish. path.
The migrating chronic erythema of Aftselius — Lipshyuttsa, apparently, is a virus dermatosis. The infection is transmitted at a sting of a tick of Ixodes ricinus. At this form of an erythema in an initial stage vasodilatation and hypostasis of a papillary layer of a derma with perivascular infiltrate from eosinophils, lymphocytes and a small amount of mast cells is noted; further fibrosis of a derma develops, in infiltrate colossal and mast cells appear. The wedge, picture is characterized by emergence through 6 — 23 in the afternoon on site of a sting of a tick of a red roundish spot, a cut within several weeks, gradually extending, can reach in dia. 15 — 20 cm and more. In the center of a spot skin quickly takes a normal form, and the trace of a sting of a tick (a reddish point) can be well visible; the edge of a spot is delimited from surrounding skin by the continuous not shelled erythematic border from 2 — 3 mm to 2 cm wide. Subjective feelings are absent. After several months (at treatment — several weeks) the erythematic border breaks up to separate fragments and disappears. In some cases the center has the taenioid form, and the inflammatory border is not interrupted, covering long distance (e.g., passing through a breast, a neck, a face). The diagnosis is based on a wedge, the picture confirmed in doubtful cases gistol. research of affected areas of skin. Differential diagnosis is carried out with other types erity, a creeping disease (see Miaza). Treatment is performed antibiotics of a broad spectrum of activity. Forecast favorable. Prevention I conclude-etsya in protection of skin from stings of mites.
Resistant figured erythema. The etiology is not known; a number of researchers considers that the disease is hereditary. At it vasodilatation of a papillary layer of a derma, small cellular infiltration around them is noted. The clinical picture is characterized by emergence on skin of a trunk or extremities of one or two erythematic spots of a round or oval form 5 — 10 cm in the diameter, not pruritic and not infiltrirovanny. Gradually central part of a spot is slightly pigmented and shelled; peripheral — remains red, the peeling, but to a lesser extent also extends to it. The diagnosis is based on a wedge, a picture. Differential diagnosis is carried out with hron. a trichophytosis (see), a tertiary roseola (see Syphilis). Treatment: vitamins A, With, groups B; outwardly — corticosteroid ointments (lorindenm
With, Ftorokortum, etc.), 2% salitsilovonaftalanny ointment. The forecast for life favorable. The centers exist is long (for years). Prevention is not developed.
A hereditary erythema of palms and soles — the dermatosis caused by congenital anomaly of an arteriovenous anastomosis; also acquired form of an erythema of palms and soles as result of dysfunction of gonads, intoxications is possible. The wedge, a picture is characterized by the symmetric crimson-red diffusion erythema which is localized on phalanxes of fingers in the field of the tenor and a hypothenar. Borders of defeat on side surfaces of brushes and feet are sharply expressed, the erythema does not extend to the back of brushes and feet. The diagnosis is established on the basis by a wedge, pictures. Differential diagnosis carry out with Deverzhi's disease (see Dever-zhi a disease), palmar and bottom psoriasis (see), a tinea (see). Symptomatic treatment, the softening ointments appoint. The forecast for life favorable, a disease lasts during all life. Prevention is not developed.
The Skarlatinoformny recurrent erythema of Fereol — Benye — sharply proceeding recurrent disease of skin of allergic genesis. Quite often develops after medicamentous intoxications, overcooling, a nervous shock, against the background of influenzal or other viral infection. The beginning of a disease sudden or with the small prodromal phenomena (a headache, an indisposition, temperature increase within 2 — 3 days), then on skin appears rash in the form of bright red spots of various size — from dot to large (10 — 20 mm in the diameter) with a tendency to merge. In 2 — 3 days rash begins to disappear. At the same time there is a macrolaminar peeling on all skin. On palms the corneous layer is torn away on all surface (a symptom of a glove). The itch, burning, damage of a mucous membrane of an oral cavity, and also recurrence of a disease are possible. The diagnosis is based on a wedge, a picture and data of the anamnesis. Differential diagnosis is carried out with scarlet fever (see), edges differs in more expressed general symptoms (intoxication, temperature), existence of a symptom of Pastia (a petechia in large folds of skin), a melkoplastinchaty peeling of skin of a trunk. Treatment: appoint the hyposensibilizing means (antihistaminic substances, a gluconate of calcium, etc.); outwardly — corticosteroid creams, zinc - a water suspension. Forecast favorable. Prevention is not developed.
The term «erythema» remained also for designation of a deep vasculitis, at Krom in skin there are inflammatory nodes (see the Erythema knotty).
Bibliogrdifferentsialny diagnosis of skin diseases, under the editorship of. A. A. Stud-nitsina, M., 1983; Mashkille ii-
dream of A. JI. and Alikhanov A. M. Analysis of 100 cases of a mnogoformny exudative erythema, Vestn. dermas, and veins., No. 11, page 4, 1983; Skripkin Yu. K. Koshnye and venereal diseases, M., 1979; To about of t i n g G. W. u. D e n k K. Derma tologische Differential diagnose, Stuttgart — N. Y., 1974. S. S. Kryazheva.