Palpable Erythematous Lesions

(1)
Hôpital Universitaire de Strasbourg, Strasbourg, France
 
Abstract
Non-purpuric, palpable red lesions are very common and have a great number of causes. They are often the consequence of cutaneous inflammatory diseases. Thus dermatological and extracutaneous associated signs, as well as context, are an important part of differential diagnosis. The “relevant” contexts are numerous and varied: neutropenia and immune deficiency, newly taken drugs, and cold triggering, to name a few. Among possible causes are severe infections (such as septicemias) and cutaneous manifestations in leukemias: the clinical situation of these patients must therefore be carefully analyzed. Indeed, these lesions can easily be trivialized, being very common with very familiar causes, such as insect bites or urticaria.
Non-purpuric, palpable red lesions are very common and have a great number of causes. They are often the consequence of cutaneous inflammatory diseases. Thus dermatological and extracutaneous associated signs, as well as context, are an important part of differential diagnosis. The “relevant” contexts are numerous and varied: neutropenia and immune deficiency, newly taken drugs, and cold triggering, to name a few. Among possible causes are severe infections (such as septicemias) and cutaneous manifestations in leukemias: the clinical situation of these patients must therefore be carefully analyzed. Indeed, these lesions can easily be trivialized, being very common with very familiar causes, such as insect bites or urticaria.
Certain papular inflammatory dermatoses can be clinically identified, for example, typical lichen papules. In such a case, they have a characteristic purple coloration and are flat, polygonal, and covered with fine white striations, called “Wickham’s striae.” They are pruritic. In case of lesions of secondary syphilis, a perilesional collarette surrounding the papule is very suggestive of this diagnosis, especially when lesions are located on extremities.
Neutrophilic dermatoses (i.e., Sweet syndrome), vasculitides, and erythema multiforme are possible causes of multiple, eruptive, edematous plaques.
Inflammatory lesions located in the hypodermis (deep-seated nodules, or “nouures” in French terminology) reflect an affection either of the adipose lobules (lobular panniculitis), of the inter-adipose septa (septal panniculitis), or of hypodermal vessels (either veins or arteries).
Papules often have an altered surface and produce intricate lesions which are discussed later on, i.e., papulopustules, scaly papules, and necrotic papules.
Box 35.1
Main Causes of Erythematous Papules
Acne
Atypical fibroxanthoma
Botryomycoma
Burn caused by marine animals and plants
Chilblain
Cutaneous Kikuchi disease
Cutaneous manifestations in septicemias
Eosinophilic folliculitis (usually pustular)
EPPER (eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy)
Eruptive xanthoma (pink)
Erythema elevatum diutinum (on the back of the hands)
Fibroblastic rheumatism
Flea bites
Folliculitis caused by infection with Malassezia (usually pustular)
Foreign body granuloma
Gianotti-Crosti syndrome
Gluteal granuloma
Gottron’s papules in dermatomyositis (back of the hands)
Granuloma annulare (which generally merges into annular lesions)
Grover’s disease (often papulovesicular)
Hordeolum (or sty) and chalazion
Insect bite and sting
Kaposi’s disease
Lymphomatoid papulosis
Multicentric reticulohistiocytosis (back of the hands)
Perforating elastoma (that merge into arciform lesions)
Pityriasis lichenoides
Prurigo
Rickettsioses
Rosacea
Ruby spots (or cherry angioma)
Sarcoidosis (often annular)
Scabies
Secondary syphilis
Urticaria
A306461_1_En_35_Fig1_HTML.jpg
Fig. 35.1
Succulent (i.e., “impregnated with fluid”) erythematous papules on an erythematous macule. Prurigo
Oct 6, 2016 | Posted by in Dermatology | Comments Off on Palpable Erythematous Lesions

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