A Family Doctor’s Tale – ERYTHEMA MULTIFORME

DOC I HAVE ERYTHEMA MULTIFORME      

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What is Erythema Multiforme?

Erythema Multiforme is an acute erythematous allergic skin reaction to a allergen or infection often associated with mucosal lesions.

A more severe erythema multiforme is Stevens-Johnson syndrome which can be potentially fatal.

What causes Erythema Multiforme?

The commonest cause is viral infections.

One third of cases occurs about 10 days after herpes simplex appears.

Other viral causes are viral pneumonia.

Bacterial infections causes are :
1.Hemophilic Streptococcus
2.Mycoplasma

Medications also causes lesions:
1.sulphonamides

2.barbiturates

3.phenylbutazone

4.Penicillins

5.Phenytoin

Radiation therapy for cancer can also cause the lesions.

The exact cause of erythema multiforme is unknown. It is believed that there is damage to the blood vessels of the skin and then damage to skin tissues.

Some forms of this condition are more severe than others.

Erythema multiforme minor is not very serious. Most erythema multiforme is caused by herpes simplex or mycoplasma infections

Erythema multiforme major which is very severe is known as Stevens-Johnson syndrome. The Steven Johnson’s syndrome is usually caused by reactions to medications  rather than infections.

Erythema multiforme occurs primarily in children and young adults.

What are the symptoms of Erythema Multiforme?

Erythema Multiforme symptoms is acute in onset .

1.lesions involve usually the face and flexor aspects of extremities;

palms and soles may be affected

2.lesions are raised pink papules annular in shape with purple center

3,the lesions are discrete and often described as target lesions

4.Sometimes the center is vesicular or bullous

5.In the mouth the mucosa is shed leaving raw red painful areas.
Tongue and lips may be similarly affected.

In severe cases also known as Steven Johnson syndrome general illness occurs with:
a.fever
b.headache
c.prostation
d.nose rashes
5.conjunctiva and eye lesions
6.vagina – sometimes weeping eczema of the mucosa
7.urethra – similar reaction may occur

6.Drug induced toxic epidermal necrosis (more severe Steven Johnson Syndrome) represents the serious form of erythema multiforme.

How is the diagnosis of Erythema Multiforme made?

The diagnosis of  Erythema Multiforme involve:
1.typical appearance of skin and mucosa

2.history of viral,bacterial and medical causes.

3.Nikolsky’s sign is a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed.

4.Skin biopsy and microscopic examination of the tissue

What are the complications for Erythema Multiforme ?
1.danger of excessive shedding of cells from skin and mucosa leading to shock and death

2.chronic infections with pneumonia

What is the treatment for Erythema Multiforme?

Treatment for severe Erythema Multiforme :
1.Hospitalization and prevention of shock and dehydration with intravenous fluids

2.treatment of the condition with high doses of corticosteroids

3.treat chronic infections with antibiotics

4.Antihistamines for itch

5.Local toilet to eyes,nose, mouth, vagina important in severe cases

6.large bullae may incised for relief

7.analgesis for pain

8.treat underlying cause and remove offending drug or radiation

9.Intravenous immunoglobulins (IVIG) to heal the disease process

10.Skin graft may be necessary in cases where large areas of the body are affected.

In the Erythema Multiforme minor, the condition is milder. Treatment involve:

1.antihistamines to control itching

2.Oral antiviral medication if it is caused by herpes simplex

3.paracetamol to reduce fever and discomfort

4. Topical local anesthetic to apply to mouth lesions to reduce  discomfort when eating and drinking

What is the prognosis of Erythema Multiforme?

1.generally good in mild cases.

2.mortality rate with Stevens-Johnson syndrome and toxic epidermal necrolysis may be high without proper treatment.

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Tagged with: Erythema Multiforme • Herpes labialis • Herpes simplex • Infection • Intravenous immunoglobulin • IVIG • Steven Johnson • Stevens–Johnson syndrome

Filed under: Medical case Studies

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