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Erythema Multiforme

Title

Ñ    Erythema Multiforme (EM)

Definition

Ñ    Hypersensitivity reaction of the skin of acute onset

Ñ    Frequently caused by infections or drugs

Pathogenesis

Causes

Ñ    Viruses:

Herpes simplex

EBV

Orf

HIV

Ñ    Mycoplasma infection

Ñ    Drugs:

Sulphonamides

Anticonvulsants

Ñ    Inflammation:

Connective tissue diseases

Wegener’s granulomatosis

Ñ    Malignancy:

Carcinoma

Lymphoma

Ñ    Pregnancy

Pathological Process

Ñ    Cell mediated (T lymphocytic) response

Ñ    Dermal oedema

Ñ    Dermoepidermal junction and superficial perivascular lymphocytic infiltrates

Ñ    Focal basal keratinocyte degeneration and necrosis

Ñ    Target lesions:

Show central epidermal necrosis and perivenular inflammation

Clinical Features

Ñ    Acute onset

IS

Ñ    Erythematous rash

Ñ    Polycyclic lesions, annular lesions, target lesions

Ñ    Symmetrical lesions commonly affects the limbs especially hands and feet

Variants

Ñ    EM major (Stevens-Johnson syndrome):

·          Mucosal involvement:

Mouth, genitalia, conjunctiva

Ñ    Toxic epidermal necrolysis:

Diffuse mucocutaneous epithelial necrosis and sloughing

Management

Control

Drugs

Ñ    Treat underlying cause

Ñ    Steroid use:

Controversial

Ñ    Recurrent disease:

Acyclovir as 80% driven by herpes simplex

Ñ    Azathioprine:

Resistant cases

Support

Ñ    Mouth care

Ñ    Intensive care:

As for burns if widespread involvement

 

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