All about erythema

Erythema is probably the most common skin disorder in the world, at least in people with fair skin. So much so that everyone, at least once in their life, experiences it in a more or less severe form for the most diverse reasons.

Certainly, in summer, at the origin of the majority of common erythema there is excessive exposure to the sun without having taken steps to protect the epidermis with a sunscreen able to effectively shield from ultraviolet rays (UvB and UvA): this causes the characteristic redness accompanied by peeling of the skin and pain to the touch.

However, the internal and external factors of the body, physical or psychological, which can trigger the typical skin inflammatory reaction, in all possible declinations, are really many and can not always be avoided.

Common, however, is the treatment of erythema, based on soothing, refreshing and protective creams of the balance of the epidermis and, only in cases of more severe and resistant inflammation, on drugs containing corticosteroids or other active ingredients, in relation to the nature of the disorder present.

What is it

To tell the truth, the term erythema is very generic and is not widely used in dermatology, as it does not allow to immediately understand the origin of the skin reaction that characterizes it, consisting of a more or less intense, marked and extensive redness of the epidermis, generally associated with burning and / or itching of variable degree and, sometimes, to a slight swelling.

The typical redness of erythema is due to a phenomenon of superficial vasodilation able to temporarily increase the blood supply in the affected area, which can thus take on a red-bright hue, when vasodilation mainly affects small arterial vessels, or bluish-red, when the venous capillaries swell.

In both cases, the simple pressure of a finger on the epidermis, compressing the blood vessels and “moving away” the blood, is enough to make the redness disappear, which reappears, however, as soon as the fingertip is lifted.

Depending on the cause that caused it, erythema can be limited to the manifestations described or be accompanied by translucent bubbles filled with fluid (papules) or pustules (small swellings generally containing pus), skin thickening or peeling of the skin more or less significant (typical, for example, of some mycoses and atopic dermatitis, but also of seborrheic dermatitis), or take a so-called powdery appearance, which seems to be covered with dust (as happens in the case of Candida colonizations, which can affect the skin or the oral and genital mucous membranes).

Itching redness that occurs during childhood exanthematous diseases such as chickenpox, measles and rubella is also an erythema: in these cases, it is surmounted first by the classic papules or then by annoying scabs.

Each of these skin reactions can therefore have different characteristics and causes, which should be investigated carefully in order to then establish what could be the most appropriate treatment to remedy the inflammatory process and what underlies it.

Possible causes of erythema

The possible causes of erythema are countless and not always easy to pinpoint precisely. The most common and most immediately recognizable include:

External chemical agents	Irritating detergents, acids, alkalis, bleach, mineral oil, solvents, synthetic or plant resins, surface burns, cosmetic products that cause allergic reactions, etc.
External physical agents	UV rays, intense cold, radiotherapy, clothing of special materials that do not respect the needs of the skin, etc.
Photosensitising substances	Perfumes, fruit acids, essential oils etc.
Skin mycoses, local or systemic viral infections	Herpes simplex or exanthematous diseases

In addition, topical or systemic drugs can also cause erythema, due to direct irritating/sensitizing action or mediated by sun exposure.

Erythema can then appear for more “subjective” reasons such as the presence of hypersensitivity or allergies to substances that are generally harmless to the majority of people (for example, in the context of allergic or irritative eczema) or as a consequence of an intense emotional reaction to a specific circumstance that triggers a characteristic vasomotor reaction.

Even nutritional deficits related to an unbalanced diet (in particular, vitamin deficiencies), allergies or intolerances to specific foods and endocrine disorders can facilitate the onset of erythema, not to mention that more than one pathology has among its side effects also the appearance of erythema and skin spots.

Diagnosis

As mentioned, recognizing erythema is simple, by virtue of its absolutely characteristic appearance, but issuing a precise diagnosis of the disorder that determined it or, in any case, establishing the mode of onset can be a considerable undertaking.

To guide in the investigation are above all:

– localization (hands, feet, ankles, wrists, lips and oral cavity, shoulders, face, genital area, body folds, etc.)

– the shape (roundish, irregular, well-defined, etc.) and the extent of the reddened spots

– recent exposure to external agents at risk (including medicines taken by mouth)

– any surrounding symptoms (fever, malaise, joint pain, etc.)

– the age, characteristics and lifestyle habits of the person concerned.

For example, the appearance of one or more reddened skin areas in a person who regularly attends the pool or gym may depend on a mycosis; if a nurse has erythema in the hands, in all probability there is an allergy to latex of the gloves used in the hospital at the origin, while if the redness has appeared after exposure to the sun, even moderate, in a person who is taking antibiotics or non-steroidal anti-inflammatory drugs (NSAIDs), the reaction is due to the photosensitizing action of these medicines.

A strong redness on the bottom of a newborn is very often due to an irritative diaper rash, while the appearance of reddened and flaky spots on the face or arms in the first years of life must make us think of atopic dermatitis: both diaper and atopic dermatitis require specific care and constant contact with a doctor.

For cases where it is difficult to determine the cause of the problem, it is also advisable to undergo more thorough analyzes, ranging from simple blood tests to a biopsy; The appropriateness of such tests must, however, be carefully assessed following the collection of the qualified opinion of a doctor.

Carefully investigating the causes of erythema and issuing a precise diagnosis of any underlying disease is important to identify the best treatment for both the underlying disorder and the skin manifestation and, if possible or necessary, to provide adequate countermeasures, both to heal, immediately, and to prevent it from recurring in the future (in particular, in the case of specific allergies and hypersensitivities and skin infections that can be prevented with simple practical measures).

Complications

Although erythema is not in itself a disorder that can endanger general health, it is not the case to neglect it because the annoyances that can derive from its mismanagement and its unfavorable evolution are decidedly unpleasant.

For example, rubbing reddened and inflamed skin can lead to a substantial increase in burning, inflammation and pain, as well as the appearance of skin lesions at risk of infection. This risk increases exponentially if papules, pustules or fissures are already present on the erythematous area (as often happens in the case of occupational irritative dermatitis of a certain importance or atopic dermatitis in children).

One of the most serious and complicated forms of erythema, fortunately rare, is Stevens-Johnson syndrome, characterized by the appearance of bubbles in the mouth, throat, eyes and genital and area, accompanied by fever and difficulty swallowing and vision; It can also have fatal outcomes.

To prevent a common erythema from evolving in a negative way, with all that follows in terms of physical and psychological discomfort and lengthening of healing times, it is important to treat the skin area correctly from the onset, avoiding both folk remedies and imaginative treatments suggested by friends and relatives and referring to the doctor or pharmacist for competent advice on OTC preparations (so-called “over-the-counter” drugs that do not require a prescription medical) or prescription that can offer real relief, in relation to the specific problem present.

How to cure erythema

The extremely wide range of possible causes of erythema means that even the most appropriate treatments in the individual case can differ considerably. However, strategies, pharmacological and otherwise, that can help relieve key symptoms, such as redness, burning, irritation, pain and sensation of dry skin, and to “refresh” the affected area, also relieving itching, are common to most forms of erythema, starting from that typical of sunburn.

Non-pharmacological strategies

The first approach to appease erythema is very simple and intuitive and consists in lowering the temperature of the affected area with fresh and moist compresses (soft sponges soaked in fresh water are perfect) or with a cold shower, if it is a diffuse erythema that arises, for example, after excessive exposure to the sun.

In both cases, the skin should be touched as little as possible and never rubbed: the cold will be enough to exert a very useful vasoconstrictor action and to reduce burning and stimulus to itching, while water will allow to moisturize the epidermis that tends to be dry and suffering, due to the alteration of the protective superficial skin barrier.

In case of diffuse erythema, even a cool bath can give considerable relief, as long as it is short (10 minutes maximum), so as not to further weaken the already fragile skin. Of course, potentially sensitizing detergents should not be added to water, while the addition of soothing and emollient substances (such as starch and oats) or a cleansing oil containing chamomile, calendula etc. can help.

Once out of the water, the ideal for drying is to wrap yourself in a very soft cloth and wait for the residual moisture to evaporate by itself: this trick is, fortunately, very easy to adopt in summer, when the heat is the master and drying quickly is not a very felt need.

Especially in case of sunburn, it should be remembered that water, as well as put in contact with the skin, should also be drunk in abundance, because skin hydration begins “from within” and an organism that has spent many hours on a beach is always short of liquids. It can also be obtained in abundance from fruit and vegetables, which must never be lacking in proper nutrition and which also allow you to obtain vitamins, antioxidants and mineral salts, all essential elements for the body and even more precious in case of erythema alone.

In particular, for the health of the epidermis exposed to UV rays, it should be remembered to fill up on vitamin A, contained in all red-orange fruits, but also vitamin C and vitamin E, powerful antioxidants present in many foods, essential to reduce damage from phototoxicity, counteract skin aging and promote the healing of erythema.

Vitamins can be easily taken through the diet but, in the event that a deficiency is found, and always with the advice of your doctor, you can easily resort to food supplements.

Soothing creams and specific medications

Whether it is sunburn or otherwise, to reduce the symptoms and promote their resolution, it is essential to apply soothing, moisturizing and emollient creams that allow you to soften the skin, greatly reducing the feeling of dryness, and moisturize it in a deep and lasting way, thanks to the presence of lipid components able to replenish the protective surface barrier, First evaporation shield.

To get the maximum benefits from this type of preparation it is important to choose high quality products, containing substances with known humectant and restorative properties of the epidermis (such as glycerin, panthenol, glycine) and lipids as similar as possible to those naturally present in the epidermis (ceramides).

An added value is represented by probiotics which, added to the cream, offer appreciable support to the reconstitution of the skin barrier and the restoration of the dermoepidermal balance. Very useful for their moisturizing, refreshing and repairing properties are also aloe gels with a high percentage of extract (90-100%).

When the erythema is very accentuated and linked to a significant inflammatory component, as in the case of atopic dermatitis or severe irritative/allergic eczema, it may be necessary to add to these “background” remedies also a treatment with specific drugs, generally based on corticosteroids.

Corticosteroids should be prescribed by the doctor and used according to the times and methods indicated by him, remembering that both their local application on the skin and the intake by mouth have a photosensitizing effect, which increases the risk of erythema and sunburn in case of sun exposure. If you use them in summer, it is good to talk to your doctor and always plan to apply a sunscreen with a high protection index (SPF 30-50) for the duration of the treatment and for a few days after its interruption.

In the event that the erythema causes discomfort or unbearable pain, the attending physician may also prescribe pain medications, for systemic therapies or for a topical application.

How to prevent sunburn

Having an erythema can be a decidedly unpleasant experience, which can last for several days. In addition to treating it, it is therefore important to learn how to prevent it in all cases where it is possible.

Of all the forms of erythema, the sun is the easiest to avoid and doing so is also a must to protect yourself from problems with cells and skin tissues much more serious, such as melanoma. Solar erythema, of course, also means that resulting from exposure to machinery that simulates the radiation emitted by sunlight, such as tanning lamps.

The basic rules to be respected to avoid damage in case of exposure to the sun include:

– identify your skin type and always use a corresponding sunscreen, repeating the application at least every 2-3 hours, even if you are in the shade or if the sky is cloudy;

– avoid exposure during the hottest hours of the day (from 11.00 to 15.00)

– use sunscreens with a high protection index, with photostable UvA and UvB filters

– always protect children with appropriate products (i.e. with SPF 50 or total screen) and expose them to the sun in moderation up to three years

– apply shielding products more frequently if you practice sports or if you tend to sweat a lot and repeat the application of sunscreen after each bath or shower

– Do not apply photosensitizing products to the skin, such as perfumes, cosmetics or non-specific creams, before exposure to the sun

– Avoid sun exposure if you are taking medications such as antibiotics, anti-inflammatories, St. John’s wort and cortisone

– at the end of the day, always apply a moisturizing and emollient cream of excellent quality, and take care of hygiene and cleaning of the affected area with a product suitable for your skin type

– avoid using “self-tanning” preparations or stimulators of melanin production when exposing yourself to the sun (possibly, do it in the previous weeks to “prepare the skin”)

In addition, it is good to remember that the increase in melanin production is a defensive reaction of the skin to the insult of UV rays and that tanning, more than a sign of health, is indicative of skin “suffering”; Therefore, the prevention of erythema should also pass through a reduction of tanning, if it is usual to undergo it excessively, and in general through greater safety during exposure to sunlight.

When to consult your doctor

When a localized but severe erythema appears, with papules, vesicles or pustules at risk of infection, or extended over an area greater than that of a hand and / or other significant symptoms such as fever, general malaise, loss of appetite and strong exhaustion, the doctor should always be consulted to investigate the situation and set up the appropriate treatment.

Even a major and extensive sunburn should always be subjected to medical evaluation, especially if it is a child or an elderly person who is affected and if there are temperature rises, fatigue, drowsiness, mental confusion (all signs of dehydration and possible heat stroke).

Other erythemas of certain medical competence are those affecting the mucous membranes of the mouth and genitals: in these cases, after an initial examination by the family doctor, it may be necessary for patients to undergo an odontostomatological or dermatological study (depending on the case and the location of the manifestations) performed by a specialist.

It is then good to contact specialists, requesting a dermatological examination, whenever an erythema appears in patients who are already in a condition that requires some attention, for example pregnant women, or those suffering from certain chronic diseases, in particular the immune system, in order to preserve in health and well-being conditions not only the skin, but the whole organism.