Name
ERYTHEMA MULTIFORM
DESCRIPTION
DETAIL
CAUSES : * RECURRENT ATTACKS - HERPES SIMPLEX INFECTION * SOLITARY ATTACKS 1. VIRAL INFECTIONS : - HERPES SIMPLEX INFECTION - VACCINIA - EPSTEIN-BARR VIRUS - COXSACKIE - ECHOVIRUS - MUMPS - POLIOVIRUS 2. BACTERIAL INFECTIONS: - STREPTOCOCCAL - BRUCELLOSIS - DIPHTHERIA - BORRELIOSIS - MYCOPLASMA 3- DEEP MYCOTIC INFECTION 4- PROTOZOAL INFECTION 5- DRUGS LIKE SULPHONAMIDES, SALICYLATES, TETRACYCLINE, ANTIRHEUMATICS 6- RADIOTHERAPY 7- COLLAGEN DISEASES LIKE SLE 8. MALIGNANCY 9- PREGNANCY 10- PREMANSTRUAL HORMONE CHANGES 11. CONSUMPTION OF BEAR -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS ⒠Stevens-Johnson syndrome ⒠Urticaria ⒠Necrotizing vasculitis ⒠Drug eruptions ⒠Contact dermatitis ⒠Pityriasis rosea ⒠Secondary syphilis ⒠Ringworm ⒠Pemphigus vulgaris ⒠Pemphigoid ⒠Dermatitis herpetiformis ⒠Herpes gestationis ⒠Septicemia ⒠Serum sickness ⒠Viral exanthems ⒠Rocky Mountain spotted fever ⒠Collagen vascular diseases ⒠Mucocutaneous lymph node syndrome ⒠Meningococcemia ⒠Lichen planus ⒠Behçet syndrome ⒠Recurrent aphthous ulcers ⒠Herpetic gingivostomatitis ⒠Granuloma annulareSKIN BIOPSY
TYPENOTES
GENERAL MEASURES : β’ Treatment of any underlying or causative disease β’ Withdrawal of any causative drugs β’ For mild cases, symptomatic treatment is sufficient. For more severe cases, meticulous wound care and use of Burowβs solution or Domeboro solution dressings. β’ Oral lesions can be treated with mouthwashes with warm saline, or a solution of diphenhydramine, lidocaine (Xylocaine), and Kaopectate to provide symptomatic relief and oral hygiene, and to facilitate oral intake DRUG(S) OF CHOICE : The use of steroids is controversial. Patients who have recurrent herpesinduced EM may benefi t from acyclovir, by reducing the number of herpetic episodes. Other causative infections should be treated appropriately. PATIENT MONITORING The disease is selflimiting. Complications are rare with no mortality. PREVENTION/AVOIDANCE : β’ Known or suspected etiologic agents should be avoided β’ Acyclovir may help prevent herpes-related erythema multiforme β’ Tamoxifen has been shown to prevent premenstrual related disease POSSIBLE COMPLICATIONS : Corneal ulceration is a serious complication of Stevens-Johnson syndrome. It is not clear whether this can occur in true EM. While there may be complications of the underlying disease, there are no other complications of EM. EXPECTED COURSE/PROGNOSIS : β’ Rash evolves over 1-2 weeks and subsequently resolves within 2-3 weeks, generally without scarring or sequelae β’ Following resolution there may be some post-infl ammatory hyperpigmentation β’ Risk of recurrence may be as high as 37%
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, PUS CULTURE TEST, BIOPSY