Erythema also occurs at times in urcemia, Bright's disease, and jaundice. According to both Le Cronier Lancas ter and H. Pye-Smith, lesions are ob served. In uraemia the lesions usually occur during the later stages of the dis ease and just shortly before the patient's death. They are at first erythematous, and in a few days become papular; fresh erythematons and papular lesions may afterward be observed at different stages of development over portions of the body. The lesions appear upon the ex tensor surfaces of the hands, forearms, and legs, and when numerous are noted upon all portions of the body, including the palms of the hands, soles of the feet, and mucous membranes, and are espe cially well developed upon the face. Upon the face they tend to become con fluent and cause great disfiguration. They arc bright red, and beyond a slight deepening of tint remain as noted for three or four days. They disappear either as flaky desquamations (often be ing as large as those noted in exfoliative dermatitis), hmmorrhages being noted in the papules either during or previous to this stage, leaving a red, brawny thick ened skin; or it may become eczematous and terminate in the formation of crusts or in the formation of pustules and abscesses. Itching sometimes accom panies this condition.
Pathology of Simple Erythema.—The erythemas are the result of disorders of the vascular system and particularly those of the smaller vessels contained in the upper layers of the corium and which radiate from there to the strata of the epidermis. Hyperemia is but an excess of blood propelled into the smaller capil larks through vasomotor origin. The hyperemia differs with the character of the exciting agency. Transitory hyper wmia caused by a slight injury generally fades quickly and no trace of its exist ence can afterward be determined, while those due to more marked lesions fade less quickly. Pressure leaves no visible change, though less pliability may be noticed. At first, in the active hyper inias, the skin may be of a lighter hue, but in passive hypemmia it becomes darker. Although the temperature is somewhat above that of the normal, it may not even affect or may even be slightly below that of the natural state.
Prognosis.—The prognosis of simple erythema is usually favorable. A slight hyperremic process, unaccompanied by inflammation, quickly subsides, although some degree of pigmentation may remain to mark its site.
Treatment of Simple Erythema.— When the disorder is likely to disappear spontaneously, it is hardly necessary to advise any form of treatment, but in protracted cases, as well as those attended by recurrence, active measures should be resorted to. Errors of digestion require
appropriate measures based upon the symptoms produced. Any intestinal irri tant should be promptly removed by cathartics. In cases attended by ting ling and burning or where a slight degree of exudation has taken place the applica tion of some bland powder, simple lotion, or unguent will easily mend matters. Boric acid, either as a plain powder, in full or diluted strengths, a lotion in half or full saturated solutions, or as an oint ment, V, drachm of boric acid to the ounce of ordinary petrolatum, will usually suffice. Lycopodium or fullers' earth will serve a similar purpose. At times it may be advisable to add a slight quantity of carbolic acid to procure early relief.
Erythema Scarlatiniforme. — Ery thema scarlatiniforme (named by Hardy), roseola scarlatiniforme (Bazin), or ery thema scarlatinoides (Besnier), is an erythematous skin eruption closely re sembling that observed in scarlatina, and from which affection it must be differen tiated.
SYMPTOMS.—According to French der matologists, there are two types of this affection. The one "erytheme scarla tinoide," an acute rash resembling either scarlatina or measles, and accompanied or not by desquamation; the other "ery theme desquamatif scarlatiniforme re cidivant," a subacute erythematous out break, resembling very closely scarlatina, usually accompanied by desquamation. As its name implies, it is a recurrent affection.
In the more acute type the lesions may be preceded, from a few hours or two or three days, by some constitutional dis turbance, notably malaise, with chilly sensations and a rise of temperature of two or three degrees. The lesions, which are of a pinkish-red or crimson color, are punctate or diffuse and situated on the chest, thighs, face, neck, and other regions, although they are not particular to any region. At times there may be slight itching or burning. The duration varies from a few days to one or more weeks. Aggravated acute types may des quamate either as thin, flaky scales or in large-sized exfoliations. Observers refer to still another type in which the affec tion stimulates more particularly these characters of rubeola.
In addition to the general malaise, subacute cases are likely to present some disturbance of the renal functions and albuminuria. The lesions are rather more lasting and exist from periods vary ing from three to six weeks. When the eruption reaches its heighth there may be a lowering of the fever. A marked symptom of this variety is the number of recurrences, while desquamation is a prominent character. Hartzell refers to the diminution of severity with each suc ceeding attack.