erythema multiforme

Question 1

what drugs may cause erythema multiforme? (3)

Answer 1

barbiturates
sulphonamides
tetracycline

Question 1

describe erythema multiforme (definition, demographic, cause)

Answer 1

• hypersensitivity (subepidermal immune deposits and in vasculature)
• young adult males (20-40yo)
• mainly viral (HSV cause), sometimes drugs and 50% idiopathic

Question 2

signs and symptoms of erythema multiforme (5)

Answer 2

• spontaneous 2-3 week episodes with complete remission
• vesicular/bullous eruptions, macules and papules
• target lesions (central erythema/blister with outer red rings)
• shallow ulcers - lips, fom, tongue
• bleeding crusted lips

Question 3

common sites for erythema multiforme oral lesions (3)

Answer 3

lips
fom
tongue

Question 4

types of erythema multiforme (4)

Answer 4

• EM minor = skin <10% SA
• EM major = skin and mucosa
• SJS (Steven Johnson syndrome)
• TEN (toxic epidermal necrolysis)

Question 5

describe the most severe forms of erythema multiforme (reaction, cause, types)

Answer 5

often a drug-induced allergy (carbamazepine, NSAID, sulphonamide)
Steven-Johnson syndrome = widespread involvement
toxic epidermal necrolysis = up to 50% skin, fluid loss, secondary infections

Question 6

erythema multiforme management (3)

Answer 6

• supportive treatment (self-limiting) = antihistamines, moisturisers, soothing MW, +/-topical steroids
• treat any viral infection = antivirals
• SJS/TEN = ICU/burns unit with supportive oral care