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Erythema Multiforme

Erythema multiforme is most often associated with herpes simplex virus (HSV) infections and follows an outbreak of HSV by 1 to 3 weeks. The eruption is self-limited, lasts 1 to 4 weeks, and requires symptomatic management. HSV-induced EM may be recurrent, and in such cases, recurrences can be prevented with suppressive antiherpetic therapy. Drugs may cause a small proportion of EM cases. Discontinuation of the implicated medication and supportive therapy results in complete resolution of the skin eruption. Short courses of oral corticosteroids may hasten recovery. In some cases of EM, no obvious cause may be elicited.

Erythema multiforme (EM) was initially described in 1866 by Ferdinand von Hebra as an acute self-limited skin disease, symmetrically distributed on the extremities with typical and often recurrent concentric "target" lesions. EM minor represents a localized eruption of the skin with mild or no mucosal involvement, corresponding to the initial description of von Hebra Erythema multiforme often starts as a red rash on the palms, soles, and back of the hands. These have a dusky red centre, a paler area around this, and then a dark red ring round the edge. Stevens-Johnson syndrome (SJS) was considered an extreme variant of EM for many years, while toxic epidermal necrolysis (TEN) was considered a different entity. Beyond this, the classification of erythema multiforme is still not finally settled. Erythema multiforme (EM) is acute inflammatory skin disease due to multiple causes. The Stevens-Johnson syndrome - in which the brunt of the trouble is borne by the moist areas (mucous membranes) inside the mouth, in the genital area, and on the conjunctiva of the eyes is a good example of this. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Histology and immunochemistry studies have shown that inflammatory infiltrates of EM and SJS/TEN are strikingly different in density and nature. For a long time it was thought to be a type of erythema multiforme major; but it may really be closer to another serious skin disorder (toxic epidermal necrolysis) in which the skin strips off from large areas of the body.

It is possible that the main title of the report Erythema Multiforme is not the name you expected. The immunologic reaction affects HSV-expressing keratinocytes. Cytotoxic effector cells, CD8 + T lymphocytes in the epidermis, induce apoptosis of scattered keratinocytes and lead to satellite cell necrosis. Some people only have erythema multiforme in the mouth. As the skin lesions age they often look like small targets with purple to dusky centers surrounded by red rings.Erythema multiforme is usually mild ( erythema multiforme minor ) -with only a few spots, causing little trouble and clearing up quickly but there is also a rare but much more severe type ( erythema multiforme major ) that can be life threatening. Approximately 90 percent of erythema multiforme minor follow outbreaks of herpes simplex .Erythema multiforme major ( Stevens Johnson syndrome ) is marked by involvement of two or more mucosal surfaces (typically oral and conjunctival [eye]). Immune complex deposition is variable and nonspecific. In severe cases, fibrinoid necrosis can occur in the stomach, spleen, trachea, and bronchi.

Causes of Erythema Multiforme

The common causes of Erythema Multiforme :-

  • Adenovirus, coxsackievirus B5, cytomegalovirus, echoviruses, enterovirus, Epstein-Barr virus, hepatitis A, hepatitis B, hepatitis C, herpes simplex, influenza, measles, mumps, paravaccinia, parvovirus B19, poliomyelitis, vaccinia, varicella-zoster, variola
  • Coccidioidomycosis, dermatophytosis, histoplasmosis
  • Viral infection (especially herpes simplex )
  • Mycoplasma pneumonia (a chest infection)
  • The most common causes of erythema multiforme are Mycoplasma pneumonia, cold sores, herpes of the genitals, and as a reaction to medication (sulfa drugs).
  • Erythema multiforme is not contagious.
  • The drugs that do this most often are those used to treat infections - such as sulfonamides, tetracyclines, amoxicillin, and ampicillin. Next come nonsteroidal anti-inflammatory drugs (given for arthritis) and anticonvulsants (used to treat epilepsy).
  • The most common single cause of erythema multiforme is the herpes simplex (cold sore) virus: but in about half of all cases no one can find the trigger.

Symptoms of Erythema Multiforme

Some are common symptoms of Erythema Multiforme :-
  • May have vesicles and bullae (blisters of various sizes)
  • Central lesion surrounded by concentric rings of paleness and redness, also called "target", "iris", or "bull's eye"
  • Even when the rash has cleared up, a few people are left with scars on their skin, or with damaged eyes.
  • sudden, red patches and blisters, usually on the palms of hands, soles of feet and face.
  • Trunk is usually not involved
  • Rash usually appears on palms, soles, other areas of arms and legs, may spread to face and rest of the body.
  • sudden, red patches and blisters, usually on the palms of hands, soles of feet, and face
  • hive-like, raised swollen areas on the skin that do not clear up like true hives
  • reddish-purple, target-shaped patches on the skin, especially the palms and soles
  • Trunk is usually not involved .

Treatment of Erythema Multiforme

  • Topical treatment, including that for genital involvement, may be performed with a gauze dressing or a hydrocolloid. Local supportive care for eye involvement is important and includes topical lubricants for dry eyes, sweeping of conjunctival fornices, and removal of fresh adhesions.
  • A liquid diet and intravenous fluid therapy may be necessary. Oral antacids may be helpful for discrete oral ulcers.
  • A mild cortisone applied directly to the irritated skin areas, colloidal baths, and wet compresses may be helpful to facilitate the clearing of the lesions.
  • Patients may need to be nursed in hospital, perhaps in a burns unit, using dressings like those needed for an extensive burn.
  • they always follow a cold sore, and come up several times a year, it may be worth taking a small daily dose of a drug designed to suppress the herpes simplex virus for several months
  • Topical anesthetics (especially for mouth lesions ) to ease discomfort that interferes with eating and drinking.
  • Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort.


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