Recurrent erythema multiforme can be a devastating disease. The condition was first described in 1922 as a generalized cutaneous eruption with inflamed buccal mucosa and purulent conjunctivitis. The disorder is believed to involve damage to the blood vessels of the skin, followed by damage to skin tissues. Erythema multiforme may become noticeable with a classic skin lesion, with or without systemic (whole body) symptoms. Thirty-one patients (51.7%) were male and 29 (48.3%) were female, with a mean (±SD) age of 37.9 years (±18.1). The primary risks of this condition are skin infections, scarring of the skin, vision problems, and even death. Skin biopsy specimens showed findings suggestive of erythema multiforme.
The mortality of Stevens-Johnson syndrome is reported as 3 to 19%. The rash usually appears on the hands and forearms but may also appear on the face, legs and feet. Call 911 for all medical emergencies. The rash itches a lot and might even burn. In the largest retrospective series of TEN in the literature, the mean age was 45, although there were several cases in children. Although the full mechanism is not understood, it is in part due to a type IV hypersensitivity immune response, mediated by T lymphocytes.2,3 The most common infectious organisms in EM are herpes simplex virus types 1 and 2, as well as Mycoplasma pneumonia.1,6 Nonsteroidal anti-inflammatory drugs, antiepileptics, and antibiotics (particularly penicillins and sulfonamides) are among the most common offending medications.1,5 Genetic predisposition to developing EM has also been suggested.1 The diagnosis is typically made clinically, as there are no diagnostic laboratory tests for this process.1,3 For confirmation, a biopsy is needed. Satellite cell necrosis was also present with papillary dermal edema.
The mortality rate is 30% to 70%. It is a type of hypersensitivity (allergic) reaction that occurs in response to medications, infections, or illness. Medications associated with erythema multiforme include sulfonamides, penicillins, barbiturates, and phenytoin. We however will continue to use the above outlined classic categories since there is no widely agreed upon new grouping system. The exact cause is unknown. A mild cortisone applied directly to the irritated skin areas, colloidal baths, and wet compresses may be helpful to facilitate the clearing of the lesions. Approximately 90% of erythema multiforme cases are associated with herpes simplex or Mycoplasma infections.
These may include allergic reactions, stomach upset, and other side effects. His entire body was covered with well-defined annular erythematous patches of variable size, which were typical targetoid shape. Viral upper respiratory infections, Mycoplasma pneumonia, pharyngitis and Herpes simplex infection are also reported to cause erythema multiforme. The list of other possible etiologies is extensive, and includes systemic lupus erythematosus, histoplasmosis, pregnancy, malignancy and external-beam radiation. In most series, some cases remain idiopathic. If it looks like an infection triggered the reaction, a doctor may recommend an antibiotic medicine. It may present with a classic skin lesion with or without systemic (whole body) symptoms.
In Stevens-Johnson syndrome, the systemic symptoms are severe and the lesions are extensive, involving multiple body areas (especially the mucous membranes). The decision was made to begin intravenous immunoglobulin (IVIG) antibody in an outpatient infusion center at a dosage of 2 mg/kg over 4 hours. The diagnostic criteria for erythema multiforme (EM) is individual “target” skin lesions less than 3 cm in diameter, less than 20% of body surface area involved, with minimal mucous membrane involvement, and biopsy compatible with EM. The cutaneous lesions are typically symmetric, and involve the extremities, with the dorsal hands and extensor aspects most commonly involved. A skin lesion biopsy and microscopic examination may be helpful to differentiate erythema multiforme from other disorders. Medication usage is most commonly associated with TEN, with up to 80% of TEN cases being attributed to drug therapy. Microscopic examination of the tissue may also show antibody deposits.
Moist compresses applied to skin lesions. Medications such as antihistamines to control itching. Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort. At 1 year of follow up, there had been no recurrence or other systemic sequelae. Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis Systemic corticosteroids to control inflammation Intravenous immunoglobulins (IVIG) to stop the process Antibiotics to control secondary skin infections Good hygiene and isolation from others may be required to prevent secondary infections. Extensive skin involvement may cause the loss of large quantities of body fluids, causing shock in addition to the risk of infection. Intensive care with support of body systems may be required.
Skin grafting may be helpful in cases in which large areas of the body are affected. In cases that are caused by the herpes virus, daily antiviral medications may be prescribed to prevent recurrences of erythema multiforme. Mild forms of erythema multiforme usually resolve without difficulty in 2 to 6 weeks, but they may recur. 1. Stevens-Johnson syndrome and toxic epidermal necrolysis are associated with high death rates. Secondary skin infection (cellulitis) Systemic infection, sepsis Loss of body fluids, shock Ocular Complications – The most common and serious long-term sequelae of Stevens-Johnson and TEN are the ocular complications. The conjunctivitis damages or completely destroys the goblet cells of the conjunctiva, which results in instability of the precorneal tear film, and corneal drying and opacification.
Ocular involvement in SJS has been associated with the presence of certain class I and class 11 MHC antigens. The incidence of long-term ocular complications from Stevens-Johnson and TEN are reported at 10 to 27% of patients.