In our case 1, the patient had a history of taking multidrugs and case 2 showed lesions due to food additives. Erythema multiforme can be induced by adverse drug reaction with a frequency of more than 1%. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. Erythema multiforme rashes are usually located on the extremities, and rarely may involve the mucous membranes. Classified as erythema multiforme minor or erythema. The disorder is most commonly induced by infection, with herpes simplex virus being the most frequent precipitator. At first the spots are small, round, slightly raised red areas, some of which turn into the target lesions described above. Erythema multiforme lesions are usually acute in nature with mild or no prodromal symptoms. Erythema multiforme minor presents as a bulging, rashlike lesion that is red, pink, purple, or brown. Peak incidence in second and third decades of life.
Erythema multiforme on the hand illustration this individual has erythema multiforme minor, with target lesions on his hands. Erythema multiforme em erythema multiforme minor of the hands note the blanching centers of the lesion specialty dermatology erythema multiforme em is a skin condition of unknown cause. Erythema multiforme pictures, treatment, causes, symptom. Erythema multiforme british association of dermatologists. 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. It is now separated from stevens johnson syndrome sjs and toxic epidermal necrolysis t.
Diagnosis, clinical manifestations and treatment in a retrospective study of 22 patients. Despite multiple associations, thought to be triggered by hsv in most cases. The main risk factors appear to be concomitant with use of valproate and exceeding the recommended initial dose of lamotrigine or the recommended rate of dose escalation sachs et al. Las lesiones cutaneas son simetricas, acrales y centripetas. Erythema multiforme is a rare skin condition, easily diagnosed based on its characteristic clinical appearance, but remains a challenge for the physician in terms of establishing its causal agent. Erythema multiforme is usually a reaction of the skin and mucous membranes that occurs suddenly. Em with mucosal involvement is known as erythema multiforme major, and without mucosal disease it is referred to as erythema multiforme minor. Lesions spontaneously resolve but frequently recur. 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. Here the lesions appear pale on the center, and pinkred around the circumference. Erythema multiforme em is an inflammatory reaction, characterized by target or iris skin lesions.
Bashir t, arti s, jyoti g, monu y, vijay k, naeem a. Erythema multiforme for parents nemours kidshealth. A revision article pdf available in american journal of infectious diseases 44 april 2008 with 1,352 reads how we measure reads. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. It is not one single entity but rather a spectrum of diseases. Erythema multiforme mainly affects adults under 40. Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm. His condition may result from a recurrent herpes simplex virus infection on the lip. Both hsv 1 and hsv 2 trigger the erythema multiforme lesions.
Erythema multiforme pictures, treatment, symptoms, causes. This means that the body is sensitive to something that causes the skin and mucous membranes to react. Desai nc, english jc 3rd j pediatr adolesc gynecol 20 feb. Pdf the term erythema multiforme em includes a wide and controversial variety of clinical expressions at the present time. Erythema multiforme minor em minor typical targets or raised, edematous papules distributed acrally. This means it usually resolves on its own without treatment. Erythema multiforme em is an inflammatory mucocutaneous skin disorder. This severe form of the disorder usually causes target lesions with painful blisters at their center, which tend to appear the trunk, eyes, and inside the mouth and genitals. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. What is erythema multiforme erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv.
The hallmark sign of multiform erythema rash is its target like appearance. There is much controversy about the proper classification of the various clinical presentations, although for simplicity, it will be described in three categories, em minor, em major, and toxic epidermal. Eritema multiforme minor pdf republic of fenerbahce. Management of erythema multiforme associated with recurrent. 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. Herpes associated erythema multiformea diagnostic dilemma. In 1950, thomas suggested the division of erythema multiforme into two forms. 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. Oral blistering report of two cases of erythema multiforme. Hebra is now known as erythema multiforme minor, while a more serious, mucocutaneous.
Erythema multiforme major em major typical targets or raised, edematous papules distributed acrally with involvement of one or more mucous membranes. Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions. Erythema multiforme minor is the most frequent form and is generally mild, erythema multiforme major, while rare, can be lifethreatening. Erythema multiforme minor, erythema multiforme major. Erythema multiforme is an acute skin condition characterized by targetoid lesions. Em has been chiefly divided into two main forms em minor and em major. Erythema multiforme major, minor, and persistent variations. Most erythema multiforme minor skin lesions often resolve in about 26 weeks.
It is estimated that 2040% of cases of erythema multiforme are secondary to herpes simplex virus infection. It presents with a skin eruption characterised by a typical target lesion. Erythema multiforme em is a skin condition of unknown cause. This reaction causes red, targetshaped or bullseye patches or sores on the skin. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. 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. 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.
Erythema multiforme, stevensjohnson syndrome and toxic. It appears as a symmetrical rash and may include the mucous membrane lesions. Erythema multiforme is associated with an acute onset. Erythema multiforme usually occurs as a reaction to an infectious agent such as herpes simplex virus or mycoplasma but may be a reaction to a.
Erythema multiforme is a reactive mucocutaneous disorder in a disease spectrum that comprises a selflimited, mild, exanthematic, cutaneous variant with minimal oral involvement em minor to a. A few people may get the rash after taking certain medications, such as seizure medicines, anesthesia medicines, nonsteroidal antiinflammatory medicines e. Erythema multiforme major this is the form that is more severe. The incidence of em has been estimated to be between 0. A variety of factors have been implicated in the pathogenesis of em.
It is an eruption of classic target lesions on the extremities associated with. Erythema multiforme nord national organization for rare. Erythema multiforme minor is a hypersensitivity reaction usually attributed to an existing infection, most commonly herpes simplex virus and mycoplasma pneumonia. The disorder is most commonly induced by infection, with.
Erythema multiforme genetic and rare diseases information. Erythema multiforme is a rare disorder that affects slightly more males than females. Erythema multiforme minor after ibuprofen use for menstrual pain. Erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. In half of the cases, the triggering agents appear to be medications, including anticonvulsants. Given this fact some clinicians have used the term haem or herpes associated erythema multiforme. Erythema multiforme is a hypersensitivity reaction to an infection or, in some cases, a medicine. Erythema multiforme em has been divided into a minor simplex form and a major bullous form. Now thought to be distinct entity, with mucous membrane involvement. In rare cases, it is caused by certain medicines or bodywide. The spots usually develop over the course of 3 4 days, starting on the hands and feet, and then spreading up the limbs to the trunk and face. Erythema multiforme may be present within a wide spectrum of severity. Erythema multiforme em minor is a bullseye rash with alternating rings of red erythema and flaky skin desquamation.
Some spots can have a small blister or scab in the middle. Two types, one mild to moderate and one severe, are recognized erythema multiforme minor and erythema multiforme major. Started inthis collection now contains interlinked topic pages divided into a tree of 31 specialty books and chapters. It is usually circular, less than 3 centimeters in size, and similar to a bullseye in appearance. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name. Erythema multiforme majortypical targets or raised, edematous papules distributed acrally erythema multiforme minor typical targets or raised, edematous papules distributed acrally with involvement of one or more mucous membranes. It is acute and selflimiting, usually resolving without complications erythema multiforme is divided into major and minor. Thus viral infections appear to trigger em minor or major but drug ingestion tends to trigger more severe sjs or ten. It may begin at any age, but is most common in children and young adults.
The minor form is additionally subdivided into papular and vesiculobullous variants, and all three have been considered a continuum of the same process. Erythema multiforme majortypical targets or raised, edematous papules distributed acrally erythema multiforme minortypical targets or raised, edematous papules distributed acrally with involvement of one or more mucous membranes. Histologically, each shows varying degrees of dermal and epidermal inflammation and injury. However, since that time, erythema multiforme major has been most commonly referred to as stevensjohnson syndrome. 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.
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. Erythema multiforme minor of the hands note the blanching centers of the lesion. Mucosal erythema multiforme fuchs syndrome, ectodermosis pluriorificialis. Em is more common in men than women and 50% are under 20 years of age.
Erythema multiforme is divided into major and minor forms and is now regarded as distinct from stevensjohnson syndrome sjs and toxic epidermal. Erythema multiforme em is an acute, selflimited skin condition. Erythema multiforme em is an acute skin reaction that comes from an infection or another trigger. In most cases, it occurs in response to an infection. Erythema multiforme is usually mild erythema multiforme minor with only skin involvement, and clearing up in days to weeks. Erythema multiforme airuhtheemuh multehformee starts with pink or red blotches. 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 major stevens johnson syndrome previously thought to be along same spectrum as minor. It occurs predominantly in young adults, is slightly more common in females, and the incidence is somewhere between 0. Erythema multiforme introduction and epidemiology etiology. Other triggers include drug reactions and various other viral and fungal infections. 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. Medicinenet does not provide medical advice, diagnosis or treatment. Several episodes of recurrences and relapses occurred during our treatment.
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