Overlap cases are reported, however, and until the pathogenesis of each is fully understood, the value of such a separation remains unclear. Skin lesions predominantly involving the extremities hands, feet, and mucosa. Erythema multiforme an overview sciencedirect topics. Erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the use of. Herpes associated erythema multiformea diagnostic dilemma mallika kishore1, sunil r panat2, ashish aggarwal3, nitin upadhyay4, nupur agarwal 5 1 post graduate student, department of oral medicine and radiology, institute of dental sciences, bareilly u. Erythema multiforme for parents nemours kidshealth. Erythema multiforme is a selfhealing disease, with an average duration of about 2 weeks. Erythema multiforme pictures, treatment, causes, symptom. Erythema multiforme following vaccination in an infant kaur s.
Erythema multiforme treatment oral antihistamines and steroids. Erythema multiforme em is an acute, selflimited skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections most commonly herpes simplex virus hsv, medications sulfa drugs, and other various triggers. Many medications such as phenothiazines, barbiturates, sulphonamides, nsaids, penicillin, and anticonvulsants have been found to cause erythema multiforme. Erythema multiforme major definition nci a severe, sometimes lifethreatening, form of erythema multiforme. Erythema multiforme is an acute, selflimiting, mucocutaneous disorder with symmetrically distributed, erythematous skin lesions, some with concentric colour changes target lesions, which resolve within 1 to 6 weeks and show compatible histology. Erythema multiforme or em is a selflimited but recurring allergic reaction or infection. Recurrent erythema multiforme is usually treated initially with continuous oral aciclovir for 6. Although there are a few case reports of erythema multiforme following vaccination in literature, the exact incidence of such cutaneous reactions has not been determined. Materials and methods biopsy specimens were obtained from twentyfive patients with oral erythema multiforme seen in the oral medicine clinic, school of dentistry, university of california at san francisco, between 1976 and 1978. Erythema multiforme minor is the most frequent form and is generally mild, erythema multiforme major, while rare, can be lifethreatening. A minor percentage of erythema multiforme cases are known to be triggered as a reaction to certain drugs. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir.
Herpes simplex infection is by far the most common etiologic agent. It varies with the age of the lesion, its appearance, and which part is biopsied. This relieves the symptoms of inflammation such as redness and itchiness. Erythema multiforme genetic and rare diseases information. Dec 01, 2006 erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages. Erythema multiforme em is an acute, immunemediated disorder affecting the skin andor mucous membranes, including the.
Erythema multiforme symptoms, diagnosis, treatments and. Postvaccination causes include bacille calmetteguerin bcg vaccination, oral polio vaccine, vaccinia, and tetanusdiphtheria. Large, symmetrical red blotches appear all over the skin in a circular. When a cause for erythema multiforme can be found, it should be treated, eliminated, or avoided e. Erythema multiforme em is a mucocutaneous disorder, which ranges from a mild, self limited, cutaneous, exanthematous variant with. Most people with classic erythema multiforme can be treated as outpatients with therapy, such as antihistamines, addressing their symptoms. Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis tb, or as a reaction to chemicals or.
Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. These spots can look like targets, with a circle around the edge and a dot in the middle. This book is distributed under the terms of the creative commons. Infections particularly herpes simplex and mycoplasma pneumonia and drugs seem to predispose toward the development. Herpes associated erythema multiformea diagnostic dilemma. Erythema multiforme history and exam bmj best practice. Erythema multiforme say airuhtheemuh multuhformee is a rash that often causes red spots. Erythema multiforme introduction and epidemiology erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the use of medications, such as phenytoin, sulfonamides, penicillins, and barbiturates. Erythema multiforme may be present within a wide spectrum of severity. A skin biopsy of erythema multiforme em may show in the epidermis epithelium. Erythema multiforme nord national organization for rare. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Erythema multiforme is usually a reaction of the skin and mucous membranes that occurs suddenly.
As children are exposed to vaccines early in their life, vaccines may be the most frequent cause for erythema multiforme. It appears as a symmetrical rash and may include the mucous membrane lesions. Characterized by target lesions that resemble a bulls eye. It presents a diagnostic dilemma because the oral cavity has the ability to produce varied manifestations.
Erythema multiforme of the oral mucosa so you can have not only lip involvement but other areas in the oral mucosa can be involved. Erythema multiforme lesions are circular and may appear in concentric rings often called target lesions. The major cause of such reoccurrence of erythema multiforme is believed to be the hsv1 infection. Part of spectrum of reactive mucocutaneous disorders with maculopapular vesiculobulbous eruptions that includes erythema multiforme em minor and major, stevensjohnson syndrome sjs, if more mucosal involvement and epidermal necrosis and toxic epidermal necrolysis ten. The rash is made of spots that are red welts, sometimes with purple or blistered areas in the center. Erythema multiforme a medical dictionary, bibliography, and annotated research guide to internet references. Erythema multiforme definition of erythema multiforme by.
The histology of erythema multiforme is characteristic but not diagnostic. Erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. Most cases involve oral mucosa only but some more widespread cases. Sep 28, 2004 erythema multiforme a medical dictionary, bibliography, and annotated research guide to internet references icon health publications on. Erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs.
It often also affects the mouth, eyes and other moist surfaces. An allergic inflammatory skin disorder which has a variety of causes and results in skin and mucous membrane lesions that affect mainly the hands, forearms, feet, mouth nose and genitals. Erythema multiforme em is an interesting dermatologic disease which has oral manifestations. Erythema multiforme a medical dictionary, bibliography, and. Recent publications challenge the concept of a continuum and propose a division of erythema multiforme minor and erythema multiforme major into separate entities with different provoking causes. Erythema multiforme is a skin condition considered to be a. Erythema multiforme pictures, symptoms, treatment, causes. There exists a subgroup of patients with recurrent em in whom frequent episodes of. Other lesions only emerge for less than 24 hours urticaria, and do not resemble the target appearance of erythema multiforme. Erythema multiforme following vaccination in an infant. Erythema multiforme em is a skin condition of unknown cause.
Treatment of erythema multiforme is a common skin disorder consisting of targetlike circular lesions. These lesions appear suddenly on the legs, arms, palms, hands, feet, and inside the mouth. Erythema multiforme em is an acute skin reaction that comes from an infection or another trigger. Stevensjohnson syndrome at one time considered to be a separate disease mucocutaneousocular disease now recognized as simply a very severe bullous form of em with widespread involvement typically including the skin, oral cavity, eyes and genitalia. This means that the body is sensitive to something that causes the skin and mucous membranes to. Characterised by target lesions that resemble a bulls eye. Erythema multiforme a medical dictionary, bibliography. Erythema multiforme has been so named because of the multiple forms it. Apr 05, 2011 erythema multiforme em is an interesting dermatologic disease which has oral manifestations. Finally, a wide variety of drugs, most commonly the sulfonamides, may cause this. Description erythema multiforme appears on the skin and the mucous membranes the lining of the mouth, digestive tract, vagina, and other organs. Erythema multiforme airuhtheemuh multehformee starts with pink or red blotches. Typically presents in a symmetrical distribution of. The histology of drug induced erythema multiforme is very similar to graftversushost disease, which is known to be mediated by t cells.
Other tests may be done looking for infections commonly seen in association with erythema multiforme, such as mycoplasma. A mild, selflimited, potentially recurring mucocutaneous inflammatory condition. Most cases of erythema multiforme resolve on their. Lesions of erythema multiforeme from seventyfive patients have been studied histologically. Erythema multiforme em is an inflammatory reaction, characterized by target or iris skin lesions. These usually erupt over 24 to 48 hours and last for 1 to 2 weeks. Target or iris lesions distributed symmetrically on the extremities and trunk characterize the condition. The type of bulla that may occur in erythema multiforme is shown here. A mild, selflimiting, potentially recurring mucocutaneous inflammatory condition. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Infections particularly herpes simplex and mycoplasma pneumonia and drugs seem to. Authoritative facts about the skin from dermnet new zealand. In half of the cases, the triggering agents appear to. Erythema multiforme a medical dictionary, bibliography, and annotated research guide to internet references icon health publications on.
Typically presents in a symmetrical distribution of lesions over the dorsal surfaces of. Erythema multiforme em is an acute, immunemediated disorder affecting the skin andor mucous membranes, including the oral cavity. Apoptotic individual keratinocytes cellular selfdestruction, earliest histological change hydropic degeneration of basal keratinocytes swollen degenerating cells at the base of the epidermis intercellular oedema spongiosis. Clinically, em is characterised by macular, papular or urticated lesions, as well as the classical target lesions distributed preferentially on the distal extremities. Erythema multiforme em is an acute, immunemediated disorder affecting the. The purpose of the present study was to examine and analyze the histopathologic features of oral erythema multiforme. Erythema multiforme pictures and diagnosis guidelines.
Erythema multiforme minor, erythema multiforme major. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme. Introduction erythema multiforme em is an acute, immunemediated condition characterized by the appearance of distinctive, targetlike lesions on the skin. Histopathologic spectrum of oral erythema multiforme. Most of the cases of erythema multiforme are related to infections. Some spots can have a small blister or scab in the middle.
Lesions spontaneously resolve but frequently recur. Oral or iv steroidsfor severe cases may be treated with there is some controversy about the effectiveness of this option hospitalizationfor widespread, lifethreatening lesions. Erythema multiforme can recur several times in a year and can persist for several years. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye.
It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name. Although there are a few case reports of erythema multiforme following vaccination in literature, the exact incidence of such cutaneous reactions has not. Erythema multiforme is an acute inflammatory reaction with characteristic patches. Feb 20, 2020 erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. These lesions are often accompanied by erosions or bullae involving the oral, genital, andor ocular mucosae picture 1af. Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm. Erythema multiforme, circular lesions hands illustration. Oct 29, 2016 erythema multiforme em is an acute, immunemediated disorder affecting the skin andor mucous membranes, including the oral cavity. Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. Definition erythema multiforme is a skin disease that causes lesions and redness around the lesions. Here we have pretty diffuse involvement of the buccal mucosa.
Erythema multiforme primary care dermatology society uk. Erythema multiforme stevens johnson syndrome, erythema multiforme major, erythema. You see ulcerative lesions, targeted lesions even in the oral cavity, and then some pseudomembrane formation. This means it usually resolves on its own without treatment. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. Erythema multiforme erythema multiforme em is an acute, self limiting, inflammatory skin eruption.
It is considered to be a hypersensitivity skin reaction triggered by a variety of stimuli, including infections and medication. It is an uncommon disorder, with peak incidence in the second and third decades of. Erythema multiforme em is a mucocutaneous disorder, which ranges from a mild, selflimited, cutaneous, exanthematous variant with minimal oral involvement to a progressive, fulminating, severe variant with extensive mucocutaneous epithelial. Oral lesions start as bullae on an erythematous base, but intact. Erythema multiforme minor em major it is predominantly a mucosal eruption of erosions and blisters in the oropharynx, on the lips, conjunctivae and genitalia accompanied by fever and prostration. Nov 14, 2011 erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Em is clinically characterized by a minor form and a major form. Erythema multiforme em is an acute, immunemediated condition, most commonly induced by. Erythema multiforme em is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus. The exact cause of this skin condition is unknown, but is often associated with viral or bacterial infections or reactions to medication. The histology of drug induced erythema multiforme is very similar to graftversushost disease, which is known to be mediated by. Mucosal lesions are common, mostly in the mouth, but also in the genital and ocular mucous membranes. Erythema multiforme multimedia encyclopedia health.
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