Ver el código de «Erythema marginatum»

==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]]
==Clinical Features==
Appearance:
* Pink to red, serpiginous or annular macules or patches
* Central clearing, with raised margins
* May coalesce into polycyclic shapes
Distribution:
* Typically found on trunk and proximal limbs
* Spares the face
Characteristics:
* Transient (lesions may appear and disappear over hours)
* Non-pruritic, often unnoticed by the patient
* Usually occurs early in the course of ARF

==Differential Diagnosis==
* Urticaria (usually pruritic and shorter-lived lesions)
* 
* Tinea corporis (scaly border; longer duration)
* 
* Erythema multiforme (target lesions; mucosal involvement)
* 
* Erythema migrans (Lyme disease; often has history of tick exposure)
* 
* Erythema annulare centrifugum
* 
* Pityriasis rosea (typically has herald patch, follows cleavage lines)
* 
* Systemic lupus erythematosus (may produce annular lesions)
* 
* Drug eruptions

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

* 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.

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

==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==


==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==
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