Erythema Marginatum

What is Erythema Marginatum?

Erythema Marginatum is a red skin rash but it can become a serious health issue, as it associated with rheumatoid fever. Erythema marginatum is ring shaped, painless, firm rashes. They develop on the surface of the skin and internally extend up to subcutaneous tissue.

The central part of the rash is clear and flat, but the borderline of the rash is elevated. Usually these rashes are situated on the thigh, arm and other part of the upper and lower limb of the body. Sometimes they also develop at the back of the body. Usually the facial region, palm and feet are not affected. Often the development of these rashes has been uncared, as they are painless. Unawareness of this syndrome causes ignorance from medical care.


Image 1 : Erythema Marginatum


In medical science, erythma stands for red and the Latin word “marginatum” means margin. Clinically Erythema Marginatum is a disease which is characterized by red skin rashes which look like nodules with distinct margin. The edge of the rash is inflamed. There are two types of Erythema marginatum are identified.

Cutaneous Nodules of Ertthema Marginatum

Image 2: Cutaneous nodules in Erythema marginatum

  • Erythema Marginatum Rheumaticum is related to rheumatic fever and progressed on thighs and other parts of the limbs. In initial stage, it is difficult to diagnose, as it does not show associated symptoms.
  • Erythema Marginatum Perstans does not develop only on the skin surface, but it also affects subsequent tissues of the skin. These rashes can develop in any part of the body, except palms and feet.

Erythema Marginatum Causes

Erythema marginatum may occur due to the development of other associated diseases. Sometimes the underlying cause is unpredictable. One of the most related causes is rheumatic fever.

Rheumatoid fever arises due to bacterial infection caused by streptococcal A bacteria. This bacterial attack acts on the immune system and causes autoimmunity. Development of Erythema marginatum always not causes rheumatic fever, but association with Jones’ criteria gives confirmation of development of rheumatic fever. Temperature increment augments rash development throughout the body; except face, palm and sole. After onset of fever, the rash arises within two to three weeks. Initially the rashes develop on thigh and gradually extended towards upper direction.

C1 esterase inhibitor (C1-INH) deficiency also causes Erythema marginatum. Deficiency of C1- INH causes sudden fluid accumulation which results inflammation. This condition is also associated with skin diseases, itching and platelet deficiency.

The rashes arise and disappear as in their own way; it is unpredictable how long they appear on the surface of the skin. They may stay for weeks, months or years. In some cases, they naturally rid off and again reappear after few, weeks or months.

Other possible reasons behind erythema marginatum are:

  • Blood cancer, lymphoma, squamous cell carcinoma and breast cancer.
  • Infection caused by Borrelia burgdorferi which results Lyme disease
  • Allergic reaction
  • Bacterial and fungal infections which include Escherichia coli, Ascaris lumbricoides and Candida albicans)
  • Puberty and Pregnancy
  • Adverse drug effects (antibiotic like penicillin, H2 anti blockers like cimetidine and  antimalarial like chloroquine or hydrocychloroquine)


The development of red rashes is the prime symptom of Erythema marginatum. The significant characteristics of the rash are:

  • The shape of the rashes are quite similar with a doughnut, the centre of the rash is pale in compare with edges which are red in colour.
  • Inflamed margin which is developed due to swelling of blood vessels which leads to gathering of WBCs.
  • The range of the diameter of the circular rashes is in between 0.5 – 2 cm.
  • The initial occurrence of the rashes is in thigh and gradually extended in upward direction. But never developed in palm, feet and face.
  • No itching sensation is associated with rashes. High temperature aggravates the symptom by darkening red colouration of the rashes.


Erythema marginatum is a symptomatic approach which has an underlying cause. For effective treatment of Erythema marginatum, it is important to diagnose the underlying cause. In fact, Erythema marginatum does not necessitate any therapeutic approach, it naturally goes away whenever the underlying cause is eliminated or cured.

Development of Erythema marginatum has not produced any pain or irritation. Usually the patient does not get noticeable problems with this syndrome. But mostly Erythema marginatum is linked with rheumatoid fever, which becomes a serious health problem, as it may convert to rheumatoid heart disease or Sydenham’s chorea. Early treatment is essential for restricting the complication.

Other associated conditions like allergy or infection can be treated with anti- allergic drug or antibacterial and antifungal drugs. The avoidance of materials which produce allergy also improves the condition.

If Erythema marginatum arises due to adverse drug reaction, then consult with the doctor and may withdrawal of drug improves the condition.

Erythema marginatum Pictures

erythema marginatum pictures

erythema marginatum rheumatic fever

erythema marginatum image

erythema marginatum pic



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