1 / 15

Erythema Multiforme

Erythema Multiforme. EM minor & EM with mucosal involvement. Self-limited, recurrent disease, usually in young adults No or only a mild prodrome (1 to 4 weeks) Sharply marginated erythematous macules  become raised, edematous papules (24 to 48 hours) Periphery: ring of erythema

kato-witt
Download Presentation

Erythema Multiforme

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Erythema Multiforme

  2. EM minor & EM with mucosal involvement • Self-limited, recurrent disease, usually in young adults • No or only a mild prodrome (1 to 4 weeks) • Sharply marginated erythematous macules  become raised, edematous papules (24 to 48 hours) • Periphery: ring of erythema Central: flatters, more pruritic and dusky

  3. Classic EM lesion • “target” or “iris” lesion with three zones • Best observed on the palms and soles • Symmetrical and acral • Central dusky purpura • Elevated, edematous, pale ring • Surrounding macular erythema

  4. Sites of Predilection • Dorsal feet • Extensor limbs • Elbows • Knees • Palms • Soles

  5. Koebner’s phenomenon or photoaccentuation • Mucosal involvement in 25% -- usually limited to the oral mucosa • More severe classic case? Two or more mucous membranes involved in 45%

  6. Steven-Johnson syndrome / EM major • Clinically different from minor • Frequently, febrile prodrome • Eruption occurs at all ages • Begins diffusely on the truck and mucous membranes • Flat, erythematous or purpuric macules  incomplete “atypical targets” (may blister centrally) • Larger and more commonly confluent lesions compared to EM minor

  7. Etiologic Factors • EM minor = herpes simplex infection • Typically orolabial • 1 to 3 weeks (10 day average) after herpes lesion • May or not follow herpes outbreaks • EM major(SJS) = medications • Most centrally accentuated eruptions with atypical targets • Sulfonamids, antibiotics, NSAIDs, allopurinol, anticonvulsants • Due to abnormal metabolism of medications

  8. Etiologic Factors • Also, EM major = Mycoplasma pneumoniae • Prominent mucosal involvement and bullous skin lesions – NOT classic iris lesions • Resemble SJS cases • And, EM major = radiation therapy • With phenytoin and tapering corticosteroids – induces EM starting at radiation port

  9. Pathogenesis • Activated T lymphocytes • Epidermis: cytotoxic or suppressor cells • Dermis: helper T cells • EM minor – specific HLA types (HLA-DQ3) • SJS – abnormalities in drug metabolism Hence, there is a genetic component for both diseases

  10. Histopathology

  11. Apoptosis of keratinocytes

  12. Spongiosis

  13. Focal vacuolar degeneration of basal keratinocytes

  14. Differential Diagnosis • Herpes simplex • Drug eruptions • Giant urticaria • Stevens-Johnson syndrome • Dermatitis herpetiformis

  15. Treatment

More Related