Erythema multiforme

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Erythema multiforme
Steven Johnsons Syndrome.jpg
ICD-10 L51
DiseasesDB 4450
MedlinePlus 000851
eMedicine derm/137 

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2] Kiran Singh, M.D. [3]

Overview

Erythema multiforme is a skin condition of unknown etiology, but some authors suggest that the disease is mediated by deposition of immune complex (mostly IgM) in the superficial microvasculature of the skin and oral mucous membrane. It can occur due to drug exposure,as well in association with some types of infections. It varies from a mild, self-limited rash (E. multiforme minor) to a severe, life-threatening form (E. multiforme major, or Stevens-Johnson syndrome) that also involves mucous membranes.

Common Causes

E. multiforme may also be caused by drug reactions, most commonly sulfa drugs, Hydrochlorothiazide, phenytoin, barbiturates, penicillin, and allopurinol, Ethynodiol diacetate and ethinyl estradiol, or a host of internal ailments. The most common predisposing infection for E. multiforme is Herpes simplex, but bacterial infections (commonly Mycoplasma) and fungal diseases are also implicated.

Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Amifostine, amoxicillin, atovaquone and proguanil hydrochloride, aztreonam, butalbital, cefaclor, cefadroxil, cefotaxime sodium, ceftazidime, certolizumab pegol, choline magnesium trisalicylate, clomiphene, cytomegalovirus immune globulin, dactinomycin, etravirine, desogestrel and ethinyl Estradiol, ibritumomab tiuxetan, indinavir, isotretinoin, ixabepilone, lincomycin hydrochloride, meropenem, oxaprozin, piperacillin, piperacillin/tazobactam, sulfasalazine, rifampin, tolmetin, trimethadione, valdecoxib.
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Diagnosis

History and Symptoms

The skin form of E. multiforme, far more common than the severe form, usually presents with mildly itchy, pink-red blotches, symmetrically arranged and starting on the extremities. It often takes on the classical "target lesion" appearance, with a pink-red ring around a pale center. Resolution within 7-10 days is the norm.

Erythema multiforme target lesions

Physical Examination

Skin

Extremities
Trunk
Neck
Face

Image:Erythema multiforme24.jpg| Erythema multiforme Adapted from Dermatology Atlas.[1]</gallery>

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Laboratory Findings

Laboratory findings are non-specific and can include an elevated erythrocyte sedimentation rate (ESR), elevated white blood cell count (WBC), and elevated liver enzymes.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "Dermatology Atlas".






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