What is erythema? Erythema- this is redness (hyperemia) of a certain area of ​​​​the human skin, in which there is an excessive flow of blood into the vessels of the microvasculature and their expansion. If blood flows excessively to the arterial part of the microcirculation, then the basis for the formation of erythema is arterial hyperemia, but if to the venous part, then venous hyperemia. In both cases, manifestations of erythema can be not only local, but also diffuse.

There are a number of differences between erythema and other skin rashes. Since erythema, in its development mechanism, is a vascular rash, it is distinguished by its disappearance when pressing on the affected area of ​​the skin, for example, with a transparent ruler, through which these changes are visible. Hemorrhagic rashes (petechiae, ecchymosis) will not disappear with pressure, since the blood comes out of the vessels and permeates the subcutaneous fatty tissue, which is a completely different development mechanism.

Causes of erythema

There are a number of physiological and pathological factors, due to which the formation of erythema occurs on the skin of the human body.

Under physiological conditions, erythema occurs under the influence of physiotherapeutic measures, under the influence of incessant friction (for example, with a strap or strap), due to massage and rubbing. It is possible that erythema may appear in too hot or frosty weather, as well as side effect after taking certain pharmacological drugs.

In any of these cases, erythema is an absolutely normal reaction of the body to the irritant and soon goes away after contact with it is eliminated.

The pathological manifestation of erythema on the skin is associated with exposure to chemicals, infectious agents (bacteria, viruses or fungi), various types of toxins, and allergens on the body. Diseases of the nervous, endocrine, cardiovascular, and blood systems also often provoke the appearance of erythema. In children, there are several types of apparently erythema: and infectious.

What diseases can cause erythema and what are the symptoms:

Many diseases known to modern medicine are accompanied by the formation of erythema multiforme, and it is often one of the diagnostic criteria and is included in the patient’s medical history.

At borreliosis The emerging ring erythema of the skin has a characteristic localization: it appears on the skin clearly at the site of an insect (tick) bite. The redness has a ring-shaped or oval shape (due to the zone of clearing of the skin in the central parts of the rash), is hot when touched, is located on a hill due to tissue swelling, which is why this erythema is called ring-shaped. But diffuse erythemas are formed not only at the site of the bite: when the virus spreads throughout the body through the bloodstream, smaller erythemas are formed in distinct areas of the skin. It is worth noting that it is with borreliosis that erythema often becomes the only diagnostic sign of infection.

There is a type of erythema such as centrifugal erythema (erythema of Darier). It also has a ring-shaped shape and looks like pink spots with a yellowish tint. The rash grows outward, thanks to which it can quickly rise above general level skin and takes the form of a protruding ring. Its edge is wavy, and the central region is lighter than the periphery.

At erythema multiforme exudative rashes appear not only on the skin, but can also affect the mucous membrane of the lips and the entire oral cavity. Erythema looks like multiple swollen spots of various sizes and shapes of a bright pink color. Often, blisters with serous contents form in the central area of ​​the spot, but the formation of hemorrhagic exudate cannot be ruled out. On the mucous membranes, the clinical picture is less bright, but when treating erythema multiforme, this localization of the process is the least favorable for humans.

In case of infection with parvovirus, infectious (viral) erythema. It appears only on the fifth day after infection. At first, the erythema is localized in the buccal areas, has a bright red color, and later descends to the neck, torso, shoulder and buttock region. At this moment, the shape of the erythema changes from oval to lacy. After the rashes disappear, but when the temperature rises, they can return, which gives reason to talk about a deterioration in the person’s general condition and the progression of the infection.

As a result of direct exposure to solar radiation, sunburn, the main manifestations of which are hyperemic skin, the formation of blisters and active peeling when touching the spot.

looks like diffusely located nodes on the skin that rise above its surface, are painful, and brown in color. As a result, flaky spots are formed. Read more about the treatment of erythema nodosum here.

When taking certain medications, it occurs fixed erythema, clinically manifested by edematous plaques or bullae, eventually turning into pigmented areas.

A special type is palmar erythema, characteristic of patients with liver pathology. With it, local redness of the palms occurs, most often in the area of ​​the elevations of the first and fifth fingers.

Treatment of erythema:

Treatment of skin rashes of the erythema type is carried out using:

Medications.

These include antihistamines (Clemastine, Diphenhydramine, Fenoxfenadine, Cetirizine, Ebastine), antibacterial (drugs are selected depending on the type of pathogen), antiviral (Ribavirin, Interferon, Acyclovir), antiseptic (Chlorhexidine, Proderm) agents.

Folk remedies.

For example, they use an alcohol tincture from mistletoe leaves. To prepare it, put 10 grams of crushed dry mistletoe berries in a jar and fill them with 500 ml of alcohol. The jar is put away in a dark, cool place (cupboard, closet) for a period of one month, after which they begin taking the tincture orally, 35 drops per a large number of clean water. The tincture should be strained before use.

Erythema-type skin rashes do not always mean that a pathological process is occurring in the body. However, even in the case of a disease accompanied by erythema, it is quite simple to diagnose it and select adequate treatment.

Redness of the skin in medicine is called erythema, appears as a result of dilation of capillaries and a rush of blood. This phenomenon does not always indicate some kind of pathology. The skin turns red when strong emotions- anger, excitement, shame.

Normally, hyperthermia goes away soon without any special measures.

Persistent redness or a rash on the body indicates the presence of health problems. Erythema is not a disease, but a symptom, and only consulting a doctor will help you find out what such an abnormal deviation means.

Kinds

Pathology amazes with the variety of types - there are 28 of them:

  • Persistent towering. Another name is persistent erythema. A rare disease with an unspecified etiology. Oblong ridges of rich red color are formed.
  • Dychromic. One of the varieties of red lichen. The spots are ash-blue. No treatment has been developed.
  • Stevens-Johnson. A variety of multiform. Characterized by general intoxication.
  • Viral. Starts off as spicy viral disease, but is distinguished by a small rash resembling diathesis. It appears in the initial stage on the cheeks, then on the internal organs. Young children are most often affected preschool age. The danger lies in damage to the functions of hematopoiesis, joints and bone marrow.
  • Infectious. It is caused by parvovirus, and the main risk group is preschool children. The rash covers the cheeks, then the entire body. It is often asymptomatic.
  • Symptomatic. They cause emotions - anger, shame, excitement.
  • Chamera. The etiology of the disease is infectious. The rash has the appearance of a butterfly, the rash merges into large spots. It is not difficult to tolerate and is accompanied by symptoms of mild intoxication.
  • Polymorphic. One of the types of erythema multiforme. The rash occurs in the form of spots, hemorrhagic effusions, nodules and blisters filled with liquid.
  • Physiological. Appears when there is a difference in temperature or under the influence of natural irritants. Occurs in infants postpartum period. It goes away on its own.
  • Centrifugal erythema of Biette. Refers to a type of lupus erythematosus.
  • Centrifugal erythema of Daria. Rash in the form of rings with unknown etiology.
  • Ring-shaped. Occurs with weak immunity, cancer, fungal and bacterial infections. The body is covered with huge spots in the form of rings.
  • Toxic form of newborns. It is of allergic origin. Treated with antihistamines.
  • Exudative multiform - has a toxic-allergic nature. Sore throat, headache, muscles. The rash grows up to 3 centimeters, the spots merge into large “continents” and have a bluish tint. They appear symmetrically on the body and frame the lips on the face. Pain and itching are felt.
  • Radial. Appears as a reaction to an x-ray examination.
  • Scarlatiniform. The causative agents are streptococci and staphylococci. The prognosis is favorable.
  • Nodular - the course of the disease can be acute or chronic. The rash looks like nodules that are painful to the touch. The diameter of the papules varies from 1/2 to 5 centimeters. There are practically no rashes on the face.
  • Solar. Appears during prolonged exposure to the open sun, sometimes it is of an allergic nature. Hyperthermia is accompanied by swelling and deterioration of well-being.
  • Miliana. Appears as a result of an allergy to the anti-syphilis drug salvarsan.
  • Cold. Occurs as a reaction to cold. There is no specific therapy.
  • Twisty Gammel. Resembles a cut of a tree, found in cancer.
  • Bordered. Autoimmune response to the administration of medicinal serums. Manifested by urticaria.
  • Afzelius-Lipschütz. Borreliosis or Lyme disease. The causative agent of the disease is a tick. Antibacterial and symptomatic therapy is carried out.
  • Telangiectatic Bloom. The second name is infrared. Occurs with prolonged exposure to infrared radiation - a fireplace, heating pad.
  • Palmarnaya. Popularly called “liver palms”. Hyperemia is noted over the entire area of ​​the palms. Cause abnormal liver and blood diseases, rheumatoid arthritis.
  • Vascular erythema.
  • Nodose. Synonym for knotty. Creeping.

Depending on the factors of occurrence, infectious and non-infectious hyperthermia are distinguished.

Infectious diseases include:

  • exanthema;
  • Lyme disease;
  • multiform;
  • undifferentiated;
  • migratory;
  • nodal

Non-infectious forms cause autoimmune reactions of the body to external stimuli.

Non-infectious forms:

  • x-ray (radiation);
  • persistent;
  • infrared.

Causes

If hyperthermia is observed for a long time, it is necessary to understand the reasons for its occurrence.

Erythema is caused by several reasons:

  • infectious diseases - measles, scarlet fever, rubella;
  • non-infectious skin diseases - dermatitis, eczema;
  • massage that causes increased skin flow;
  • exposure to external factors - sun, wind, chemicals;
  • allergic and autoimmune reactions.

Signs

It manifests itself in different ways and depends on the type of disease.

Caused by infection, it is accompanied by fever, aches and swelling of the joints. The onset is acute, there is a strong headache, weakness, chills.

Exudative erythema is the most dangerous and can lead to death. Begin with common symptoms ailments - aches and pains in muscles and joints, headaches and sore throat. The rash covers the skin of the forearms, palms, palms and soles, mucous membranes of the oral cavity and nasopharynx. In addition to spots, the skin is covered with papules with serous contents. They burst and form open bleeding ulcers.

Lyme disease is viral in origin. The carriers are ticks. Persistent redness appears at the site of the bite, which increases in size. Accompanied by tissue compaction at the site of suction, and symptoms of damage to the central nervous system and musculoskeletal system.

One type of erythema is exanthema. It begins acutely, with an increase in body temperature, accompanied by headache and emotional agitation. After a few days, the headache subsides, and a pink, erythematous rash covers the body. After recovery, the skin returns to its original appearance.

Ointments, creams and gels used in the treatment of erythema

Flucinar ointment

Skin erythema, as medical practice shows, is not a disease. This is a condition in which persistent overflow of the capillaries with blood occurs, during which erythematous redness of the dermal layer is observed. The more intense the congestion of the blood supply structures, the stronger the redness. The well-known feeling of a rush of blood to the face during shame is also erythema, but only on the face. But it's not that simple. In this case we're talking about about the physiological type of erythema, there is also a pathological variety. In such a situation, we have to talk about a full-fledged independent disease.

According to the data medical statistics, erythema is not the most common disease. It occurs in different forms ah, about 15% of people. As a rule, the pathological process goes away on its own without medical care within a few days. The skin is restored on its own.

There are at least a dozen forms of the disease process. However, we should consider only the main ones that occur most often.

Reasons for the development of pathological erythematous lesions

All factors in the development of skin erythema in adults can be divided into two groups. The first category concerns increasing the sensitization of the body. This happens due to a number of reasons:

Depending on the location of the trigger process, the erythematous lesion is located. This could be the face, the skin of the limbs, or the body.


The reverse process is also possible when the immune system is excessively weakened. For what reasons might it be declining?

  • Alcohol abuse.
  • Hypothermia.
  • Frequent infectious viral diseases (ARVI).
  • Tobacco smoking.
  • Heavy and constant stressful situations, psycho-emotional and physical overload. They provoke the release of corticosteroids, which inhibit the production of specific immunoglobulins.

The second group of factors is much more serious. These are diseases that cause secondary erythema. Among them, the most frequently observed are:

An increased risk of developing erythematous lesions is observed in people prone to allergies.

Theoretically, any chronic disease can lead to the development of a problem. Physiological erythema goes away on its own and is caused by everyday factors. It does not pose a danger to life or health.

Symptoms

Manifestations largely depend on the type of erythematous skin lesion, but general symptoms can be identified:

  • Redness of the skin. It is caused by intense blood flow to the dermal layer (capillaries fill, hyperemia occurs).
  • Rashes: red spots of varying sizes, forming clear and clearly visible rounded lesions. It is necessary to distinguish erythema from dermatitis.
  • Peeling of the dermis.
  • The appearance of ulcers.
  • In some cases, nodules may form on and under the skin.

Private symptoms characteristic of individual forms also appear, such as hyperthermia (increased body temperature), weakness, insomnia, neurological impairment, and others.

The photo below shows images of classic non-infectious erythema (it is the most common in clinical practice):


However, the symptoms of different forms are still different. They should be discussed in more detail.

Non-infectious erythema

Develops as a result of increased sensitization of the body. Non-infectious erythema manifests itself as small rashes in the arms, armpits, back, and torso. It is characterized by the appearance of spots that have a pinkish tint. The sizes vary: from a few millimeters to tens of centimeters. Over time, the spots grow with the formation of large foci. Around there is a rounded ring-shaped area of ​​healthy dermis of a pale shade. The pigmentation of erythema itself is uneven.

Other signs:

  • Discomfort when touched.
  • Peeling of the skin.
  • Appearance of silvery skin flakes.
  • Itching, burning in the affected areas.

These are nonspecific symptoms that can be “tailored” to many diseases, therefore mandatory differential diagnosis is required.

Erythema infectiosum

It manifests itself with the same classic symptoms, but in addition to them there are other characteristic signs:

  • Ulceration of areas of rash. Clearly demarcated papules are formed, filled with transparent or greenish exudate.
  • Pain syndrome. The pain is sharp, aching, pulling. They intensify at night.
  • Hyperthermia is an increase in body temperature to subfebrile and febrile levels.

Infectious erythema is extremely difficult to distinguish “by eye” from erysipelas of the dermal layer. An objective diagnosis is required.

There are several forms of erythema infectiosum.

Spotted Rosenberg

Causes massive damage to the dermis in the torso, arms, legs and entire body. A person literally becomes spotted - covered with weakly pigmented spots. The most common pathology is among young people and children. Characterized by the disease high temperature(over 39 degrees), weakness, lethargy, headache, depression, insomnia. Symptoms may occur gastrointestinal tract: enlarged liver, pancreas.

Erythema multiforme

She is multi-form. In 99% of clinical situations it is caused by the herpes simplex virus (HSV). Characterized by the following symptoms:

  • Large foci of erythematous lesions (1.5-2 centimeters). They appear on the skin 3-4 days after the onset of the pathological process.
  • Increase in body temperature to significant levels (39-40 degrees).
  • Over time, all the spots merge with each other. This sign is typical only for this form of erythema.
  • On the 7-8th day after the lesion, exudation occurs, that is, ulceration of the spots and the appearance of papules filled with serous or other fluid. This is another classic sign of a skin infection.

Knotty

Erythema nodosum is characterized by a list of typical manifestations of the infectious profile. A specific symptom also occurs: the formation of large dense formations under the skin. They protrude several millimeters above the dermal layer. Possible increase in body temperature. This form of erythema develops spontaneously and is not caused by visible reasons. The development of symptoms of general intoxication (headache, dizziness, weakness and drowsiness) is likely.

Sudden erythema

It appears quickly. The temperature suddenly rises to 39-40 degrees Celsius. Symptoms of general intoxication of the body are observed. After 1-2 days, hyperthermia subsides and an imaginary improvement occurs. After this, a rash forms on the arms, legs, abdomen, torso, and face. After a few days, the rash goes away. The entire pathological process lasts no more than 5-7 days, which determines the name of this form of erythema.

Undifferentiated

It is characterized by the occurrence of a complex of the symptoms described above in different combinations. Due to the inability to clearly identify the source of the problem, it is called undifferentiated. It is rare. We are not always talking about an infectious disease, but, as a rule, a similar etiology occurs.

Therapy

Treatment involves eliminating the main factor that caused the erythema (disease, condition). Antihistamines are used to relieve symptoms. If it is infectious in nature, you cannot do without antibiotics. They are prescribed only based on the results of an objective study. Anti-inflammatory drugs and analgesics can also be used.

Erythema is a complex problem. It is multifaceted in nature and requires individual approach in every clinical case. The disease should be treated only under the supervision of a doctor. Self-medication is ineffective and unacceptable. It will only lead to aggravation of the condition.

Erythema is the formation of a rash, redness of the skin caused by the dilation of small blood vessels. There are several types of the disease, differing in clinical symptoms and causes of epidermal defects. Skin erythema can manifest itself as a physiological sign that goes away on its own and does not require special treatment.

Types of disease

Skin erythema can be physiological or pathological. The reason for the first form is the impact sun rays, reaction to reception medicines, shame, massage or other external influence.

Redness of the skin and the formation of a rash occur in places where the irritant is exposed; in some forms of erythema, the lesions are localized throughout the body.

Classification of pathology

Distinguish the following types erythema:

  • The nodular type of erythema is characterized by the formation of dense nodes in the subcutaneous tissue. Seals can reach 2–5 cm in diameter. The dermis on top is smooth, red, the spots do not have clear boundaries, the surrounding tissues are swollen. Erythema nodosum causes pain when palpating the nodes, there is no itching. After 3-5 days, the seals begin to dissolve, forming bruises on the surface of the skin. The rash is most often localized in the lower legs, on one or both limbs. May appear on the face, thighs or buttocks.
  • Infectious erythema of Rosenberg occurs at the age of 18–25 years, begins with symptoms reminiscent of the common flu, patients are bothered by chills, aches in the joints, muscles, and low-grade fever. A week later a rash appears on the body bright red, first round spots form, increasing in size and resembling lace. The skin may itch, after a week the spots disappear, sometimes they recur when exposed to hot or low temperatures to the dermis.
  • Erythema infectiosum of Chamera most often affects children. This type of illness is characterized by an increase in body temperature to subfebrile levels, the appearance of a butterfly-shaped rash on the face, and less commonly, papules form on other parts of the body. Blisters last up to 2 weeks.

  • Toxic or allergic erythema occurs in newborn infants. The pathology is caused by the body's adaptation to environment, usually a skin rash appears on days 2–4 of life. The risk of developing the disease increases during difficult pregnancy, fetal hypoxia, and placental insufficiency. Erythema on the face and body appears as red spots with blisters in the center. Papules contain yellowish liquid. In most cases, the rash is localized in the joints, on the arms, legs, buttocks and never appears on the palms and soles. The rash is accompanied by itching, restlessness of the child, and frequent crying. Papules go away in 1–3 weeks.
  • Warm erythema is characterized by the appearance of a mesh-like rash on the front of the thighs. Hyperpigmented areas form on the skin in response to prolonged exposure to infrared and ultraviolet radiation. With repeated thermal heating, melanosis or diffuse hyperkeratosis and atrophy of the epidermis appear on the surface of the lesions.
  • Erythema induratum of Bazin is a form of focal cutaneous tuberculosis. The pathology has the appearance of a lilac-red, flat spot, slightly elevated above the surface of the dermis. The node is formed in the subcutaneous fatty tissue, has a dense consistency, and can reach the size of a chicken egg. With Bazin's erythema, the nodes are painful and appear on the extremities, less often on the mucous membranes of the mouth and nasal cavity.
  • Sudden exanthema begins with a sharp increase in body temperature to 38–40°; after three days, hyperthermia passes and a rash appears on the face, limbs and skin of the body. The rash appears as small pink spots that may coalesce into larger lesions. After 2–3 days, the rash disappears without a trace.
  • Ring-shaped erythema has the appearance of rounded rashes in the shape of rings, with blisters located along the edge of the ridge. In the center of the lesion, the skin is pigmented and peels; spots can reach 20 cm in diameter. The erythema persists for several months, and dark areas remain at the site of the rash.

  • Exudative erythema multiforme is diagnosed mainly in young people and can be caused by infectious diseases, allergic reactions, have an idiopathic nature. The disease begins with signs of general malaise, hyperthermia, chills, myalgia, and headache. After 2–3 days, a rash appears; it is localized on the mucous membranes of the oral cavity, genitals, soles, feet, hands, skin of the elbows, knees. The rash looks like edematous papules with sunken central part purple, vesicles with serous or hemorrhagic contents may form in the center.
  • Palmar and plantar erythema is hereditary. The main symptom is red spots on the soles and palms. No discomfort occurs with the plantar form of the pathology; there is no hyperhidrosis.
  • Persistent raised erythema is a type of vasculitis, most often found in men mature age. The pathology begins with the formation of small nodules on the skin, which merge into larger red-blue plaques. To the touch, the nodules are dense, smooth, shiny, rising above the surrounding tissues. Signs of the disease, a nodular rash, persist for years, there are no other clinical symptoms.
  • Migratory erythema occurs after insect bites and may be a symptom of Lyme disease. A hyperemic ring up to 30 cm in diameter forms on the skin at the site of the bite. The stain can persist for up to several months and go away on its own. Specific treatment does not produce results.
  • Stevens-Johnson syndrome is a malignant exudative erythema. Large blistering rash forms on the surface of the mucous membranes of the mouth, genitals, eyes, larynx, and skin of the lips. It is difficult for a person to eat, to close his mouth, which causes constant drooling, and the body temperature rises to 40°. Purulent conjunctivitis, fibrosis of the cornea of ​​the eyes develops, and urination is impaired.

Diagnosis of erythema

Patients with hyperemic spots and rashes on the skin are examined by a dermatologist using a digital dermatoscope, which allows for multiple image magnification. The study helps to assess the condition of the epidermis and conduct differential diagnostics.

Swabs are taken from the surface of the skin and analyzed for microflora. Patients with Bazin's erythema should undergo consultation and treatment with a phthisiatrician. Patients must undergo a general, biochemical test of blood, urine, and feces for worm eggs. If allergic erythema is suspected, an allergen test is performed.

Bacterial culture is carried out to identify the causative agent of the infectious form of the disease. At the same time, antibiotics are selected to which pathogenic microorganisms are most sensitive. If you have pain or erythema in the joint area, you should be examined by a rheumatologist or immunologist. When large nodes form on the skin, a biopsy of the contents is taken and a histological examination is performed.

Additional diagnostic methods include:

  • chest x-ray;
  • bronchoscopy;
  • Ultrasound of the abdominal veins;
  • rhinoscopy;
  • pharyngoscopy.

In 50% of cases, it is not possible to establish the exact cause of erythema; symptomatic therapy is carried out.

Treatment methods

Therapy for erythema begins with sanitation and elimination of foci of infection, allergens, and chronic diseases. To reduce the inflammatory process of the skin and relieve pain, patients take non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac).

If erythema nodosum is diagnosed, treatment is carried out by laser, extracorporeal hemocorrection, patients undergo a course of magnetic therapy, phonophoresis with Hydrocortisone. The skin at the sites where the rash appears is treated with glucocorticoids. Compresses with Dimexide are applied to the joint area.

For exudative erythema multiforme, treatment begins with a single injection of Betamethasone, and eneterosorbents, plenty of fluids, and diuretics are prescribed. Patients take desensitizing medications:

  • Clemastine;
  • Chloropyramine.

Antibiotics are prescribed only for secondary skin infection. Local applications are made with proteolytic enzymes, antibiotics, and the dermis is treated with antiseptics and corticosteroid drugs. To eliminate rashes on the oral mucosa, rinse with solutions containing baking soda, chamomile.

When treating a toxic type of erythema in newborns, contact with the allergen is excluded, detoxification is carried out, and diuretics, antihistamines, and vitamins are prescribed. The skin is treated with zinc powder, oil solutions with vitamins, and the elements of the rash are lubricated with aniline dyes.

To treat Stevens-Johnson syndrome, patients are prescribed adrenal hormones. To cleanse the blood, hemosorption and plasmapheresis are performed.

The person is treated in intensive care and the body is detoxified. An effective treatment for erythema maligna is blood plasma transfusion.

Antihistamines, potassium, and calcium are prescribed. To prevent secondary inflammation, antibiotics and antifungals are indicated. Skin with rash elements is treated with antiseptic solutions (Chlorhexidine, Furacilin) ​​and ointments with corticosteroids.

Diet selection

During treatment of erythema, it is necessary to follow a diet, refrain from eating fatty, fried, spicy, salty foods, alcohol, and carbonated drinks. These products irritate the mucous membranes, worsen the patient’s condition and delay recovery.

The menu should include fermented milk products, fresh vegetables, and fruits.

The treatment prognosis is favorable. Only malignant erythema of the mucous membranes and skin occurs in a complicated form. Ulcerative-necrotic processes can develop with the addition of a secondary infection, suppuration of the rash, or damage to internal organs, development of anaphylactic shock.

Erythema persistently elevated is considered to be a localized form of leukocytoclastic vasculitis, although the site of this disease has not been definitively determined. There is a symptomatic form associated with taking medications and various diseases (ulcerative colitis, infections, polyarthritis), and a much rarer idiopathic form. A possible connection between persistent raised erythema and paraproteinemia is suggested. J. Herzberg (1980) considers extracellular Urbach cholesterosis to be a variant of persistent elevated erythema. Isolated family cases have been described. Clinically, persistent raised erythema is manifested by pinkish or reddish-bluish nodules, often located in groups near the joints (especially on the dorsum of the hands, in the area of ​​​​the knee and elbow joints) and merging into large plaques of irregular, sometimes ring-shaped, outlines, often with retraction in the center, which makes them similar to granuloma annulare. Ulcerations, bullous and hemorrhagic rashes are possible, and if infected, vegetation develops. Hyperpigmentation remains at the site of regressed lesions. Skin lesions such as persistent raised erythema may be seen in Sweet's syndrome.

Pathomorphology is characterized by signs of allergic vasculitis, i.e. destructive changes in the walls of blood vessels and their infiltration, as well as infiltration of perivascular tissue predominantly by neutrophilic granulocytes with symptoms of karyorrhexis. In the small vessels of the upper third of the dermis, swelling of endothelial cells, fibrinoid changes, especially in fresh elements, and their infiltration with neutrophilic granulocytes are noted. In older elements, the vessels undergo hyalinosis, which is characteristic of this disease. In the infiltrate, in addition to neutrophilic granulocytes, lymphocytes and histiocytes are found. Subsequently, fibrous changes in the vessels and dermis predominate, however, here too, focal inflammatory infiltrates of varying intensity can be detected, among the cells of which leukoclasia is sometimes detected. May be in different quantities extracellular deposits of cholesterol, which is responsible for the yellow color of some lesions. With significant cholesterol deposits, a special variant of this disease is identified - extracellular cholesterosis, which is not associated with lipid metabolism disorders, but is probably the result of severe tissue damage with extra- and intracellular cholesterol deposits.

Histogenesis. Most patients exhibit circulating immune complexes, increased levels of IgG or IgM, and in 50% of cases there is a defect in neutrophil chemotaxis. Using direct immunofluorescence using the immunoperoxidase method, deposits of immunoglobulins G, A, M and the C3 component of complement around the vessels are detected in the lesions. Some patients suffer from IgA or IgG monoclonal gammopathy or myeloma. The role of infectious agents, in particular antigens of streptococcus and Escherichia coli, in the development of the disease is assumed.