We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. Management of erythema multiforme associated with recurrent. 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. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. There is no temperature elevation, unless it is associated with the dilation of arteries in the deeper layer of the skin. Erythema disappears on finger pressure, while purpura or bleeding in the skin and pigmentation do not.
Erythema multiforme major this is the form that is more severe. 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. This is a condition that is caused by an allergic reaction to medications or an inflammatory reaction to viruses and fungi. Sometimes, a person may also get the rash after taking medicine. Granular c3 and igm at basement membrane and in vessels.
He has also provided dozens of columns for medical newsletters. Medicinenet does not provide medical advice, diagnosis or treatment. Erythema multiforme em is a type of cytotoxic dermatitis, which can be triggered by many factors. When seen in adults, it usually occurs between the ages of 20 and 40, although it can happen to people of any age. Drug eruptions, erythema multiforme, stevensjohnson. Multiforme polymorphic first classified by bastuji garin et al to separate from sjs ten in 1922 described by hebra in 1866 as erythema exudativum multiforme 122920. Erythema multiforme pictures, treatment, symptoms, causes. Erythema multiforme definition of erythema multiforme by. 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.
Erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Erythema multiforme em is an acute, selflimited, inflammatory cutaneous disorder caused by infection or drugs that is characterized by bulls eye lesions, blisters, and erythematous plaques on the skin fitzpatrick and bernhard 1987. It presents with a skin eruption characterised by a typical target lesion. Erythema multiforme em is a skin condition of unknown cause. Erythema multiforme skin disorders merck manuals consumer. Pdf erythema multiforme em is an acute, immunemediated condition, most commonly induced by. Erythema multiforme em is a rare skin disorder that mainly affects children. The other two more severe disorders are stevensjohnson syndrome and toxic epidermal necrolysis. Examples of erythema not associated with pathology include nervous blushes. Jun 18, 2018 erythema multiforme em is a rare skin disorder that mainly affects children. Ferril has spoken at numerous conferences for doctors. Description erythema multiforme appears on the skin and the mucous membranes the lining of the mouth, digestive tract, vagina, and other organs. Erythema multiforme em adalah merupakan suatu penyakit akut dari kulit dan membran mukosa yang dapat menyebabkan beberapa jenis lesi kulit, karenanya dinamakan multiforme greenberg,2003. This reaction causes red, targetshaped or bullseye patches or sores on the skin.
Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. Erythema multiforme pictures, treatment, causes, symptom. Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. Erythema multiforme majus significantly differed from stevensjohnson syndrome, overlap, and toxic epidermal necrolysis by occurrence in younger males, frequent recurrences, less fever, milder. 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. Large, symmetrical red blotches appear all over the skin in a circular. Erythema multiforme american academy of family physicians. Ferrils treatment plans are designed to be shared with other providers as educational advice only.
The rash usually starts off looking like pink or red blotches that develop over a few days into round shapes that look like targets with red, pink, and pale rings. In half of the cases, the triggering agents appear to be medications, including anticonvulsants. Erythema multiforme is a rare disorder that affects slightly more males than females. Experts once believed that erythema multiforme em, stevensjohnson syndrome sjs, and toxic epidermal necrolysis ten were all one disease on a spectrum of severity, with em the mildest form and ten the most severe. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. However, these may return or recur in over 30% of the individuals. Erythema multiforme is not indicative of a contagious disease and must not be mistaken as a sign of measles and other viral exanthems. Erythema multiforme airuhtheemuh multehformee starts with pink or red blotches. Stevensjohnson syndrome knowledge for medical students. It is an uncommon disorder, with peak incidence in the second and third decades of life. In the second case, no histopathologic findings were presented by the author. See also introduction to hypersensitivity reactions and inflammatory skin disorders. An allergic inflammatory skin disorder which has a variety of causes and results in skin and mucous membrane lesions that affect mainly the hands, forearms, feet, mouth nose and genitals.
Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions. Erythema multiforme an overview sciencedirect topics. Erythema multiforme is an acute, selflimited inflammatory disorder of the skin and mucous membranes with a characteristic histopathology, a tendency for. In rare cases, it is caused by certain medicines or bodywide.
Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Erythema multiforme em, in its modern definition, is an acute, selflimited syndrome with distinctive skin lesions with or without mucosal lesions. Erythema multiforme em is an acute skin reaction that comes from an infection or another trigger. Erythema multiforme manifests as the sudden onset of asymptomatic, erythematous macules, papules, wheals, vesicles, bullae, or a combination on the distal extremities often including palms and soles and face. More detailed information about the symptoms, causes, and treatments of erythema multiforme is available below. The ocular picture varied from mild mucopurulent conjunctivitis to. Erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity. Erythema multiforme is an acute inflammatory skin disease where 90% of the minor cases follow outbreaks of herpes simplex. Erythema multiforme is a hypersensitivity reaction to an infection or, in some cases, a medicine. Treatment of erythema multiforme, erythema multiforme. Erythema multiforme genetic and rare diseases information. Erythema multiforme is part of a group of 3 related skin disorders and it is the mildest of the three. Multiforme polymorphic first classified by bastuji garin et al to separate from sjs ten in 1922 described by hebra in 1866 as. 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.
It occurs with any skin injury, infection, or inflammation. It may begin at any age, but is most common in children and young adults. Finally, a wide variety of drugs, most commonly the sulfonamides, may cause this syndrome. Not all cases of erythema multiforme em can be prevented, especially if the offending agent is not apparent or remains unknown. Clinical features, diagnosis, and treatment of erythema multiforme. Erythema multiforme nord national organization for rare. Outcomesresolutions most erythema multiforme minor skin lesions often resolve in about 26 weeks. Although it is selflimiting, recurrences are common. Erythema multiforme minor is the most frequent form and is generally mild, erythema multiforme major, while rare, can be lifethreatening. Herpes simplex infection is by far the most common etiologic agent. Em minor, a mild allergic reaction, occurs most commonly. Target lesions vesiculobullous disorder download this article as. Penyakit ini merupakan suatu reaksi hipersensitivitas, yang karakteristik dengan adanya lesi target pada kulit atau lesi ulserasi pada mukosa. Erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the use of certain medication and presents with cutaneous or.
Pathogenesis of erythema multiforme is a commonly identified supplication in light of the fact that it is of interest when evaluating erythema multiforme lips, erythema multiforme mouth, and erythema multiforme prednisone. Abstract erythema multiforme em is an uncommon, immune. Erythema multiforme may be a mild condition erythema multiforme minor, or it may be a severe, possibly lifethreatening condition erythema multiforme major or stevensjohnson syndrome. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme. Erythema multiforme is an inflammatory skin disorder characterized by patches of red, raised skin that often look like targets and usually are distributed symmetrically over the body. This means it usually resolves on its own without treatment. Erythema from the greek erythros, meaning red is redness of the skin or mucous membranes, caused by hyperemia increased blood flow in superficial capillaries.
Erythema multiforme mouth is a noted item of interest because it applies to erythema migrans photo, erythema migrans vs erythema multiforme, and erythema multiforme autoimmune. Erythema multiforme, stevensjohnson syndrome, toxic. It is acute and selflimiting, usually resolving without complications. Erythema multiforme caused by oral furosemide jama. Erythema multiforme may be a mild condition erythema multiforme minor, or it may be a severe, possibly lifethreatening condition. Erythema is a common side effect of radiotherapy treatment due to patient exposure to ionizing radiation. Two cases of erythema multiforme secondary to furosemide have been reported in the past. More detailed information about the symptoms, causes, and treatments of erythema multiforme is. Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening.
Pdf on sep 6, 2017, rakhi issrani and others published. When involvement of the mucous membrane accompanies erythema multiforme bullosum, serious ocular sequelae may occur. Pdf erythema multiforme em is an acute, selfhealing inflammatory. More recently, however efforts to link disease morphology with cause have led to reconsideration of that dogma. Erythema multiforme inflammatory diseases online course. Mild forms of erythema multiforme usually get better in 2 6 weeks, but they may return. Target, or iris, lesions, with central clearing, are characteristic of this disorder. The classic lesion is annular with a violaceous center and pink halo separated by. Toxic epidermal necrolysis, manifested by widespread epidermal desquamation, is the most severe form of this disorder. Erythema multiforme em is an acute, immunemediated condition characterized by the appearance of distinctive targetlike lesions on the skin picture 1ah. Erythema multiforme mainly affects adults under 40. In most cases, it occurs in response to an infection. Erythema multiforme major is the term used to describe em with severe mucosal involvement and.
Some spots can have a small blister or scab in the middle. These lesions are often accompanied by erosions or bullae involving the oral, genital, andor ocular mucosae picture 2ac. In more severe cases called erythema multiforme major, it can affect the lips and the inside of the mouth. A case report of erythema multiforme bangladesh journals online. Use of the terminology em minor and em major is a reasonable approach to separating the classical mild cutaneous syndrome, as described by hebra em minor, from the usually more severe. These lesions appear suddenly on the legs, arms, palms, hands, feet, and inside the mouth.
The patient presents weeks after exposure to a medication with fever and other flulike symptoms. Treatment of erythema multiforme is a common skin disorder consisting of targetlike circular lesions. No, erythema multiforme itself is not a contagious disease. Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm. Erythema multiforme symptoms, diagnosis, treatments and. Definition erythema multiforme is a skin disease that causes lesions and redness around the lesions.
Of 162 previously reported cases of erythema multiforme with mucosal involvement, the eyes were affected in 148. Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. Erythema multiforme is a selfhealing disease, with an average duration of about 2 weeks. Erythema multiforme em is a clinical conundrum, the name. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. Tell a friend about us, add a link to this page, or visit the webmasters page for free fun content. Erythema multiforme is a skin condition considered to be a hypersensitivity reaction to infections or. It is an uncommon disorder, with peak incidence in. Stevensjohnson syndrome sjs is a rare, immunemediated, skin reaction that results in blistering of skin and extensive epidermal detachment.
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