Chronic Erythemas and Skin Conditions

Chronic Erythemas

• Red-Violet Rash: This type of rash can be indicative of several conditions, particularly Tuberculosis of the skin, which is a specific manifestation of a mycobacterial infection that can affect the skin. Psoriasis, a chronic autoimmune skin disorder characterized by rapid skin cell proliferation leading to scaling and inflammation, and Lichen planus, which presents as flat, itchy, purplish lesions, are also notable causes. Additionally, Lupus erythematosus, an autoimmune disease that can affect multiple organ systems and causes various skin manifestations, and Reticuloid skin conditions, which include chronic dermatoses such as Mycosis Fungoides (a type of cutaneous T-cell lymphoma), can produce similar red-violet rashes.
• Brick Red/Copper/Rusty Rash: This distinctive coloration is commonly associated with secondary or tertiary stages of Syphilis, a sexually transmitted infection caused by the bacterium Treponema pallidum. The skin manifestations in these stages can vary and may include a range of red or copper-colored lesions reflecting systemic effects.
• Dark Red Rash: Also known as the manifestation of Besnier-Boeck-Schaumann disease, more commonly referred to as Sarcoidosis. This disease is characterized by the formation of granulomas, which can affect the skin and lead to a variety of rashes.
• Orange-Red Rash: Often observed in patients with Lymphomas, particularly cutaneous lymphomas that affect the skin. These rashes may be indicative of an underlying malignancy and warrant further evaluation.
• Lilac-Red Rash: This coloration is commonly associated with Scleroderma, an autoimmune disorder that leads to skin thickening and hardening, and Dermatomyositis, which is characterized by muscle weakness and skin rashes, notably a violaceous rash over the eyelids (heliotrope rash) and on the knuckles (Gottron's papules).
• Gray-Brown Rash: Typically observed in Leprosy (Hansen's disease), which is caused by the bacterium Mycobacterium leprae. This condition primarily affects the skin and peripheral nerves, leading to skin discolorations and lesions.

Other Skin Lesions

• Bluish-Purple Spots/Patches: These lesions can indicate various conditions. A notable concern is that a halo of red-violet surrounding these spots/patches may suggest a malignant transformation, indicating the need for further investigation or biopsy for accurate diagnosis.
• Small Red or Dark Spots: These are often associated with Pediculosis Pubis, commonly known as pubic lice infestation. The lesions result from intense itching and scratching as a response to the presence of lice, leading to secondary skin changes and irritation.
• Red-Pink Rash: Known as Pelagroid erythema, this rash may result from nicotinic acid deficiency, presenting as a fiery rash particularly in sun-exposed areas, and might be linked to a broader nutritional deficiency syndromes.
• Red or Pink Rash on Joints: Commonly referred to as Erythema, especially noted over the elbows, which may result from various inflammatory conditions, including autoimmune diseases or forms of arthritis.
• Medication-induced Rash: Referred to as Fixed Drug Eruptions, these rashes reappear in the same location upon re-exposure to the offending medication and can present as well-defined erythematous plaques.
• Generalizing Rashes: Conditions such as Erythema multiforme characterized by target-like lesions, Erythema roseolum often related to viral infections, and Erythema scarlatiniform associated with streptococcal infections fall into this category, indicating a broader systemic involvement.
• Erythrodermias: These can be classified as either primary conditions, such as psoriasis or eczema, or secondary causes related to systemic diseases, leading to extensive erythema and scaling affecting a large portion of the body surface area.

Vascular Lesions

• Telangiectasias: These lesions manifest as dilated superficial blood vessels that become less visible when pressure is applied. Commonly associated with conditions like rosacea, an inflammatory skin disorder characterized by facial redness, lupus erythematosus—with systemic implications—and chronic alcoholism leading to skin changes. Long-term corticosteroid use can also result in the development of these vascular lesions due to the thinning of the skin.

• Vascular Stars: These are a special form of telangiectasias that radiate outward in a star-like pattern, often seen in patients with cirrhosis of the liver, reflecting increased pressure in the blood vessels.

• Spider Angiomas: Characterized by a central red spot with radiating blood vessels, these are frequently noted in individuals with liver disease and are also commonly seen in pregnant women due to hormonal changes.

• Hemangiomas: These are benign vascular tumors that can vary greatly in size and shape, typically appearing at birth or shortly thereafter. They most commonly resolve without treatment but can be associated with specific syndromes if multiple lesions occur.

• Small Red Spots: Also known as Capillary hemangiomas, these represent tiny vascular tumors that often appear as small red or purple nodules on the skin, which may grow initially before regressing over time.

• Varicose Veins: These are dilated veins primarily affecting the lower extremities due to factors such as prolonged standing or sitting, leading to associated stasis dermatitis. This condition manifests as inflammation of the skin diverging from poor circulation, often accompanied by changes in skin color, texture, and a predisposition to dermatitis and ulcers in advanced cases.