On clinical examination, diffuse erythema of the labial mucosae with small vesicles and crusted erosions on both the superior and inferior vermillion borders were noted figure. Erythema multiforme is a skin condition considered to be a. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Detection of herpes simplex virus dna in cutaneous lesions of erythema multiforme. Erythema multiforme em is an acute, selflimited cutaneous or mucocutaneous disorder, characterized by the development of symmetrically distributed, fixed. Erythema multiforme em is an acute, selflimited, and sometimes recurring mucocutaneous condition. Target lesions vesiculobullous disorder download this article as. Pdf erythema multiforme em is an acute, selfhealing. Cyclosporine therapy for bullous erythema multiforme. Em is said to be rare in childhood, and very few paediatric. Due to the similarities in clinical and histological findings, it was. Erythema multiforme em, in its modern definition, is an acute, selflimited syndrome with distinctive skin lesions with or without mucosal lesions. Although these 3 entities may present in a similar manner, specific. Thirty female and twenty male patients, ranging in age.
Acute annular urticaria is a common and benign cutaneous hypersensitivity reaction seen in children that manifests with characteristic annular, arcuate, and polycyclic urticarial lesions in association with acral edema. Medications associated with erythema multiforme include sulfonamides, penicillins, barbiturates, and phenytoin. He has also provided dozens of columns for medical newsletters. Erythema multiforme induced by alendronate sodium in a.
Urticaria multiforme is a benign cutaneous hypersensitivity reaction seen in pediatric patients that is characterized by the acute and transient onset of blanchable. Erythema multiforme, stevensjohnson syndrome and toxic. 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. The classic lesion is annular with a violaceous center and pink halo separated by a pale ring target or iris lesion. It may begin at any age, but is most common in children and young adults. Variations in clinical course, a complicated nomenclature, and the artificial hiatus separating dermatology from internal medicine have been contributory factors in making a difficult subject even more involved. Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening.
German shepherd dogs and pembroke welsh corgis appeared predisposed. Erythema multiforme is part of a group of 3 related skin disorders and it is the mildest of the three. Viral skin diseases picture of erythema multiforme minor erythema multiforme em minor is a bullseye rash with alternating rings of red erythema and flaky skin desquamation. Mucosal erythema multiforme fuchs syndrome, ectodermosis pluriorificialis. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Erythema multiforme is a selfhealing disease, with an average duration of about 2 weeks. Erythema multiforme em is an acute self limited, usually mild, and often. Erythema multiforme and stevensjohnson syndrome sjs, erythema multiforme major in children symptoms and treatment stevensjohnson syndrome is an immunecomplex mediated hypersensitivity reaction that can be triggered by infectious etiologies or the use of anticonvulsants, antibiotics or any other drug. Cyclosporine therapy for bullous erythema multiforme jama. This evidence ranges from mere epidemiologic associations, such as lichen planus, to molecular biological investigations that have identified the virus in the pathologic tissues of cutaneous vasculitis, vasculitis with mixed. Picture of skin diseases and problems erythema multiforme minor. Further inspection of her mouth showed erythema and erosions on the inner cheek and mild focal. Erythema multiforme a 3in1 reference book pdf free pdf. 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.
An epidemic of erythema multiforme and erythema nodosum. View the article pdf and any associated supplements and figures for a period of 48 hours. Some spots can have a small blister or scab in the middle. A description of the clinical and epidemiologic features of this unusual epidemic forms the basis of this report. Article pdf available in indian journal of medical and paediatric oncology august 2018 with 88 reads how we measure reads. Erythema multiforme em is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus. Herpes simplex infection is by far the most common etiologic agent. Erythema multiforme minor typically affects only one mucosa and can be associated with symmetrical target skin lesions on the extremities. The naming of this disease has had an interesting but confusing evolution over the past years. Erythema multiforme em is a type of cytotoxic dermatitis, which can be triggered by many factors. An additional 24 dogs and five cats with definitive or presumed erythema multiforme were found in the veterinary literature. It is an uncommon disorder, with peak incidence in the second and third decades of. Erythema multiforme british association of dermatologists. Erythema multiforme an overview sciencedirect topics.
The differential diagnosis for targetoid lesions is broad, but detailed physical examination can aid in identifying differentiating features. Erythema multiforme is a type of hypersensitivity allergic reaction that occurs when certain medications are taken, with infections, or illness. Erythema multiforme in a child with kawasaki disease jaad. Em primarily affects apparently healthy young adults.
Erythema multiforme em is an acute mucocutaneous hypersensitivity. Erythema multiforme baby is a normally identified questioning in view of the fact that it is of concern when evaluating erythema marginatum vs erythema multiforme, erythema multiforme lupus, and erythema multiforme patient handout. This paper represents a clinical analysis of 14 cases of stevensjohnson syndrome that were seen during an 18 month period at the united states army hospital at fort dix, n. Medicinenet does not provide medical advice, diagnosis or treatment. December, 62, 8, 2, november, 27, 5, october, 36, 0, september, 30, 3. Treatment of recurrent erythema multiforme with adalimumab as. Erythema multiforme em is a hypersensitivity reaction which tends to develop suddenly. Erythema multiforme is a chronic mucocutaneous inflammatory disease with a variable recurrent pattern. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. A more recent article on erythema multiforme is available. It is associated with acral and facial angioedema, dermatographism, favorable response to antihistamines, and a self.
Erythema multiforme minor pdf download lcanordaychin. Erythema multiforme airuhtheemuh multehformee starts with pink or red blotches. 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. Usually it will disappear on its own, but sometimes treatment may be. Finally, a wide variety of drugs, most commonly the sulfonamides, may cause this syndrome. Use of some antiretroviral arv drugs can also cause erythema multiforme. Background in adults, erythema multiforme em is thought to be mainly related to herpes infection and stevensjohnson syndrome sjs to drug reactions. Erythema multiforme nord national organization for rare. The validity of this classification has been challenged by some reports, especially for cases in. Methods a retrospective analysis of 77 paediatric cases of em or sjs admitted to the childrens hospital in bordeaux between. Background it was proposed that stevensjohnson syndrome and toxic epidermal necrolysis differed from erythema multiforme majus by the pattern and localization of skin lesions objective to evaluate the validity of this clinical separation design casecontrol study settings active survey from 1989 to 1995 of 1800 hospital departments in europe. Erythema multiforme is a rare disorder that affects slightly more males than females. Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions.
Erythema multiforme and stevensjohnson syndrome chest. It is acute and selflimiting, usually resolving without complications. Erythema multiforme a 3in1 reference book pdf for free. Erythema multiforme em is an acute, selflimited, and. Lichen planus, erythema nodosum, and erythema multiforme in a. The definition of em in this chapter is based on the classification proposed by bastujigarin et al. Recurrent erythema multiforme dermatology jama network. The other two more severe disorders are stevensjohnson syndrome and toxic epidermal necrolysis. Erythema multiforme primary care dermatology society uk. After identification of the hepatitis c virus hcv in 1989, evidence was established supporting its role in the pathogenesis of a number of cutaneous diseases. Cutaneous lesions labeled as erythema multiforme are often encountered in medical practice. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. Erythema multiforme is a distinctive hypersensitivity syndrome characterized by skin and mucous membrane lesions and, in its more severe forms, mucosal lesions with constitutional symptoms and, at times, visceral involvement.
A recent update article pdf available in biomedical and pharmacology journal 111. A 43yearold african american woman with medical history of hepatitis c virus hcv infection was seen for a 2year history of painful skin lesions on her legs and arms. Recurrent erythema multiforme dermatology jama jama. See also introduction to hypersensitivity reactions and inflammatory skin disorders. Erythema multiforme em presents with true target lesions, with at least 3 zones of color including an erythematous or purpuric central area, a surrounding area of lighter erythema and edema, and a dark erythematous. It is an uncommon disorder, with peak incidence in. Both hsv 1 and hsv 2 trigger the erythema multiforme lesions.
Erythema multiforme is a rare autoimmune mucocutaneous disorder that is acute in onset, recurrent in nature and is usually selflimiting. Erythema multiforme major with swollen lips and crusted erosions. There are two variants of this condition, one with mucosal involvement, termed erythema multiforme major, and one without mucosal involvement, known as erythema multiforme minor. Aug 18, 2018 a 41yearold woman presented to our clinic because of the sudden appearance of erosions on and swelling of her lips. Although it is selflimiting, recurrences are common. Em is selflimiting, usually resolving without complications. The incidence of em has been estimated to be between 0. In these diseases, fatalities may result from various causes, including secondary infection or visceral organ damage to lung, liver, or kidneys. In an investigation of patients with erythema multiforme minor, mycoplasma pneumoni.
Erythema multiforme is an uncommon acute inflammatory disorder caused by exposure to microbes or drugs. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. 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 is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. Meanwhile, the medicines destroy the immune system and spark damaging effects. Erythema multiforme em is an acute, immunemediated condition characterized by the appearance of distinctive. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome 3. An epidemiologic investigation provided evidence that histoplasmosis was the cause. Diagnosis of kd is based on wellknown clinical criteria. It presents with a skin eruption characterised by a typical target lesion. Erythema multiforme speaker a type of allergic reaction usually triggered by infections, most often herpes simplex infection. 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. It is most often mistaken for erythema multiforme and occasionally for serum sickness.
Pdf erythema multiforme em is a life threatening mucocutaneous disorder where early diagnosis and management is of utmost important. Her lesions improved with prednisone but recurred when treatment was discontinued. One of the most intriguing discoveries of the past 20 y is the finding that herpes simplex virus hsv is responsible for precipitating most of the erythema multiforme em episodes in adults and children brice et al, 1989 x brice et al. Erythema multiforme mainly affects adults under 40.
The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Erythema multiforme for parents nemours kidshealth. Diagnosis, classification, and management of erythema. Eritema multiforme pediatria pdf yearmonth, html, pdf, epub, total. Erythema multiforme em is a skin condition of unknown cause. This material may not otherwise be downloaded, copied, printed, stored, transmitted. Here we report a case of kd associated with erythema multiforme em as a variation from the expected. Sixteen patients and 16 matched controls were studied using an enzymelinked immunosorbent assay elisa to measure antibody of the igg, iga, and igm classes against hsv1. Mucous membrane lesions without cutaneous involvement em is usually called minor when mucous membranes are spared or minimally affected, for example, lips, and majus or major when at least two mucosal sites are involved.
From our study on patients with oral erythema multiforme, we found no evidence to correlate the occurrence andor severity of em and the hsv1. Correlations between clinical patterns and causes of. Herpesassociated erythema multiforme dermatology jama. Erythema multiforme inflammatory diseases online course. Erythema multiforme genetic and rare diseases information. It is estimated that 2040% of cases of erythema multiforme are secondary to herpes simplex virus infection. 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. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme. Erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name. Erythema multiforme em is an acute, selflimiting disease of the skin and mucous membranes described by hebra in 18661. Herpes associated erythema multiformea diagnostic dilemma.
Clinically, em is characterised by macular, papular or urticated lesions, as well as the classical target lesions distributed preferentially on the distal extremeties. Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. 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. Ferril has spoken at numerous conferences for doctors. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. Erythema multiforme ppt 1 free ebook download as powerpoint presentation. It is mistaken most often for erythema multiforme and, occasionally, for a serumsicknesslike reaction. Diagnosis and particularly the management of erythema multiforme and stevensjohnson syndrome are controversial in medical textbooks and thus in individual cases. Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males.
1458 41 512 933 669 1275 1054 1189 329 279 269 191 1420 894 544 610 653 796 1606 37 611 533 1103 1220 746 641 455 259 1108 739 630 1348 339 681 994 1224 452 940