erythema multiforme, nodosum, SJS, TEN

Question 1

what is erythema multiforme?

Answer 1

hypersensitivity reaction, varying severities:
erythema multiforme minor
erythema multiforme major
SJS - <10% BSA
TEN - >30% BSA

Question 2

erythema multiforme - causes

Answer 2

bacterial, fungal, parasitic + viral infections
ADR - penicillin, aspirin, allopurinol
malignancy - NHL, multiple myeloma, leukaemia

Question 3

erythema multiforme - symptoms

Answer 3

multiple erythematous plaques
concentric rings
symmetrical distribution

Question 4

SJS - symptoms

Answer 4

fever > 39
fatigue
lesions in mucous membranes
conjunctivitis

Question 5

erythema multiforme - investigations

Answer 5

FBC - low
WCC - low
eosinophils - high

LFTs - high

viral titres

urinalysis - mild proteinuria

Question 6

erythema multiforme - treatment (general, EM minor, major, SJS)

Answer 6

conservative:
remove causative agent
SCORTEN score - mortality in SJS + TEN
incise + drain large bullae

medical:
EM minor - topical steroids, oral antihistamines
EM major - IV fluids, antiseptic + analgesic mouthwash
SJS - IV fluids, antiseptic + analgesic mouthwash, ophth review, genital care + catheterisation, treatment of superadded infection

Question 7

erythema multiforme - complications

Answer 7

dehydration
electrolyte imbalance
ARDS
eye problems - conjunctivitis, corneal ulcers, symblepharon
renal failure

Question 8

erythema nodosum - what is it?

Answer 8

immune mediated disorder causing a panniculitis a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue (the fatty layer under the skin – panniculus adiposus).