Erythema marginatum - Revision history

Rossdonaldson1: /* Admit */

2025-12-10T23:12:56Z

Admit

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	* There is suspected or confirmed carditis		* There is suspected or confirmed carditis
	* Patient is febrile, toxic, or has signs of systemic involvement		* Patient is febrile, toxic, or has signs of systemic involvement
	* Requires workup and treatment initiation for suspected acute rheumatic fever		* Requires workup and treatment initiation for suspected [[acute rheumatic fever]]

	==See Also==		==See Also==

Rossdonaldson1: /* Workup */

2025-12-10T23:12:32Z

Workup

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	* CBC (may show leukocytosis)		* CBC (may show leukocytosis)
	* ESR/CRP (typically elevated in ARF)		* ESR/CRP (typically elevated in ARF)
	* ECG (look for PR prolongation)		* [[ECG]] (look for PR prolongation)
	* Echocardiogram if there are signs/symptoms of carditis		* [[Echocardiogram]] if there are signs/symptoms of carditis

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Diagnosis */

2025-12-10T23:12:06Z

Diagnosis

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	===Diagnosis===		===Diagnosis===
	Diagnosis ~~of erythema marginatum~~ is clinical and often supportive in the context of other signs of [[~~Acute rheumatic fever\|~~acute rheumatic fever]]. Confirm diagnosis of ARF using revised [[Jones criteria]]:		Diagnosis is clinical and often supportive in the context of other signs of [[acute rheumatic fever]]. Confirm diagnosis of ARF using revised [[Jones criteria]]:

	* Major criteria: migratory arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules		* Major criteria: migratory arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules

Rossdonaldson1 at 23:10, 10 December 2025

2025-12-10T23:10:32Z

← Older revision		Revision as of 23:10, 10 December 2025
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	==Background==		==Background==
	Erythema marginatum ~~is a~~ rare, non-pruritic rash that is one of the major Jones criteria for acute rheumatic fever (ARF)~~. It is strongly~~ associated with post-streptococcal autoimmune responses, particularly in children and adolescents. Though uncommon in the ED, its recognition is important because it may be an early or subtle clue to a potentially serious systemic illness, especially when accompanied by joint pain, fever, or cardiac involvement.		[[File:960px-Erythema marginatum.jpg\|thumb\|Classic Erythema marginatum rash]]
			*A rare, non-pruritic rash that is one of the major Jones criteria for [[acute rheumatic fever]] (ARF)
			*Strongly associated with post-streptococcal autoimmune responses, particularly in children and adolescents
			*Though uncommon in the ED, its recognition is important because it may be an early or subtle clue to a potentially serious systemic illness, especially when accompanied by joint pain, fever, or cardiac involvement.

	~~[[File:960px-Erythema marginatum.jpg\|thumb\|Classic Erythema marginatum rash]]~~
	==Clinical Features==		==Clinical Features==
	Appearance:		===Appearance===
	* Pink to red, serpiginous or annular macules or patches		* Pink to red, serpiginous or annular macules or patches
	* Central clearing, with raised margins		* Central clearing, with raised margins
	* May coalesce into polycyclic shapes		* May coalesce into polycyclic shapes
	Distribution:
			===Distribution===
	* Typically found on trunk and proximal limbs		* Typically found on trunk and proximal limbs
	* Spares the face		* Spares the face
	Characteristics:
			===Characteristics===
	* Transient (lesions may appear and disappear over hours)		* Transient (lesions may appear and disappear over hours)
	* Non-pruritic, often unnoticed by the patient		* Non-pruritic, often unnoticed by the patient
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	==Differential Diagnosis==		==Differential Diagnosis==
	* Urticaria (usually pruritic and shorter-lived lesions)		* Urticaria (usually pruritic and shorter-lived lesions)
	*
	* Tinea corporis (scaly border; longer duration)		* Tinea corporis (scaly border; longer duration)
	*
	* Erythema multiforme (target lesions; mucosal involvement)		* Erythema multiforme (target lesions; mucosal involvement)
	*
	* Erythema migrans (Lyme disease; often has history of tick exposure)		* Erythema migrans (Lyme disease; often has history of tick exposure)
	*
	* Erythema annulare centrifugum		* Erythema annulare centrifugum
	*
	* Pityriasis rosea (typically has herald patch, follows cleavage lines)		* Pityriasis rosea (typically has herald patch, follows cleavage lines)
	*
	* Systemic lupus erythematosus (may produce annular lesions)		* Systemic lupus erythematosus (may produce annular lesions)
	*
	* Drug eruptions		* Drug eruptions

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	===Workup===		===Workup===
	* Rapid strep test or throat culture		* Rapid strep test or throat culture
	*
	* Anti-streptolysin O (ASO) or anti-DNase B titers		* Anti-streptolysin O (ASO) or anti-DNase B titers
	*
	* CBC (may show leukocytosis)		* CBC (may show leukocytosis)
	*
	* ESR/CRP (typically elevated in ARF)		* ESR/CRP (typically elevated in ARF)
	*
	* ECG (look for PR prolongation)		* ECG (look for PR prolongation)
	*
	* Echocardiogram if there are signs/symptoms of carditis		* Echocardiogram if there are signs/symptoms of carditis

	===Diagnosis===		===Diagnosis===
	Diagnosis of erythema marginatum is clinical and often supportive in the context of other signs of [[Acute rheumatic fever\|acute rheumatic fever]]. Confirm diagnosis of ARF using revised [[Jones criteria]]:		Diagnosis of erythema marginatum is clinical and often supportive in the context of other signs of [[Acute rheumatic fever\|acute rheumatic fever]]. Confirm diagnosis of ARF using revised [[Jones criteria]]:

	* Major criteria: migratory arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules		* Major criteria: migratory arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules
	*
	* Minor criteria: fever, arthralgia, elevated ESR/CRP, prolonged PR interval		* Minor criteria: fever, arthralgia, elevated ESR/CRP, prolonged PR interval
	*		* A diagnosis of ARF typically requires 2 major or 1 major + 2 minor criteria, plus evidence of recent group A Streptococcus infection.
	A diagnosis of ARF typically requires 2 major or 1 major + 2 minor criteria, plus evidence of recent group A Streptococcus infection.

	==Management==		==Management==
	* Treat underlying acute rheumatic fever:		* Treat underlying acute rheumatic fever:
	*		**[[Penicillins\|Penicillin]] or other antibiotics to eradicate streptococcal infection
	** [[Penicillins\|Penicillin]] or other antibiotics to eradicate streptococcal infection
	*
	** [[Aspirin]] or [[Nonsteroidal anti-inflammatory drugs\|NSAIDs]] for arthritis		** [[Aspirin]] or [[Nonsteroidal anti-inflammatory drugs\|NSAIDs]] for arthritis
	*
	** [[Corticosteroids]] in severe carditis		** [[Corticosteroids]] in severe carditis
	*
	* Skin lesions themselves do not require direct treatment, as they are self-limited		* Skin lesions themselves do not require direct treatment, as they are self-limited
	*
	* Patient and family education about recurrence prevention and long-term prophylaxis		* Patient and family education about recurrence prevention and long-term prophylaxis

	==Disposition==		==Disposition==
	Discharge ~~if patient is~~ well-appearing, hemodynamically stable, and has a plan for follow-up with cardiology and primary care for rheumatic fever management		===Discharge===
			*If well-appearing, hemodynamically stable, and has a plan for follow-up with cardiology and primary care for rheumatic fever management

	Admit ~~if:~~		===Admit===
	* There is suspected or confirmed carditis		* There is suspected or confirmed carditis
	* Patient is febrile, toxic, or has signs of systemic involvement		* Patient is febrile, toxic, or has signs of systemic involvement

Rossdonaldson1: /* External Links */

2025-12-10T22:31:17Z

External Links

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	==External Links==		==External Links==
	[https://www.cdc.gov/groupastrep/diseases-hcp/acute-rheumatic-fever.html CDC – Acute Rheumatic Fever]		*[https://www.cdc.gov/groupastrep/diseases-hcp/acute-rheumatic-fever.html CDC – Acute Rheumatic Fever]
			*[https://www.ahajournals.org/doi/10.1161/cir.0000000000000205 American Heart Association – Jones Criteria Summary]
	[https://www.ahajournals.org/doi/10.1161/cir.0000000000000205 American Heart Association – Jones Criteria Summary]

	==References==		==References==
	<references/>		<references/>

Cole Ettingoff: /* Clinical Features */

2025-05-05T17:52:32Z

Clinical Features

← Older revision		Revision as of 17:52, 5 May 2025
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	Erythema marginatum is a rare, non-pruritic rash that is one of the major Jones criteria for acute rheumatic fever (ARF). It is strongly associated with post-streptococcal autoimmune responses, particularly in children and adolescents. Though uncommon in the ED, its recognition is important because it may be an early or subtle clue to a potentially serious systemic illness, especially when accompanied by joint pain, fever, or cardiac involvement.		Erythema marginatum is a rare, non-pruritic rash that is one of the major Jones criteria for acute rheumatic fever (ARF). It is strongly associated with post-streptococcal autoimmune responses, particularly in children and adolescents. Though uncommon in the ED, its recognition is important because it may be an early or subtle clue to a potentially serious systemic illness, especially when accompanied by joint pain, fever, or cardiac involvement.

			[[File:960px-Erythema marginatum.jpg\|thumb\|Classic Erythema marginatum rash]]
	==Clinical Features==		==Clinical Features==
	Appearance:		Appearance:

Cole Ettingoff: /* Diagnosis */

2025-05-05T17:47:22Z

Diagnosis

← Older revision		Revision as of 17:47, 5 May 2025
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	* Echocardiogram if there are signs/symptoms of carditis		* Echocardiogram if there are signs/symptoms of carditis
	===Diagnosis===		===Diagnosis===
	Diagnosis of erythema marginatum is clinical and often supportive in the context of other signs of acute rheumatic fever. Confirm diagnosis of ARF using revised Jones criteria:		Diagnosis of erythema marginatum is clinical and often supportive in the context of other signs of [[Acute rheumatic fever\|acute rheumatic fever]]. Confirm diagnosis of ARF using revised [[Jones criteria]]:

	~~Major criteria: migratory arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules~~

	~~Minor criteria: fever, arthralgia, elevated ESR/CRP, prolonged PR interval~~

			* Major criteria: migratory arthritis, carditis, chorea, erythema marginatum, subcutaneous nodules
			*
			* Minor criteria: fever, arthralgia, elevated ESR/CRP, prolonged PR interval
			*
	A diagnosis of ARF typically requires 2 major or 1 major + 2 minor criteria, plus evidence of recent group A Streptococcus infection.		A diagnosis of ARF typically requires 2 major or 1 major + 2 minor criteria, plus evidence of recent group A Streptococcus infection.

Cole Ettingoff: /* External Links */

2025-05-05T17:46:20Z

External Links

← Older revision		Revision as of 17:46, 5 May 2025
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	==External Links==		==External Links==
			[https://www.cdc.gov/groupastrep/diseases-hcp/acute-rheumatic-fever.html CDC – Acute Rheumatic Fever]

			[https://www.ahajournals.org/doi/10.1161/cir.0000000000000205 American Heart Association – Jones Criteria Summary]

	==References==		==References==
	<references/>		<references/>

Cole Ettingoff: /* Disposition */

2025-05-05T17:45:10Z

Disposition

← Older revision		Revision as of 17:45, 5 May 2025
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	==Disposition==		==Disposition==
			Discharge if patient is well-appearing, hemodynamically stable, and has a plan for follow-up with cardiology and primary care for rheumatic fever management

			Admit if:
			* There is suspected or confirmed carditis
			* Patient is febrile, toxic, or has signs of systemic involvement
			* Requires workup and treatment initiation for suspected acute rheumatic fever

	==See Also==		==See Also==

Cole Ettingoff: /* Management */

2025-05-05T17:44:46Z

Management

← Older revision		Revision as of 17:44, 5 May 2025
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	* Treat underlying acute rheumatic fever:		* Treat underlying acute rheumatic fever:
	*		*
	* Penicillin or other antibiotics to eradicate streptococcal infection		** [[Penicillins\|Penicillin]] or other antibiotics to eradicate streptococcal infection
	*		*
	* Aspirin or NSAIDs for arthritis		** [[Aspirin]] or [[Nonsteroidal anti-inflammatory drugs\|NSAIDs]] for arthritis
	*		*
	* Corticosteroids in severe carditis		** [[Corticosteroids]] in severe carditis
	*		*
	* Skin lesions themselves do not require direct treatment, as they are self-limited		* Skin lesions themselves do not require direct treatment, as they are self-limited