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Erythema Marginatum – Pictures, Symptoms, Treatment, Causes

Written by Dr.Mary

What is Erythema Marginatum?

Erythema marginatum is a rare skin condition characterized by the onset of pink or reddish rings in the trunks and the inner regions of the limbs. These rings are primarily observed on the surfaces of the extensor muscles. It is a distinctive rash that appears and disappears periodically which may last for months.

Erythema marginatum is neither a disease nor a disorder but rather a symptom signifying the existence of an underlying condition that triggered the attack. This uncommon skin condition is divided into two types and the following are:

Erythema marginatum rheumaticum

This is the asymptomatic form of erythema marginatum that is superficial in occurrence. This type is usually associated with rheumatic fever and is also considered as a type of gyrate erythema and has no known etiology. The multiple skin eruptions can be seen dispersed all over the trunk and on the skin surface of the limbs.

Erythema marginatum perstans

This is the type of erythema marginatum that exhibit skin lesions distributed all over the skin surface of both the legs and the arms. The lesion can also spread to the other areas of the body except in the palm of the hands and soles of the feet. Erythema marginatum perstans may also affect the deep layer of the skin and the onset is believed to be associated with an existing underlying condition.

The incidence of erythema marginatum is prevalent in light skinned individuals and is rather hidden or difficult to observe in dark skinned people. It can affect people of all ages including children and is twice common in male gender than in female. Some percentage of rheumatic fever cases are also being linked or associated with erythema marginatum.

Erythema Marginatum Symptoms

The onset of erythema marginatum is represented by macular rings with pale center or a similar appearance to a doughnut. The circular fashion of the macula has rough edges signifying the slow development as revealed in the appearance of the rings. The lesions may be elevated or flushed while the core of the ring is small and flattened. The core of the ring is clear while the rash is spreading peripherally to adjacent areas. The rash or the circular rings assume a pinkish to reddish color with the core that is pale or clear.

The rash can occur in multiple areas of the body but cannot appear on the face, palms of the hands and soles of the feet. The pinkish or reddish rings have various sizes that range from 0.5cm to 8cm in diameter. The rings will spread and increase in size overtime and will tend to have an irregular shape or may have an indented margin. The initial onset is on the lower trunk then slowly extends in an upper direction. The rash on the lower part disintegrates as it extends upward where it becomes more apparent.

Erythema marginatum is generally non-pruritic that no irritation and itchy sensation can be experienced. The rash however can be aggravated by body temperature where it gets worse during hot shower or extreme heat in the weather. The aggravation is characterized by reddish discoloration where it disintegrates as soon as the body temperature is back to normal.


Erythema marginatum has no clear or definite etiology. The sudden alteration in the epidermal layer of the skin is the result of inflammation in the blood vessels is prompted by the lymphocytes histiocytes. The exact cause of the alteration of the epidermal layer of the skin in erythema marginatum has not been clearly identified. There are several factors however that are being considered to trigger the onset of erythema marginatum and the following are:

Rheumatic fever

Rheumatic fever is often associated with erythema marginatum. It is an inflammatory disease caused by group A streptococcus bacterial infection. This inflammatory disease is prevalent in children with ages from 5 to 15 years although can also occur in adults. Erythema marginatum is among the clinical features of Rheumatic fever and the rash is non-pruritic and generally not painful. The onset of rash can go unnoticed and usually fades then reappear within hours that may persist for weeks or months. Rheumatic fever is also regarded as the most common cause of erythema marginatum as revealed in most cases reported.


Lyme disease

Lyme disease also results to erythema marginatum as among its symptoms. It is an infectious disease caused by Borrelia burgdorferi and is prevalent in North America. It is a tick-borne disease that is transmitted to humans through bites from infected ticks of the genus of Ixodes.


Allergic reaction towards a wide range of stimuli can trigger the onset of rash as its response to the stimuli. This could include food ingested, exposure to chemical agents, and environmental exposures. The allergic food reaction is the most common trigger of rash particularly in blue cheese and tomatoes.


Malignancy is also one factor considered for the onset or erythema marginatum. Life-threatening diseases and disorders such as leukemia, lymphoma, breast cancer and squamous cell carcinoma are among the considered triggers of erythema marginatum.


Infection from a broad spectrum of causative agents can result to small eruptions. Escherichia coli, Ascaris lumbricoides and Candida albicans are among the infectious agent known to elicit the rash of erythema marginatum.

Adverse reaction

Adverse reaction to certain drugs used for medication can also elicit the rash eruption. Pharmacological drugs such as penicillin, antimalarial chloroquine or hydrocychloroquine and cimetidine are being linked to the activation of erythema marginatum in some cases.


A hormonal change is another factor being considered in erythema marginatum as seen in pregnant women. The onset of puberty is activated by hormonal changes thus explains the onset of erythema in children aged 15 years or those already in their puberty stage. Erythema marginatum during pregnancy usually resolve right after delivery.


Erythema marginatum is not a primary disease but rather a symptom of a number of disorders that treatment directed towards the rash is not necessary. The rash usually resolves on its own even without treatment although they tend to linger for weeks, months and even a year.

Rheumatic fever is the most common cause of erythema marginatum that treating the underlying condition is necessary to prevent medical complications that may arise from erythema marginatum as the condition if can result to an inflammation in the heart which is potentially life-threatening.

Withdrawal from drugs and any other medication that can aggravate the rash is necessary. Food that can elicit allergic reaction should be avoided to prevent the onset of erythema marginatum while those that are caused by an infection can be managed with antibiotic treatment to eradicate the infection.

Erythema Marginatum Pictures

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