What is Erythema multiforme ?
Erythema Multiforme
Erythema multiforme is a skin reactions that can be triggered by an infection or some medicine . Its usually mild and goes away in a few weeks . There also a rare , severe form that can affect the mouth , gentials and eyes and can be life - threatening. This is known as erythema multiforme major . Erythema multiform is an immune - mediated , typically self- limiting , mucocutaneous condition charactertised by target lesions. Significant mocosal involvement distinguishes erythema multiforme major from multiform minor. Episode can be isolated , recurrent , or persistent .
In most cases , erythema multiforme is precipitated by herpes simplex virus {HSV } infection , alternative trigger include other infections , medications, and vaccinations. Classic target lesion present as concentric rings of color variation which develop symmetrically in an acral distribution , with or without involvement of mucous membranes .
Erythema Multiforme Pictures :
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What are the causes of erythema multiforme ?
Infection precipitates 90% of cases , with HGV type 1 being the predominant cause . other infectious triggers include :
- HSV type 2
- Cytomegalovirus
- Epstein - barr virus
- Infuenze virus
- Vulvovaginal candidiasis
- Sars- cov 2
- Orf
Mycoplasma pneumoniae infection is often listed as a trigger of erythema multiforme , however mucocutaneous manifestation associated with this infection have recently been classified as their own independent entity , Mycoplasma pneumoniae induced rash and mucositis [ MIRM ]. Medication which may trigger erythema multiforme include :
Antibiotics
Anti - epileptics
Non- steroidal anti- inflammatory drugs
Vaccinations
Other conditions associated with erythema multiforme include :
Inflammatory bowel disease
Hepatitis C
Leukaemia
Lymphoma
Solid organ cancer malignancy
Sign & Symptoms of erythema multiforme :
A person with erythema multiforme may also experience the following symptoms :
- itching and burning rash, which is the most common symptom
- fever or body temperature of 100.4F or higher
- Headache
- joint pain and swelling
- sores in the moth
- sores in the moth
- sores and redness in the eyes
- sensitivity to light
- joint pain
How to treat erythema multiforme ?
Treatment is often not neended as episodes are typically self limiting with no ongoing complications . However , ocular involvement should always prompt ophthalmology referral given the risk for more serious sequelae .
Treatment of symptomatic mild cases :
-itch oral antihistamines and / or topical steroids for itch or discomfort associated with cutaneous lesion
- pain for mild mucosal involvement , oral washes containing antiseptic or local anaesthetic .
- precipitating infections - treat appropriately
- offending medications - cease and avoid in future
- may require hospital admission for support of oral intake
Although evidence is limited , prednisone has beeb suggested to reduce the severity and duration of symptoms in these cases.
What are the features of erythema multiforme ?
Many patients report prodromal symptoms including fatigue , malaise myalgia or fever . these likely represent the course of precipitating illness rather than true prodrome .
CUTANEOUS FEATURES :
Cutaneous lesions develop at the peripheries before spreading centrally .
Distrubution is usually symmetrical with a preference for extensor surfaces.
May be painful , pruritic , or swollen
Early lesion present as round , erythematous papules which later develop into target lesions .
Atypical lesions may be present with typical lesions. Atypical lesions are raised with poorly defined borders and / or fewer zones of color variation .
In severe disease , up to hundred of lesion may be present in different developmental stages , at times making it difficult to identify characteristic lesion .
MUCOSAL FEATURES :
Lesions develop as blisters , which then break to reveal shallow erosion with a white overlying pseudo - membrane .
Erythema multiforme favours oral membranes , but may also present with urogenital and rarely , ocuklar lesions .
Mucous memebrane involvement can be painful and significantly limit oral intake lesion may be precede or follow cutaneous lesions .
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