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Erythema Multiforme

more about Erythema Multiforme

  • This is a rash that appears suddenly.  It usually is symmetrical (i.e., if it is on one arm, it is also on the other).
  • It usually occurs between 10 and 30 years of age.
  • It can be divided into two types: (1) Erythema multiforme minus (Hebra's disease); and (2) Stevens-Johnson syndrome, a very severe form.
  • Stevens-Johnson syndrome can be life-threatening.  It generally involves prominent blistering of the mouth and eyes.

  • Fever, chills, lack of energy, muscle pain
  • Skin rash on the arms, legs, palms, soles, mouth/lips
  • It has multiple morphologic stages (multiple types of appearances):
    1. Red spots
    2. Red, raised, large lesions
    3. Red, raised, small lesions
    4. Hive-like
    5. Deep red appearance
    6. Blisterlike
    7. Targetlike (red outside with clear inside)
  • Erythema multiforme minus:
    1. Skin rashes over the face, dorsum of hands and feet, palms and soles.  It may spread to trunk.
    2. Burning and itching.
  • Stevens-Johnson syndrome:
    1. Fever, lack of energy, muscle pain, headache, and Diarrhea followed by skin eruption
    2. Prominent blistering in mouth; and eye involvement (corneal ulcers or uveitis may occur)
    3. Denudation of skin
    4. It can be life threatening.

  • Infection

    1. Herpes simplex, Epstein-Barr virus, Mumps, Group A streptococci, Hepatitis B
    2. Mycoplasma pneumoniae (''walking pneumonia"), brucellosis, Diphtheria, etc.
    3. Protozoan and fungal infections

  • Medications such as Dilantin, sulfa antibiotics, and anti-inflammatories
  • Vaccines -- Tetanus, BCG, Diphtheria
  • Pregnancy
  • Certain diseases (e.g., sarcoidosis, collagen vascular diseases)
  • Malignancy, such as Leukemia and lymphoma
  • Radiation therapy
  • Sunlight
  • Pregnancy

  • Skin biopsy

  • Erythema multiforme minus --
    1. Oral antihistamines
    2. Moist compresses
  • Stevens-Johnson syndrome -- treat in a burn unit
    1. Intravenous fluid and nutritional support
    2. Ophthalmologic consultation
    3. Topical anesthetics
    4. Saline or Burow's solution compresses
    5. Antibiotics for secondary bacterial infection
    6. Paraffin gauze or hydrogel dressing to denuded areas
  • Corticosteroid treatment is often tried, but there is no clear evidence of effectiveness.
  • For mouth lesions -- 1% diphenhydramine elixir mixed with Kaopectate or 1% dyclonine

  • Seek immediate emergency treatment for your child.  This condition, especially the Stevens-Johnson syndrome, can be life threatening.

  • Hives
  • Drug reactions
  • Meningococcemia
  • Rocky Mountain spotted fever
  • Secondary syphilis
  • Toxic shock syndrome

more about Erythema Multiforme

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