Does DVT Cause Erythema?
Yes, erythema is a recognized clinical manifestation of deep vein thrombosis, though it occurs in only approximately one-quarter of patients with DVT.
Frequency and Clinical Context
Erythema was observed in 26% of patients with DVT in the prospective MASTER registry, making it less common than the other cardinal signs of extremity edema (80%) and pain (75%) 1.
The American College of Radiology confirms that pain, swelling, erythema, and tenderness are common signs of DVT, with erythema representing redness of the skin over the affected area 2.
Erythema in DVT is thought to result from a systemic inflammatory response triggered by thrombus formation and vein wall damage, reflected by elevated white blood cell counts and C-reactive protein levels 3.
Clinical Presentation Patterns
When erythema is present, it typically appears as redness over the thrombosed vein and may be accompanied by warmth of the overlying skin 2, 4.
The combination of unilateral limb swelling, erythema, and pain creates diagnostic overlap with cellulitis and erysipelas, which is why DVT must be considered in the differential diagnosis of these presentations 5.
In superficial vein thrombosis (SVT), erythema is more likely to be present than in DVT, often accompanied by local pain, induration, and a palpable cord along the superficial vein 1.
Important Clinical Caveats
Classic clinical symptoms are not present in all cases of acute DVT—approximately one-third of patients with DVT are asymptomatic, making clinical diagnosis challenging 1, 2.
The absence of erythema does not exclude DVT, as the majority of DVT patients (74%) do not exhibit this finding 1.
When evaluating a patient with unilateral limb swelling and erythema, the risk of concurrent DVT in cellulitis/erysipelas is low (2.1% for proximal DVT), but compression ultrasound should still be considered when clinical suspicion is high 5.
Diagnosis should be based on objective imaging (duplex ultrasound) rather than clinical signs alone, as relying solely on symptoms leads to missed diagnoses 2, 4.