Erythema

Erythema, the gross manifestation of dilatation of the smaller arterioles, is usually the earliest macroscopically visible sign of inflammation. It is of particular importance in the present context since tests involving measurement of erythema are among the most sensitive means of discovering antiinflammatory activity. Most of the substances capable of increasing vascular permeability also produce vasodilatation erythema, without associated exudation, can often be produced by low concentrations of such substances. However, the persistence of the erythema of inflammatory reactions contrasts with the transient nature of that produced by histamine or bradykinin. 

When nicotinic acid esters are applied to the skin of patients with rheumatoid arthritis, an anomalous vasoconstriction frequently occurs instead of the usual erythema and was at first thought to offer diagnostic possibilities . It is now apparent, however, that the effect is attributable to the therapeutic use, by such patients, of acetylsalicylic acid, which is remarkably potent in retarding the development of the reaction -.  

Further study of the mechanism of erythema seems to be worthwhile in 

More research has been devoted to the study of increased vascular permeability than to any other aspect of inflammation, and several excellent reviews on the subject have recently appeared . Increased vascular permeability here refers to the increased tendency for fluid and plasma proteins to pass through the vessel wall into the extravascular space. Various methods of studying the process have been described, usually involving either the assay of extravasated protein or protein-bound dyes such as trypan blue, or the measurement of the degree of swelling produced in a rat s paw after the subcutaneous injection of an irritant (see page 67). 

The concept of an endogenous mediator of increased permeability was supported by the classical studies of Lewis on histamine. The increase in vascular permeability is a biphasic process, the earlier transient stage, in some species at least, resulting from the release of histamine. After suitable mild inflammatory stimuli, the tissue oedema may often be inhibited by anti-histaminic drugs. In a limited sense, therefore, antihistaminic drugs may be regarded as having anti-inflammatory activity, but they are not discussed in detail in this review. 

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Blood dyscrasias are quite uncommon, but if they occur may be serious enough to cause discontinuance of the therapy. Both topical and systemic adrninistration of sulfas can cause hypersensitivity reactions, such as urticaria, exfoHative dermatitis, photosensiti2ation, erythema nodosum, and in its most severe form, erythema multiformexudativum. (Stevens-Johnson syndrome). In general, however, use of sulfonamide therapy is considered relatively safe. 

Soap as used in personal cleansing products has a long safe history of use. Modem soaps have been specifically formulated to be compatible with skin and to be used on a daily basis with minimal side effects. Excessive use of soap for skin cleansing can dismpt the natural barrier function of skin through the removal of skin oils and dismption of the Hpid bdayer in skin. This can result in imperfect desquamation or a dry appearance to skin and cause an irritation response or erythema, ie, reddening of the skin. Neither of these is a permanent response and the eHcitation of this type of skin reaction depends on the individual s skin type, the product formulation, and the frequency of use. 

Calcium chloride solutions, typically employed at 2—5% concentration, are used as antispasmodics, diuretics (qv), and in the treatment of tetany. Concentrated solutions of calcium chloride cause erythema, exfoUation, ulceration, and scarring of the skin (39). Injections into the tissue may cause necrosis. If given orally calcium chloride can cause irrita tion to the gastrointestinal tract unless accompanied by a demulcent. There is no pubHshed information on mutagenicity or carcinogenicity caused by calcium ions or calcium chloride. Calcium chloride has been given a toxicity or hazard level 3 (40). Materials in this classification typically have LD q below 400 mg/kg or an LC q below 100 ppm. 

Physiological Effects. The sulfur and nitrogen mustards act first as cell irritants and finally as a cell poison on all tissue surfaces contacted. The first symptoms usually appear in 4—6 h (4). The higher the concentration, the shorter the interval of time between the exposure to the agent and the first symptoms. Local action of the mustards results in conjunctivitis (inflammation of the eyes) erythema (redness of the skin), which may be followed by blistering or ulceration and an inflammatory reaction of the nose, throat, trachea, bronchi, and lung tissue. Injuries produced by mustard heal much more slowly and are much more Fable to infection than bums of similar intensity produced by physical means or by other chemicals. 

The SPE is defined as the ratio of the time required to produce a perceptible erythema on a site protected by a specified dose of the uv protectant product to the time required for minimal erythema development in the unprotected skin. An SPE of 8 indicates that the product allows a subject to expose the protected skin 8 times as long as the unprotected skin to produce the minimum erythema response. The measurement can be quite subjective unless skin color and the history of reactions to sun exposure of the test subjects are taken into account. The MED range for Caucasians at 300 nm averages 34 mj/cm. The range is 14—80 mj/cm. Perspiration or the use of artificial irradiation devices can create additional problems. 

LD50 (see Ch. 5), death occurring within 30 days. Erythema (reddening of skin) within 3 weeks. 

Light and Toxic Reactions In many individuals, exposure to ultraviolet radiation from the sun causes skin reactions such as erythema, thickening of the epidermis, and darkening of existing pigment. Exposure to ultraviolet light also increases the risk of different forms of skin cancers, especially malignant melanoma. ... 

The nurse should administer each IV dose of vancomycin over 60 minutes Too rapid an infusion may result in a sudden and profound fall in blood pressure and shock. When giving the drug IV, the nurse closely monitors the infusion rate and the patient s blood pressure. The nurse reports any decrease in blood pressure or reports of throbbing neck or back pain. These symptoms could indicate a severe adverse reaction referred to as "red neck or "red man syndrome. 9/mptoms of this syndrome include a sudden and profound fall in blood pressure, fever, chills paresthesias and erythema (redness) of the neck and badk. 

Ribavirin is given by inhalation and can cause worsening of respiratory status, hypotension, and ocular irritation, including erythema (redness of skin), conjunctivitis, and blurred vision. 

Skin—rash, erythema, irritation, skin eruptions, exfoliative dermatitis, Stevens-Jbhnson syndrome, ecchymosis, and purpura... 

Pemphigus, bullous dermatitis herpetiformis, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, mycosis fungoides, severe psoriasis, severe seborrheic dermatitis, angioedema, urticaria, various skin disorders, such as lichen planus or keloids... 

Impaired wound healing, thin fragile skin, petechiae, ecchymoses, erythema, increased sweating, suppression of skin test reactions, subcutaneous fat atrophy purpura, striae, hyperpig mentation, hirsutism, acneiform eruptions, urticaria, angioneurotic edema... 

Adults fever injection site complaints of soreness, erythema, swelling, induration and numbness, varicellalike rash upper respiratory illness headache fatigue cough myalgia disturbed sleep nausea diarrhea stiff neck irritability nervousness constipation... 

Transient pain, erythema, swelling or itching at the injection site, headache, nausea, abdominal pain, muscle aches, and dizziness... 

Adverse reactions to immune globulins are rare. However, local tenderness and pain at the injection site may occur. The most common adverse reactions include urticaria, angioedema, erythema, malaise, nausea, diarrhea, headache, chills, and fever. Adverse reactions, if they occur, usually last for several hours. Systemic reactions are extremely rare... 

Paresthesia, glossitis, anorexia, nausea, vomiting, maculopapular erythema, aches, edema of the extremities, nail growth disturbances, increase in blood pressure, virilization... 

Dryness, erythema, burning, peeling, oiliness/oily skin, diarrhea, bloody diarrhea, abdominal pains, colitis Skin irritation, tenderness, pruritus, erythema, peeling, oiliness and burning sensations Mild and transient pruritus, burning, stinging, erythema, photosensitivity... 

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