Acute Rheumatic Fever Skin Manifestations

Distinguishing Between Erythema Marginatum and Subcutaneous Nodules

The American Heart Association differentiates erythema marginatum as a unique, evanescent pink rash with pale centers and rounded or serpiginous margins, present on trunk and proximal extremities, not facial, and heat can induce its appearance and it blanches with pressure 1, 2, 3
Subcutaneous nodules are firm, painless protuberances found on extensor surfaces, located at specific joints including knees, elbows, wrists, occiput, and along spinous processes of thoracic and lumbar vertebrae 1, 2, 3
The American Heart Association describes subcutaneous nodules as firm, small, mobile lumps beneath the skin overlying bony prominences 1, 2, 3

Subcutaneous nodules appear in 0-10% of Acute Rheumatic Fever cases, making them one of the rarer major criteria, according to the American Heart Association 4, 5
Nodules are more often observed in patients who also have carditis, as stated by the American Heart Association 1, 2, 3
Subcutaneous nodules almost never occur as the sole major manifestation of Acute Rheumatic Fever, and they show no racial or population variability, as noted by the American Heart Association 1, 2, 3