ERYTHEMA MULTIFORME
ETIOLOGY:
- Idiopathic: Most common cause
- Viral : HSV (most important) HBV, Mumps, Adenovirus
- Bacteria :Streptococci, tuberculosis, M. pneumoniae
- Fungal : Coccidioidomycosis, Histoplasmosis.
- Drugs -: Antibiotics (Sulphonamide), Phenytoin, NSAIDS.
- Autoimmune disease: SLE, thyroiditis, RA
- Others: Sarcoidosis, Pregnancy, Malignancy.
CLASSIFICATION :
- Erythema multiforme major-typical 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; epidermal detachment involves less than 10% of total body surface area (TBSA)
- Toxic epidermal necrolysis
- Stevens–Johnson syndrome-widespread blisters predominant on the trunk and face, presenting with erythematous or pruritic macules and one or more mucous membrane erosions; epidermal detachment is less than 10% TBSA for Stevens-Johnson syndrome and 30% or more for toxic epidermal necrolysis.
CLINICAL FEATURES:
Prodromal Features :
- Prev Attack (30%)
- Preceding Infection Fever (T>103.1 deg C)
- Cutaneous Lesions
- Mucous Lesions
CUTANEOUS LESIONS :
- Symmetrical, Acral, Centripetal Rash
- Hemorrhagic crusts
- Extensor aspect : Extremities > Face > Neck > Trunk
- Predilection to Sun-Exposed Areas / Koebnerization
- Well-defined, circular, blanching papule / plaque that persists for 01 week – Self-limiting in 04 weeks – Persistent / Continuous EM
Typical Target Lesion
- Dusky Central Disk / Bulla (later Violaceous / Purpuric)
- Infiltrated Pale Ring
- Erythematous edematous halo Larger lesions show Central Bulla and Marginal ring of vesicles , Herpes Iris of Bateman
- vesicles, ruptured to form ulcers covered with pseudomembrane
Raised Atypical Target lesions / Targetoid lesions
- SJS-TEN lesions – mostly Macular MUCOSAL LESIONS
- 70% Cases
- Lips – Cutaneous Target Lesions Serous Crusting
MUCOSAL LESIONS :
- LIPS – Mucosal (Erosions / Vesicles / Bullae)
- GINGIVAL / Ventral Tongue
- Hard Palate – Spared
- Pharynx / Larynx / Trachea / Bronchi
- Conjunctivitis B/L with Vesicles / Erosions
- Nasal / Urethral / Anal Mucosae
- 2/3 Mucosal Sites sans Cutaneous inv – FUCH’s SYNDROME


TREATMENT:
- Treating underlying Etiology
- Reducing morbidity – Oral CS
- Anti-Virals
- Macrolides / Quinolones for MPAEM
- Oral EM – Topical CS / Anesthetics / Antacids
- RECURRENT EM
- Anti-Virals
- Topical Acyclovir
- Azathioprine
- Thalidomide
Exam Important
- The most clinically significant skin eruption associated with M. pneumoniae infection is Erythema multiforme major
- After taking sulphonamide group of drugs, one patient developed certain oral lesions of Erythema multiforme
- Erythema multiforme lesions consist of vesicles, ruptured to form ulcers covered with pseudomembrane.
- While touching, the lesions of Erythema multiforme bleed easily with Hemorrhagic crusts on lips and other skin .
- Commonest etiology among infection of erythema multiforme is Viral
- In Erythema multiforme Target lesions are seen
- Erythema multiforme Involves face and neck regions
- Erythema multiform shows Sign of internal malignancy
- Erythema multiforme is most commonly caused by idiopathy
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