Clear diagnostic criteria can be lacking for definitive diagnosis in less than clearcut cases. Erythema multiforme definition of erythema multiforme by. It presents with a skin eruption characterised by a typical target lesion. 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. This website provides free medical books this website provides over 0 free medical books and more for all students and doctors this website the best choice for medical students during and after learning medicine. Em primarily affects apparently healthy young adults. Erythema multiforme is a skin condition considered to be a. When seen in adults, it usually occurs between the ages of. July i96i the hlstoloaical diagnosis of dermatitis herpetiformis, bullous pemphkiotd and erythema multiforme.
Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. Erythema multiforme british association of dermatologists. Definition erythema multiforme is a skin disease that causes lesions and redness around the lesions. We report a case of recurrent herpes associated erythema multiforme managed with prophylactic acyclovir. Erythema multiforme pictures, treatment, causes, symptom. Pubmed journal articles for erythema multiforme were found in prime pubmed. Bullous erythema multiforme is a recurring condition due to the point that it has connections with erythema nodosum behandeling, erythema migrans bilder, and erythema multiforme vs hives. Dermatitis herpetiformis, erythema multiforme and bullous.
Interest has only recently been raised by the association of generalized bullous eruptions with benign tumors. Bullous pemphigoid bp is a chronic, autoimmune, subepidermal, blistering skin disorder unlike pemphigus where the blistering is intraepidermal. In acute phase, prednisolone 4060mg daily is usually needed to control the eruption. Erythema multiforme bullosum definition of erythema. Sex distribution for the 3 diseases was as follows. Erythema multiforme em is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus. 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. As part of the attack, the cytotoxic t cells release proinflammatory cytokines like interferon gamma and tumor necrosis factor alpha which attracts other immune cells to the area.
An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme. Pierard dermatological department, state university, ghent, belgium. Ppt bullous skin disorders bsd powerpoint presentation. The clinical presentation began initially with typical bullous erythema multiforme. Bullous erythema multiforme following herpes zoster and. Erythema multiforme em is an uncommon, immunemediated disorder that presents with. It is acute and selflimiting, usually resolving without complications. Dosage should be reduced as soon as possible to low maintenance, taken on alternate days until treatment is. Annular bullous lesions with atypical erythema multiforme. Erythema multiforme major this is the form that is more severe. Both hsv 1 and hsv 2 trigger the erythema multiforme lesions. Erythema multiforme, generalized fixed drug eruption, impetigo and acute viral infections particularly chickenpox in adults can all be confused with bp on first presentation. This type of erythema multiform is characterized by bullous lesion formation. It usually happens to infections such as hsv or mycoplasma or just viral illness.
Guidelines for the management of bullous pemphigoid. It is an uncommon disorder, with peak incidence in the second and third decades of. Erythema multiforme minor this form is not that serious. Suspected triggering factors include orf virus infection, furosemide, citalopram, thioridazine, flupentixol, amoxicillin, and. Erythema multiforme em is a rare skin disorder that mainly affects children. Erythema multiforme em is an acute, selflimited skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections most commonly herpes simplex virus hsv, medications sulfa drugs, and other various triggers.
By stressing the importance of acantholysis in the histology of true pemphigus, civatte 1943, 1949 and the. Erythema multiforme em is a hypersensitivity reaction which tends to develop suddenly. Usually it will disappear on its own, but sometimes treatment may be. Erythema multiforme can be induced by adverse drug reaction with a frequency of more than 1%. Vesicles and bullae are accumulations of fluid within or under the epidermis. Johnson syndrome, fixed drug eruption, bullous pemphigoid, paraneoplastic pemphigus, sweets. The incidence of em has been estimated to be between 0. This progressed to the picture of toxic epidermal necrolysis. Erythema multiforme bullosa stevensjohnson syndrome. Drugs adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1% 14. Erythema multiforme is caused by various insults often from an infectious agents, drugs and food additive 3,4,5. Erythema multiforme is an acute skin condition characterized by targetoid. Free publisher full textpmc free full textpmc free pdf.
It may begin at any age, but is most common in children and young adults. Erythema multiforme an overview sciencedirect topics. Skin lesions predominantly involving the extremities hands, feet, and mucosa. Immunosuppressive therapy with cyclosporine introduced in the 1970s dramatically improved the survival of kidney, liver, and heart transplants. Herpes associated erythema multiformea diagnostic dilemma. It is estimated that 2040% of cases of erythema multiforme are secondary to herpes simplex virus infection. In the severe form of the disease erythema multiforme major bullous erythema multiforme the skin, eyes, oesophagus gullet, airways, as well as the mouth can be affected and the condition can be life threatening without treatment. Erythema multiforme, especially em major and sjs can occur after. A condition in which a person gets an allergic skin reaction in response to medicines, infections, or illnesses. In bullous erythema multiform, the rash may initially appear small and flat.
Clinical features, diagnosis, and treatment of erythema multiforme. Erythema multiformelike bp is a rare variant, with only 8 cases reported in the literature, 49 including 5 women and 3 men aged between 16 and 80 years. Request pdf on oct 1, 2007, n ben fradj and others published drugs induced bullous erythema multiforme find, read and cite all the research you need on researchgate. A bullous lesion is a type of a large lesion that contains fluid. Erythema multiformelike bullous pemphigoid actas dermo. Rarely, it can be a drug reaction or it can be from cancer, collagen vascular disease or it may be idiopathic and people. Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions. Subepidermal blisters occur between the dermis and the epidermis. Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. Pdf erythema multiforme em is an acute, selfhealing inflammatory mucocutaneous.
Synthesized recommendation grading system for dynamed content. Management of erythema multiforme associated with recurrent. Bullous pemphigoid mimicking bullous erythema multiforme. In our case 1, the patient had a history of taking multidrugs and case 2 showed lesions due to food additives.
Erythema multiforme em is an acute, immunemediated mucocutaneous condition that characteristically presents with acrally distributed targetoid lesions. Druginduced erythema multiformelike bullous pemphigoid article pdf available in acta dermato venereologica 793. Their roofs are relatively thick and so they tend to be tense and intact. Erythema multiforme is a type iv hypersensitivity reaction, meaning that the damage is caused when cytotoxic t cells inappropriately attack the basal epithelial cells. Prognosis of mild erythema mutliforme is good as it gets better in 26 weeks, but the problem may return whereas its hard to treat severe forms. Erythema multiforme primary care dermatology society uk. Annular bullous lesions with atypical erythema multiforme in leprosy. Clinical features, diagnosis, and treatment of erythema. Erythema multiforme is a rare disorder that affects slightly more males than females. In herpes simplex virus hsvassociated em, the findings are thought to result from cell. Patients with recurrent erythema multiforme despite suppressive antiviral therapy should be.
Erythema multiforme commonly occurs between the ages of 10 and 40. 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. Prime pubmed erythema multiforme journal articles from pubmed. Realize that you can most likely experience a healthy life free. Erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages.
What is the prognosis of erythema multiformesteven johnson syndrome. To access free multiple choice questions on this topic, click here. Erythema multiforme em is a wellestablished mucocutaneous reaction to certain antigenic stimuli, usually infections or drugs. Large, symmetrical red blotches appear all over the skin in a circular. The patient immediately improved and currently is free of lesions. The best documented precipitating factors of em are herpes simplex virus hsv and mycoplasma infection 2, 3. Erythema multiforme a 3in1 reference book pdf for free. Erythema multiforme is a rare autoimmune mucocutaneous disorder that is acute in onset, recurrent in nature and is usually selflimiting. Bullous erythema multiforme is a disorder in which oral and genital erosions, ocular inflammation and cutaneous bullae may follow a viral or bacterial. Realize that you can most likely experience a healthy life free of depression, discomfort, and fatigue. Erythema multiforme em is a skin condition of unknown cause. Pdf druginduced erythema multiformelike bullous pemphigoid. Drugs induced bullous erythema multiforme request pdf.
Cyclosporine therapy for bullous erythema multiforme. Bullous erythema multiforme jama dermatology jama network. What are the complications of erythema multiformesteven johnson syndrome. When the disease has been triggered by an infection, usually the organism cannot be found in the skin lesions, although. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome 3. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. The median age of the 80 patients at the time of the first biopsy removal was 45 years. Health, general erythema multiforme care and treatment complications and side effects erythema nodosum ofloxacin dosage and administration prednisolone skin. Clinically, em is characterised by macular, papular or urticated lesions, as well as the classical target lesions distributed preferentially on the distal extremeties.
806 1223 1377 1023 1053 834 395 876 1018 249 261 698 880 1197 957 1428 916 1254 1369 1339 274 1114 446 698 204 319 394 716 504 1284 1208 472 251 1313 642 415 11 113 1116 1040 1223 1340 1054 18 232 494