Erythema marginatum: Causes, Treatment, and Image

Erythema marginatum (EM) occurs in about 10% in the first attacks of ARF on children. It is also very rare in adults like chorea.

Erythema marginatum

Many patients and parents have reported a non-radical, painless, and attractive erythema rash on the trunk, which is usually seen only in light-skinned patients.

It might also interest you to know that in 1831 this disease was first named “erythema marginatum rheumatism” by bright and described by Cheadle in 1889.

What you should know about Erythema marginatum

If you have a lineage on the medical field, you will be familiar with the fact that “erythema” means red and “marginatum” is from a Latin word “margin”. In other words, erythema marginatum is redness or rash in which their margins are easily visible because they are elevated.

Basically, erythema marginatum (EM) is redness or rash in which their margins are easily visible because they are elevated.

Read on to learn more about EM.

More about Erythema marginatum

Erythema marginatum is also a type of annular erythema.

It has reddened and raised edges with a flat and clear center. You can see this on the trunk and nearby limbs. In most of the cases, it doesn’t affect the palms, face, and soles of the feet. People often overlook it cause it is painless or itchy. It’s simply there and it doesn’t let you feel anything.

How can I identify the erythema marginatum rash?

The EM rash can look like a pattern with a faint look on your skin with a pinkish center and a flat or slightly elevated red border. The general shape can be regular rings or semi-circle, or even less regular shapes with a wavy margin.

EM fades over time. It can only appear for hours, or for days or more. The rash does not cause itching or pain, and may not be noticeable at darker skin tones.

Erythema marginatum shows up mainly on the trunk and limbs. Usually does not appear on the face.

Image of erythema marginatum

What are the causes of this rash?

There are various conditions that can lead to erythema marginatum rash. These conditions include:

Hereditary angioedema

erythema marginatum may be a sign of hereditary angioedema which shows up early. The rash takes place in about 42 to 58 percent of children with a type of hereditary angioedema called C1-INH-HAE, newborns are not excluded.

Also, this rare genetic disease takes place in about 1 in 50,000 people. Most times the symptoms do not appear until after puberty.

EM rash might be important as a warning of an upcoming attack. most times the rash is mistakenly diagnosed as hives, delaying angioedema tests.

Symptoms include:

  • cramps
  • nausea
  • swelling of the face, hands, arms, and legs
  • gastrointestinal problems
  • irritability
  • lastly fatigue

Lyme disease

Rarely, erythema marginatum may be a skin symptom of Lyme disease, although erythema migrans is often observed with this condition.

Lyme is a debilitating disease transmitted by the bacteria Borrelia burgdorferi through black-legged deer ticks. It is very difficult to diagnose because of the variety of symptoms it follows which mimics the symptoms of many diseases.

Other symptoms include:

  • fatigue
  • achy, stiff, or swollen joints
  • headache, fever, dizziness, and other flu-like symptoms
  • night sweats and sleep disturbances
  • cognitive decline
  • neurological problems


Adverse reactions to certain medications can cause an EM rash. For instance, an amoxicillin-clavulanate (Augmentin) antibiotic combination can cause erythema marginatum.

Rheumatic fever

Rheumatic fever is the major cause of erythema marginatum. It is present in about 10 to 25 percent of people with this disease.

Rheumatic fever is also a complication from strep throat that isn’t treated with antibiotics adequately. This disease can cause serious heart damage. Rheumatic fever and rheumatic heart disease are mostly seen in undeveloped countries. This disease is however rare in the United States.

symptoms include:

  • fever
  • joint pain
  • nodules under the skin
  • heart valve damage
  • elevated C-reactive protein in the blood
  • and lastly other skin rashes

Other Possible Causes of EM

Other possible causes of the erythema marginatum include:

  • Firstly Lyme disease
  • Allergy (most common are blue cheese and tomatoes)
  • Infection (Candida albicans, Ascaris lumbricoides, Escherichia coli)
  • Drugs (penicillin, cimetidine, chloroquine)
  • Malignancy (especially leukemia, breast cancer, squamous cell carcinoma, and lymphoma)
  • lastly Pregnancy

How is the cause of erythema marginatum being diagnosed?

If you recently had a sore throat, your medical specialist may order blood tests to look for signs of rheumatic fever. They can also conduct tests to check if there’s any damage in the heart. There is no test for the diagnosis of rheumatic fever.

Also, If you or your child has a rash that looks like EM, I advise you to see a doctor. The rash itself is not dangerous but could indicate a serious underlying condition.

Your doctor will also ask about your medical history, the medications you are taking, and other symptoms.

Diagnosing of Lyme is often based on symptoms and a blood test.

Treating the causes of the rash

There is no cure for erythema marginatum. The rash goes out on its own. You may need to treat a pathological condition causing the rash.

You can treat the fever with the following:

  • antibiotics for infection
  • salicylates for arthritic symptoms
  • corticosteroids for heart involvement

Hereditary angioedema is treated by a C1 esterase inhibitor (Cinryze) or icatibant (Firazyr).

Erythema marginatum vs. Erythema Migrans what’re their differences?

EM has a similar look to erythema migrans except for the central part that has a transverse aperture. EM spreads throughout the body while migrans erythema expands into a localized part. You can see the rheumatic fever in patients with Erythema marginatum. Erythema migrans is also common among patients with Lyme disease.


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