erythema multiforme


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Erythema Multiforme

 

Definition

Erythema multiforme is a skin disease that causes lesions and redness around the lesions.

Description

Erythema multiforme appears on the skin and the mucous membranes (the lining of the mouth, digestive tract, vagina, and other organs). Large, symmetrical red blotches appear all over the skin in a circular pattern. On mucous membranes, it begins as blisters and progresses to ulcers. A more advanced form, called Stevens-Johnson syndrome, can be severe and even fatal.

Causes and symptoms

Erythema multiforme has many causes, most commonly are drugs. Penicillin, sulfonamides, certain epilepsy drugs, aspirin, and acetaminophen are the most likely medication-induced causes. Erythema multiforme can also be caused by certain diseases. Herpes virus and mycoplasma pneumonia are likely infectious causes.

Diagnosis

The appearance of the rash is sufficiently unique to identify it on sight. Having identified it, the physician will determine the underlying cause.

Treatment

Erythema multiforme is inadvertently treated when the causative agent, whether it be a drug or a disease, is treated. In severe cases, cortisone-like medication is often used along with general supportive measures and prevention of infection.

Prognosis

As a rule, the rash abates by itself without damaging the skin. Only in the case of infection, severe blistering, or continued use of an offending drug does complications occur.

Resources

Books

Fauci, Anthony S., et al., editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1997.

Key terms

Herpes virus — Viruses that can infect the skin, mucous membranes, and brain, and they are responsible for such diseases as herpes simplex, chicken pox, and shingles.
Mycoplasma pneumonia — An incomplete bacterium that infects the lung.

erythema

 [er″ĭ-the´mah]
redness of the skin caused by congestion of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation.
erythema chro´nicum mi´grans a ring-shaped erythema due to the bite of a tick of the genus Ixodes; it begins as an erythematous plaque several weeks after the bite and spreads peripherally with central clearing. Often there are also systemic symptoms, including chills, fever, headache, vomiting, backache, and stiff neck. See also lyme disease.
gyrate erythema (erythema gyra´tum) erythema multiforme characterized by the development of lesions that tend to migrate and spread peripherally with central clearing.
erythema ab ig´ne permanent erythema produced by prolonged exposure to excessive nonburning heat. It is seen most often on the legs of women, but under appropriate environmental circumstances, it can occur anywhere on the body in either sex.
erythema indura´tum a chronic necrotizing vasculitis, usually occurring on the calves of young women; see also bazin's disease.
erythema infectio´sum a mild, self-limiting disease of childhood characterized by a lacelike skin rash symmetrically distributed on the hands, arms, and legs, with few or no other symptoms; occasionally there is a low grade fever, and the condition often clears up without specific treatment. The incubation period is six days to two weeks. This disease is contagious and originally was believed to be a form of rubella; because the rash can resemble that of scarlet fever and German measles, it is important to differentiate this mild condition from those more serious ones. Called also fifth disease.
erythema margina´tum a type of erythema multiforme in which the reddened areas are disk-shaped, with elevated edges.
erythema margina´tum rheuma´ticum a superficial, often asymptomatic, form of gyrate erythema associated with some cases of rheumatic fever, which is characterized by the presence on the trunk and extensor surfaces of the extremities of a transient eruption of flat to slightly indurated, nonscaling, and usually multiple lesions.
erythema mi´grans geographic tongue.
erythema multifor´me a symptom complex representing a reaction of the skin and mucous membranes secondary to various known, suspected, and unknown factors, including infections, ingestants, physical agents, malignancy, and pregnancy. The conditions in the complex are characterized by the sudden onset of a reddened macular, bullous, papular, or vesicular eruption, the characteristic lesion being the iris, bull's eye, or target lesion, which consists of a central papule with two or more concentric rings. The complex includes a mild self-limited mucocutaneous form (erythema multiforme minor) and a severe, sometimes fatal, multisystem form (stevens-johnson syndrome).
erythema nodo´sum a type of panniculitis occurring usually as a hypersensitivity reaction to multiple provoking agents, including various infections, drugs, sarcoidosis, and certain enteropathies. It may also be of idiopathic origin. It most often affects young women and is characterized by the development of crops of transient, inflammatory, nonulcerating nodules that are usually tender, multiple, and bilateral, and most commonly located on the shins; the lesions involute slowly, leaving bruiselike patches without scarring. The acute disease is often associated with fever, malaise, and arthralgias. A chronic variant sometimes occurs without any serious associated systemic disease.
toxic erythema (erythema tox´icum) a generalized erythematous or erythematomacular eruption due to administration of a drug or to bacterial or other toxins or associated with various systemic diseases.
erythema tox´icum neonato´rum a benign, idiopathic, very common, generalized, transient eruption occurring in infants during the first week of life, usually consisting of small papules or pustules that become sterile, yellow-white, firm vesicles surrounded by an erythematous halo and some edema.

er·y·the·ma mul·ti·for·me

an acute eruption of macules, papules, or subepidermal vesicles presenting a multiform appearance, the characteristic lesion being the target or iris lesion over the dorsal aspect of the hands and forearms; its origin may be allergic, including drug sensitivity, or it may be caused by herpes simplex infection; the eruption, although usually self-limited (for example, multiforme minor), may be recurrent or may run a severe course, sometimes with fatal termination (for example, multiforme major or Stevens-Johnson syndrome).

er·y·the·ma mul·ti·for·me

(er'i-thē'mă mŭl-ti-fōr'mē)
An acute eruption of macules, papules, or subdermal vesicles presenting a multiform appearance, the characteristic lesion being the target or iris form of lesion over the dorsal aspect of the hands and forearms; its origin may be allergic, seasonal, or from drug sensitivity, and the eruption, although usually self limited, may be recurrent or may run a severe course, sometimes with fatal termination (Stevens-Johnson syndrome).
Synonym(s): herpes iris (2) .
Enlarge picture
ERYTHEMA MULTIFORME

erythema multiforme

Abbreviation: EM
A rash usually caused by an immune response to drugs or to an infection, esp. herpes simplex virus. It may express itself on the skin in multiform ways, including macules, papules, blisters, hives, and, characteristically, iris or target lesions. It may involve the palms and soles, the mucous membranes, the face, and the extremities. The disease is usually self-limited. The most severe (and occasionally fatal) variant of the illness, in which the eyes, mouth, and internal organs are involved, is called Stevens-Johnson syndrome, or toxic epidermal necrolysis. Synonym: Hebra disease (1.) See: illustration
See also: erythema

erythema multiforme

A hypersensitivity disorder featuring red, raised skin eruptions of various sizes and shapes (‘multiforme’) occurring symmetrically on the face, neck, forearms, backs of the hands, and legs. It is associated with drug and other allergies, many infections and pregnancy.

Hebra,

Ferdinand von, Austrian dermatologist, 1816-1880.
Hebra disease - an acute eruption of macules, papules, or subdermal vesicles presenting a multiform appearance. Synonym(s): erythema multiforme; familial nonhemolytic jaundice
Hebra prurigo - a severe form of chronic dermatitis with secondary infection. Synonym(s): prurigo agria; prurigo ferox

erythema multiforme

A mucocutaneous disease that occurs as a hypersensitivity to drugs (e.g. sulfonamides) or as a consequence of infection. The condition, which principally affects young people, is characterized by the sudden appearance of various erosions of the mucous membranes and epidermis. A common complication is conjunctivitis, which may become severe with cicatrization, abnormal lid margin function, symblepharon, corneal ulceration and vascularization and keratoconjunctivitis sicca. The patient complains of pain, discharge, photophobia and reduced vision if the cornea is involved. Treatment includes cleansing of the eyelids with antibiotic ointment and, if severe, topical steroids. Syn. Stevens-Johnson syndrome (although this term applies to the severe form of the disease). See Stevens-Johnson syndrome.
References in periodicals archive ?
Clinical classification of cases of toxic epidermal necrolysis, Stevens--Johnson syndrome, and erythema multiforme. Arch Dermatol.
[11] Interestingly both patients had erythema multiforme precipitated by different drugs, some years before a diagnosis of SLE was made.
can be associated with erythema multiforme even if a patient does not have any flares," Dr.
Lupus erythematosus associated with erythema multiforme: Report of two cases and review of the literature.
* Erythema multiforme is a type of hypersensitivity reaction that commonly occurs in response to infections such as herpes simplex and mycoplasma or medications such as barbiturates or penicillins.
They are progressive, severe variants of Erythema multiforme spectrum with drugs being the most common associations.
Rarely, Orf infection in humans has been associated with systemic sequelae such as erythema multiforme or widespread papular or morbilliform eruptions (3).
Major criteria include worsening renal function, acute hepatocellular injury, and rash (toxic epidermal necrosis, erythema multiforme, diffuse maculopapular rash, or exfoliative dermatitis).
Smallpox vaccine administration can trigger a wide range of dermatologic reactions, from severe conditions such as eczema vaccinatum and progressive vaccinia, to milder reactions such as generalized vaccinia and erythema multiforme.
During the vaccination program, no cases of eczema vaccinatum, erythema multiforme major, fetal vaccinia, postvaccinial encephalitis or encephalomyelitis, progressive vaccinia, or pyogenic infection of the vaccination site have been reported (Table 1).
Gilbert advised being on the alert for herpes whenever a patient has erythema multiforme, as herpes is the most common cause of this condition.
Bullous pemphigoid and paraneoplastic pemphigus are both chronic in their course and have distinguishing histopathologic characteristics that will not be present in erythema multiforme. Sweet's syndrome is also associated with infection; however, histology reveals a dense neutrophilic infiltrate with dermal edema on biopsy.