Erythema multiforme em is an acute skin reaction that comes from an infection or another trigger. Herpes associated erythema multiforme a diagnostic dilemma mallika kishore1, sunil r panat2, ashish aggarwal3, nitin upadhyay4, nupur agarwal 5 1 post graduate student, department of oral medicine and radiology, institute of dental sciences, bareilly u. Erythema multiforme em has been divided into a minor simplex form and a major bullous form. Pdf stevensjohnson syndrome sjs is a very rare, acute, serious and potentially fatal. Erythema multiforme and angioedema with indapamide and sertraline. Erythema multiforme is a reactive mucocutaneous disorder in a disease spectrum that comprises a selflimited, mild, exanthematic, cutaneous variant with minimal oral involvement em minor to a. Erythema multiforme is divided into major and minor forms and is now regarded as distinct from stevensjohnson syndrome sjs and toxic epidermal. Erythema multiforme em is a rare skin disorder that mainly affects children. It is now separated from stevens johnson syndrome sjs and toxic epidermal necrolysis t. Erythema multiforme nord national organization for rare.
Erythema multiforme minor mild if you have the mild form of em, you may feel perfectly well but just have an uncomfortable rash. It is most intense over the backs of the hands and feet. Em is clinically characterized by a minor form and a major form. Small pdfs are especially useful when viewed and sent on a mobile device such as iphone. Erythema multiforme minor is localized, with minimal or no mucosal involvement. Erythema multiforme genetic and rare diseases information. Erythema multiforme may be present within a wide spectrum of severity. A few people may get the rash after taking certain medications, such as seizure medicines, anesthesia medicines, nonsteroidal antiinflammatory medicines e.
The histopathological results showed septal panniculitis with a small non caseating granuloma fig. Erythema exsudativum multiforme, minor form definition eryhema multiforme is an acute, selflimited condition characterized by the abrupt onset of symmetrical fixed red papules some of which evolve into target lesions. Erythema multiforme major also called stevensjohnson syndrome is more severe. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. Two types, one mild to moderate and one severe, are recognized erythema multiforme minor and erythema multiforme major. Most of the time, its minor and caused by an infection or medication.
It is usually circular, less than 3 centimeters in size, and similar to a bullseye in appearance. It can occur due to drug exposure,as well in association with some types of infections. Erythema multiforme major this is the form that is more severe. Erythema multiforme major, also known as stevensjohnson syndrome, is a more severe mucosal and skin disease characterized by signs and symptoms reminiscent of serum sickness chapter 46. Clinical, etiologic, and histopathologic features of stevensjohnson. Eritema multiforme minor pdf republic of fenerbahce.
Smallpdf the platform that makes it super easy to convert and edit all your pdf files. Recently, erythema multiforme has been classified as minor, major, stevensjohnson syndrome or toxic epidermal necrolysis, where erythema multiforme minor is the mildest type of lesion and toxic epidermal necrolysis the most severe2,3 table 1. Erythema multiforme em is a skin condition that takes the form of bullseyelike lesions. Erythema multiforme minor presents as a bulging, rashlike lesion that is red, pink, purple, or brown. Feb 20, 2020 erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. Sometimes blisters develop and quickly break to form erosions and ulcers. Erythema multiforme, stevensjohnson syndrome and toxic.
The disorder is believed to involve damage to the blood vessels of the skin, followed by damage to skin tissues. Erythema multiforme em minor is a bullseye rash with alternating rings of red erythema and flaky skin desquamation. Erythema multiforme pictures, treatment, symptoms, causes. Methods a retrospective analysis of 77 paediatric cases of em or sjs admitted to the childrens hospital in bordeaux between.
Some spots can have a small blister or scab in the middle. Erythema multiforme em is conventionally separated into em minor and em major. Erythema multiforme for parents nemours kidshealth. Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm. In erythema multiforme major, one or more mucous membranes are typically affected, most often the oral. Erythema multiforme em is an acute skin condition that may be recurrent in some cases. This means that the body is sensitive to something that causes the skin and mucous membranes to react. Erythema multiforme an overview sciencedirect topics. Pdf carbamazepine, hlab1502 and risk of stevensjohnson. Em without mucous membrane involvement em minor and em with mucous membrane involvement em major. Management of erythema multiforme associated with recurrent. Pediatrics 2007 may acute annular urticaria is common in childhood, benign, and selflimiting, but the lesions can be misleading. Histologically, each shows varying degrees of dermal and epidermal inflammation and injury. Dec 01, 2006 erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages.
Em minor as the name suggests is the less severe of the two types and accounts for 80% of em. Erythema multiforme multimedia encyclopedia health. However, the decision to exclude small studies may affect the amount of proposed therapies. Erythema multiforme is usually seen in children and young adults aged 2040, especially males. Erythema multiforme em is an immunemediated, mucocutaneous condition characterized by target lesions. Nov 14, 2011 erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Files are available under licenses specified on their description page. Given the small number of biopsy specimens obtained from patients with sjs due to. Erythema multiforme em is a skin condition of unknown cause. Erythema exsudativum multiforme, stevensjohnson szindroma es. Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis tb, or as a reaction to chemicals or. In erythema multiforme minor, mucous membrane involvement is absent or mild. In em minor, lesions often present as papules, which might enlarge and. Herpes associated erythema multiformea diagnostic dilemma.
The histopathological results showed septal panniculitis with a small noncaseating granuloma fig. This page includes the following topics and synonyms. Erythema multiforme is usually a reaction of the skin and mucous membranes that occurs suddenly. It occurs most commonly in association with the herpes simplex virus as an immune response to the infection. Symptoms of em depend on the type of disease you have. The term erythema multiforme em includes a wide and controversial variety of clinical expressions at the present time. Erythema multiforme is a skin condition that develops in response to infection or, in rare cases, certain medications.
When a cause for erythema multiforme can be found, it should be treated, eliminated, or avoided e. Some forms of this condition are more severe than others. In its minor form, erythema multiforme will usually get better in 2 to 4. Erythema multiforme minor pdf download lcanordaychin. Diagnosis, classification, and management of erythema. At first the spots are small, round, slightly raised red areas, some of which turn into the target lesions described above. The spots usually develop over the course of 3 4 days, starting on the hands and feet, and then spreading up the limbs to the trunk and face. Pdf recently, the usa fda has made a labeling change to the drug. Most people with classic erythema multiforme can be treated as outpatients with therapy, such as antihistamines, addressing their symptoms. Erythema multiforme is associated with an acute onset. Most erythema multiforme is associated with herpes simplex or mycoplasma infections. Erythema multiforme lesions are circular and may appear in concentric rings often called target lesions. Erythema multiforme, stevensjohnson syndrome and toxic epidermal. When seen in adults, it usually occurs between the ages of 20 and 40, although it can happen to people of any age.
Erythema multiforme, circular lesions hands illustration. A case of erythema nodosum associated with mycoplasma. Erythema multiforme em is a rare, acute hypersensitivity reaction most commonly triggered by herpes simplex virus hsv infections. This means it usually resolves on its own without treatment. Background in adults, erythema multiforme em is thought to be mainly related to herpes infection and stevensjohnson syndrome sjs to drug reactions. Erythema multiforme introduction and epidemiology erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the use of medications, such as phenytoin, sulfonamides, penicillins, and barbiturates. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Dermis erythema exsudativum multiforme, minor form. The rash that is associated with erythema multiforme will usually develop quickly and could be the only symptom that a person has with this medical condition. Solving all your pdf problems in one place and yes, free. Systemic immunomodulating therapies for stevensjohnson.
Erythema multiforme em, stevensjohnson syndrome sjs, and toxic epidermal necrolysis ten are considered as a spectrum of epidermal bullous diseases involving the skin and mucous membranes, usually triggered by drugs or infection. The minor form is additionally subdivided into papular and vesiculobullous variants, and all three have been considered a continuum of the same process. Erythema multiforme em is an interesting dermatologic disease which has oral manifestations. Erythema multiforme knowledge for medical students and. Mucosal changes, if present, consist initially of redness of the lips and inside the cheek. Walker, n erythema multiforme and vaccination, brit.
821 28 474 442 567 877 1108 1424 1087 589 214 154 1166 1047 490 930 1076 738 1367 1485 1157 338 835 607 1187 241 1415 408 199 482 1513 1424 1014 1114 1178 67 192 1144 1322 530 334 42 1077 849