Definition And Description

Erythema consists In a circumscribed or diffused patch, or several such patches, characterized by redness, a little heat and sometimes itching. The patches may be of temporary duration only, or may persist for a considerable time. The name is not strictly applicable to any definite and particular disease, but should rather be taken in a generic sense as the designation of a symptom, implying the idea of superficial congestion. Thus the redness which follows exposure to the sun or to artificial heat has been termed erythema coloricum; that which follows the application of irritating substances like mustard or capsicum, has been termed erythema ab acribus; that which is induced by the pressure of badly fitting garments - garters, stays, pads, straps, trusses, etc. - has been called erythema traumaticum. These are all trivial affairs, which soon disappear when the cause which produced them no longer continues in action. There are, however, other forms of congestion or simple hyperemia of the skin that appear to be due to internal causes. Such, for instance, as the temporary flushings of the face that occur in women about the time of the menopause, and which last sometimes for a few minutes only, sometimes for an hour or more. When these are frequently repeated, the hyperemia becomes more persistent, giving rise to a chronic condition which, in time, may lead to a pronounced Rosacea.

In certain cases, dyspeptic conditions and hepatic derangements may give rise to hyperemic conditions of the face, which may, with equal propriety, be called erythema.

In addition to the foregoing there are two definite affections of the skin that have received the generic name of erythema with a qualifying addendum: I allude to the so-called Erythema multiforme, and E. nodosum. These will be considered separately.

Diagnosis

The name erythema simply may be applied in accordance with usage to a variety of hyperemic conditions of the skin, arising from a multitude of causes, and, as before said, should be regarded rather as the designation of a symptom than as the name of a definite disease. The important point in diagnosis is to ascertain, if possible, the nature of the erythema, that is, the cause on which it depends.

Prognosis

The prognosis will naturally depend on the etiological elements of the case, and is, of course, good when the erythema is due to temporary and external influences, and more grave when internal derangements are at the bottom of the trouble.

Treatment

The forms of erythema that depend on temporary, external influences, require no treatment other than the removal of the cause, while those that depend on gastro-intestinal, uterine, and other internal derangements require such hygienic and constitutional measures as may be demanded by the peculiar circumstances of the case. The special treatment of the lesion, however, demands attention. In the erythematic flushings of women, Amyl Nitrite, as first pointed out by Ringer, has proved of decided service at our hands. It should be given in quite small doses, and may be administered by the mouth or by inhalation. I find the following a convenient method of administrating it internally: Take a vial of unmedicated homoeopathic pellets of convenient size; pour into it sufficient amyl nitrite to cover them. At the end of a few days they will be saturated. Then turn them out on a piece of unsized paper, and permit the amyl nitrate to evaporate until they are just dry on the surface, and do not stick together, then replace them in the vial and keep for use. The pellets will absorb about one-fifteenth their weight of the drug, and, if a given number be weighed prior to medication, the amount that each will contain can be readily estimated, and the dose regulated accordingly. For inhalation take a vial of convenient size, a ladies vinai-grette, for instance, fill it with the finest toilet sponge, and pour in sufficient amyl to saturate the sponge and cork tightly. A whiff or two of this is the appropriate dose. In more persistent erythemata, belladonna, as mentioned by Bartholow, sometimes proves of service.

In addition to internal treatment, local applications will prove of ser-vice in the more persistent forms of erythema. In the milder varieties the author has used both arnica and belladonna, and ergot, in ointment or lotion to advantage. In decidedly chronic cases, especially if there be any tendency to infiltration or desquamation, slightly stimulant applications should be made. The white precipitate or citrine ointments, or ointments containing one of the empyreumatic oils, will be required. Contractile collodion is also useful.

Besides the drugs mentioned, the following may be considered: Am-monii Chloridum, 15; Bismuthi Subnitras, 32; Plumi Oleas, 89; Plum-bi Subacetas, 89; Rhus Toxicodendron, 99; and Stramonium, 108.