Erythema multiforme an overview sciencedirect topics. Of 162 previously reported cases of erythema multiforme with mucosal involvement, the eyes were affected in 148. Erythema multiforme in children pubmed central pmc. Erythema multiforme is a hypersensitivity disorder that mostly affects children and young adults, though it can affect people of any age. 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. The early clinical presentations of stevensjohnson syndrome sjs and toxic epidermal necrolysis ten are similar to that of erythema multiforme major emm.
Erythema multiforme is part of a group of 3 related skin. Minor erythema multiforme case report medcrave online. Erythema multiforme em is an acute mucocutaneous hypersensitivity reaction characterised by a skin eruption, with or without oral or other mucous membrane lesions. Erythema multiforme major is a form of rash with skin loss or epidermal detachment. Erythema multiforme em is an acute selflimiting mucocutaneous disease that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. In half of the cases, the triggering agents appear to be medications, including anticonvulsants. Erythema multiforme for parents nemours kidshealth. Some spots can have a small blister or scab in the middle. Erythema multiforme em, in its modern definition, is an acute, selflimited syndrome with distinctive skin lesions with or without mucosal lesions. Erythema multiforme has different forms, such as erythema multiforme minor, which is not very serious when compared to erythema multiforme major stevensjohnson syndrome, a more severe and sometimes fatal condition. Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. Be aware you can most assuredly enjoy a normal life free of depression, pain, and fatigue. It occurs predominantly in young adults, is slightly more common in females, and the incidence is somewhere between 0. Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions.
Erythema multiforme minor is localized, with minimal or no mucosal involvement. Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening. A doctor might prescribe topical steroids if symptoms persist. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Erythema multiforme em is a rare skin disorder that mainly affects children. Aug 18, 2018 the patient was otherwise healthy, with good oral hygiene. Distinguishing between erythema multiforme major and stevens. Em without mucous membrane involvement em minor and em with mucous membrane involvement em major. Cytotoxic molecules, especially granulysin, are expressed in the skin lesions of sjsten and cause extensive keratinocyte death. The small observed risk of em is outweighed by the benefits of hepatitis b prevention. Clinically, em is characterised by macular, papular or urticated lesions, as well as the classical target lesions distributed preferentially on the distal extremities. Erythema multiforme em is an acute, immunemediated disorder affecting the skin andor mucous membranes, including the.
She had been taking paracetamol and amoxicillin for 3 days for a sore throat and fever. Erythema multiforme ppt 1 free ebook download as powerpoint presentation. It may begin at any age, but is most common in children and young adults. Diagnosis, classification, and management of erythema. 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. Erythema multiforme em is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus. Erythema multiforme major article about erythema multiforme.
Ferrils treatment plans are designed to be shared with other practitioners as scientific advice only. Erythema multiforme major erythema multiforme major berger, kyan james 19980301 00. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. According to some sources, there are two conditions included on a spectrum of this same disease process. The patient was otherwise healthy, with good oral hygiene. Herpes associated erythema multiforme a diagnostic dilemma mallika kishore1, sunil r panat2, ashish aggarwal3, nitin upadhyay4, nupur agarwal 5 1 post graduate student, department of oral medicine and radiology, institute of dental sciences, bareilly u. For this report, we shall define these clinical problems as follows. It occurs most commonly in association with the herpes simplex virus as an immune response to the infection. It is an eruption of classic target lesions on the extremities associated with mild fever and. It is an eruption of classic target lesions on the extremities associated with. Erythema multiforme is a rare disorder that affects slightly more males than females. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. The term erythema multiforme majus is sometimes used to imply a bullous blistering presentation.
Erythema multiforme major, journal of emergency medicine 10. The classic lesion is annular with a violaceous center and pink halo separated by. Erythema multiforme minor pdf download lcanordaychin. 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. Erythema multiforme and hepatitis b immunization jama. Erythema multiforme is associated with an acute onset. Find out information about erythema multiforme major. Erythema multiforme em is a skin condition of unknown cause. Erythema multiforme minor usually resolves by itself, but treatment is sometimes necessary. Erythema multiforme primary care dermatology society uk. On the other hand, the expression of erythema multiforme major em major is rare and may possibly transition to stevensjohnson syndrome sjs with a high mortality rate, or toxic epidermal necrolysis ten, making early treatment intervention and cause identification very. Show full abstract erythema multiforme major is the rarer form and defined by oral, genital, or ocular mucosal erosions or bullae in addition to the classic lesions.
Based on the clinical symptoms and medical history, we diagnosed erythema multiforme em major. Erythema multiforme em minor is a bullseye rash with alternating rings of red erythema and flaky skin desquamation. Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm. Erythema multiforme merck manuals professional edition. Erythema multiforme major vs stevens johnson syndrome is a natural investigation considering that it concerns erythema multiforme baby, erythema multiforme causes mnemonic, and erythema multiforme oral. Picture of skin diseases and problems erythema multiforme minor. Erythema multiforme major with swollen lips and crusted. Erythema multiforme and stevensjohnson syndrome chest. In em minor, lesions often present as papules, which might enlarge and. It presents with a skin eruption characterised by a typical target lesion. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. Additional and relevant useful information for erythema multiforme. Erythema multiforme genetic and rare diseases information.
Em is more common in men than women and 50% are under 20 years of age. Erythema nodosum pdf is a normally noted condition for the reason that it is crucial when pondering erythema multiforme major, eczema multiforme, and erythema multiforme histopathology. Erythema multiforme is a rare autoimmune mucocutaneous disorder that is acute in onset, recurrent in nature and is usually selflimiting. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name. 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. On the other hand, the expression of erythema multiforme major em major is rare and may possibly transition to stevensjohnson syndrome sjs with a high mortality rate, or toxic epidermal necrolysis ten, making early treatment intervention and cause identification very important. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome 3. Eight cases of erythema multiforme em have been reported to the us food and drug administration fda in temporal association with inoculation with the hepatitis b vaccine. 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 mucocutaneous hypersensitivity reaction characterised by a skin eruption, with or without oral or other mucous membrane. Recently, erythema multiforme has been classified as minor, major, stevensjohnson syndrome or toxic epidermal necrolysis, where erythema multiforme minor is the mildest type of lesion and toxic epidermal necrolysis the most severe2,3 table 1.
Erythema multiforme major induced by sunitinib for metastatic. Em primarily affects apparently healthy young adults. Erythema multiforme airuhtheemuh multehformee starts with pink or red blotches. Ferrils treatment plans are designed to be shared with other practitioners as. Erythema multiforme nord national organization for rare. 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.
Erythema multiforme em is an immunemediated, mucocutaneous condition characterized by target lesions. Erythema multiforme major vs stevens johnson syndrome. When involvement of the mucous membrane accompanies erythema multiforme bullosum, serious ocular sequelae may occur. Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. Em with mucosal involvement is known as erythema multiforme major, and without mucosal disease it is referred to as erythema multiforme minor. Herpes associated erythema multiformea diagnostic dilemma mallika kishore1, sunil r panat2, ashish aggarwal3, nitin upadhyay4, nupur agarwal 5 1 post graduate student, department of oral medicine and radiology, institute of dental sciences, bareilly u. Methods a retrospective analysis of 77 paediatric cases of em or sjs admitted to the childrens hospital in. Management of erythema multiforme associated with recurrent.
Herpes associated erythema multiformea diagnostic dilemma. Erythema multiforme em is an acute skin condition that may be recurrent in some cases. Erythema multiforme major, also known as stevensjohnson syndrome, is a more severe mucosal and skin disease characterized by signs and symptoms reminiscent of serum sickness chapter 46. Erythema multiforme major, also known as stevensjohnson syndrome, is a more severe mucosal and skin disease characterized by signs and symptoms reminiscent of serum. Kyan james berger, md, ucsd medical center, department of emergency. It is acute and selflimiting, usually resolving without complications. More recently, however efforts to link disease morphology with cause have led to reconsideration of that dogma. Based on the clinical symptoms and medical history, we. It is now separated from stevens johnson syndrome sjs and toxic epidermal necrolysis t. When seen in adults, it usually occurs between the ages of 20 and 40, although it can happen to people of any age. Erythema multiforme, stevensjohnson syndrome, toxic. The definition of em in this chapter is based on the classification proposed by bastujigarin et al. Background in adults, erythema multiforme em is thought to be mainly related to herpes infection and stevensjohnson syndrome sjs to drug reactions.