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WHAT: Erythema marginatum. Erythema Marginatum: an evanescent, erythematous rash characteris- tically (though not commonly) seen in the early stages of rheumatic fever. The rash is not limited to rheumatic fever, however, and has also been reported in patients with allergic drug reactions, sepsis and glomerulonephritis. WHY: Although the rash is not pathognomonic of rheumatic fever, its presence is helpful in conjunction with other manifestations of rheumatic fever, particularly carditis with which it is most often associated. HOW: The rash is characterized by pink, evanescent, slightly raised small macules with a sharply demarcated and irregular border. The erythematous areas often have pale centers. The rash commonly occurs over the trunk and inner aspects of the upper arms and thighs, but never on the face. It is non-painful and rarely pruritic, may appear and disappear in a matter of hours only to return, and may be brought out by a hot bath or shower. The rash blanches on pressure, and is a transient rash which tends to migrate from place to place. REFS: 1) Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 32:664, 1965. 2) Dictionary of the Rheumatic Diseases, Volume I: Signs and Symptoms. American Rheumatism Association, 1982. (Descriptor #133).
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