Erythema multiforme

ERYTHEMA MULTIFORME Description: an acute eruption of macules, papules, or subepidermal vesicles presenting a multiform appearance, the characteristic lesion being the target or iris lesion over the dorsal aspect of the hands and forearms; its origin may be allergic, including drug sensitivity, or it may be caused by herpes simplex infection; the eruption, although usually self-limited (e.g., multiforme minor), may be recurrent or may run a severe course, sometimes with fatal termination (e.g., multiforme major or Stevens-Johnson syndrome). Erythema multiforme, an eruption of skin lesions caused by an infection or an allergic reaction to certain medications, can prove deadly in most severe form. The condition usually develops in young people who have been exposed to herpes or who have taken older types of antibiotics Alternative Names: Lyell's syndrome; Stevens-Johnson syndrome; Toxic epidermal necrolysis. Erythema multiforme is a skin disorder characterized by symmetrical, red, raised skin areas all over the body. These patches often look like "targets" (dark circles with purple-grey centers). The skin condition may be chronic and usually lasts for two to four weeks each time. Most often, this disorder is caused by the herpes simplex virus. Other causes may include the following: An interaction with a certain medication, other infectious diseases, and certain vaccines. Mild forms of erythema multiforme usually get better in 2 - 6 weeks, but they may return. More severe forms may be difficult to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis have high death rates.ERYTHEMA MULTIFORME Symptoms: Symptoms Include: Fever.
  • General ill feeling.
  • Itching of the skin.
  • Joint aches.
  • Multiple skin lesions.
Other symptoms that may occur with this disease: Bloodshot eyes.
  • Dry eyes.
  • Eye burning, itching, and discharge.
  • Eye pain.
  • Mouth sores.
  • Vision abnormalities.
Causes and Risk factors: Erythema multiforme is a type of allergic reaction that occurs in response to medications, infections, or illness. Medications include: Barbiturates, Penicillins, Phenytoin, and Sulfonamides. Infections include: Herpes simplex, Mycoplasma. The exact cause is unknown. The disorder is believed to involve damage to the blood vessels of the skin, followed by damage to skin tissues. Some forms of this condition are more severe than others. Erythema multiforme minor is not very serious. Erythema multiforme major (also called Stevens-Johnson syndrome) is more severe. The more severe form is usually caused by reactions to medications, rather than infections. Erythema multiforme occurs primarily in children and young adults. Risk Factors: Males younger than 20 develop erythema multiforme more often than any other age group, and the condition rarely occurs in infant and toddlers or people older than 50 years. About one third of people who have one episode of erythema multiforme will have at least one more episode. Diagnosis: The diagnosis is based mainly on the appearance of the skin lesion, especially if there is a history of risk factors or related diseases. Tests may include: Nikolsky's sign: Typically, your health care provider will test for this sign simply by twisting a pencil eraser against your skin. If positive, a blister will form in the area, usually within minutes. Skin lesion biopsy and microscopic examination of the tissue. Treatment: Treatment goals include: Controlling the illness that is causing the condition.
  1. Preventing infection.
  2. Treating the symptoms.
Treatment of mild symptoms may include: Medications such as antihistamines to control itching.
  • Moist compresses applied to the skin.
  • Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort.
  • Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking.
Treatment of severe symptoms may include: Antibiotics to control any skin infections.
  • Corticosteroids to control inflammation.
  • Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
  • Intravenous immunoglobulins (IVIG) to stop the disease process.
Practicing good hygiene and staying away from other people may help prevent secondary infections. Skin grafting may be helpful in cases in which large areas of the body are affected. In cases that are caused by the herpes virus, daily antiviral medications may be prescribed to prevent erythema multiforme from returning. Medicine and medications: Acyclovir: Patients who have herpes-induced erythema multiforme (EM) may benefit from acyclovir. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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