Saturday, February 4, 2017

Introduction To Erythema multiforme

Definition: Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction.
Etiology: It occurs in response to medicines, infections, or illness

  • Herpes simplex virus (HSV; frequently labialis) is strongly associated but may not be clinically apparent. Other viruses, bacteria (M pneumoniae, Chlamydia, Salmonella, Mycobacterium), and fungi (Histoplasma capsulatum, dermatophytes)
  • are also associated. 
  • Medications account for <10%; NSAIDs, sulfonamides, antiepileptics, allopurinol, and antibiotics are
  • responsible for the majority. 
  • Physical factors such as trauma, ultraviolet light exposure, and cold have been reported to elicit EM.

Clinical Features: 

Erythema Multiforme. Symmetric distribution of targetoid macules and plaques. The dusky central zone is more obvious on the left waistline lesions.

  • Erythema multiforme (EM) begins with symmetric, erythematous, sharply defined extremity or trunk macules, and evolves into a “targetoid” or “bull’s eye” morphology (a flat, dusky, central area with two concentric, erythematous rings).
  • Bullae may appear in the central dusky area (bullous EM).
  • The mucous membranes, typically oral, may become involved and raise concern for Steven Johnson Syndrome. 
  • The typical targetoid lesions allow a diagnosis to be made clinically (bullae, purpura, and mucosal involvement should prompt a dermatology consultation).
  • The rash usually persists for 1 to 4 weeks.
Erythema Multiforme. Wrist, hand, and fingers with typical central dusky centers surrounded by the concentric “bull’s eye” rings.


Classification:
The condition varies from a mild, self-limited rash to a severe, life-threatening disease.
  • Erythema multiforme minor—typical targets or raised, edematous papules distributed acrally
  • Erythema multiforme major—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)
  • SJS/TEN—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.
Management: 
  • Prevention of HSV recurrences is essential. Antivirals administered after lesions present have minimal clinical impact, but patients should be referred for future prophylaxis consideration.
  • Use of facial sunscreens and lip balms may help prevent UVB-induced recurrences. 
  • Systemic steroids are discouraged but can be considered in atypical presentations. 
  • With the distinctive clinical findings and no systemic symptoms, patients may be discharged home. Systemic symptoms and atypical presentations require admission and dermatologic consultation.
Treatment of mild symptoms may include:
  • Medicines such as antihistamines to control itching
  • Moist compresses applied to the skin
  • Oral antiviral medicine if the reaction is caused by herpes simplex
  • Pain medication recommended by your doctor to reduce fever and discomfort
  • Topical anesthetics (especially for mouth sores) to ease discomfort that interferes with eating and drinking
Treatment of severe symptoms may include:
  • Antibiotics for skin infections
  • Corticosteroids to control inflammation
  • Treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis (top layer of skin separates from the lower layers)
  • Intravenous immunoglobulins (IVIG, an injection of healthy cells from donors into a vein) to stop the disease process

2 comments:

  1. Don't You Think It's High Time You Tried Herbal Remedy?

    In 2015, I was diagnosed of genital herpes.. I was 21 years old and I had no idea what that was. When my doctor explained to me what Genital Herpes was all about and what type I had...I was freaked out! if I had missed coming to the ER any sooner, I would have possibly died without having the slightest clue of what led to my death, as i have never heard of, or experienced the virus before! The rashes grew and i have been living with it ever since then. Most of the time, I feel dirty knowing i was living with herpes. Though the doctor already encouraged me to keep using my medications even though there is no permanent cure for the virus. So i continued with my medications, which only makes the rashes to disappear, and reappear after some days. Late last year, I started surfing the web, seeking for herbal treatment as alternative. So i was on YouTube one evening,i stumbled upon a comment about Dr. Ugo and how his herbal medications cured a woman's daughter of Herpes and I decided to reach out to him. He asked me some questions which i answered, after which He prepared some herbs and sent them to me. He then guided me on how to use them. i used the herbal medications for about ,21days. The rashes gradually dried up. So i went for a test and came back home Herpes free. So My experience with this virus made me to realize, people should find out more about themselves before it's too late. So that when tested positive, they will know how to go about it before it becomes late. If you are having any sickness or virus and needs deliverance contact Dr.Ugo (for your permanent healing) He is the right person to tell your health challenges to. You can contact the doctor via his email address : ugoherbalhome@gmail.com

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  2. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
    I was so happy that day, i wanted to be there but the distance was a barrier to me. I told him how the virus had eaten me up and and a truly believe there's cure for herpes. He told me me with assurance that my case wont be different and he had been curing lots of people With his herbal medicine and most people due contact him from the States and preperd the medicine and made use of the DHL to reach him.
    Honestly speaking Dr. Akpu power his a great and gifted herbalist,His destined to herbs.
    He made me do away with the medical prescription,the acyclovir (Zovirax), famciclovir(Famvir), and valacyclovir (valtrex). you don't know him because you haven't meet this man try and contact him yourself Dr. Akpu in Africa is popularly known in his City,and you can request for his address yourself. I'm so happy now cos,I and my cousin had been confirmed negative till date..the Lord is good in my life. Dr. Akpu sent me his herbal medicine that heal me too, 🙏 🙏 Dr. Akpu for giving me another life.
    Contact Dr.akpu for all kids of sickness@
    Dr.akpupowerherbscenter@gmail.com

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