erythema multiforme / steven johnson syndrome / toxic epidermal necrolysis Flashcards
what causes erythema multiforme ?
herpes simplex virus
orf - parapox virus skin disease of sheep and goat
bacteria - mycoplasma , streptococcus
drugs - penicillin , sulphonamides , carbamezapine , allopurinol , NSAIDS , oral contraceotive pills
SLE
sarcoidosis
malignancy
how is erythema multiforme treated ?
self limiting disease
- spontaneously resolves in 2-4 weeks
symptomatic relief - analgesia
how to differentiate erythema multiforme for SJS?
erythema multiforme lesions are typically confined to skin with one or more mucous membranes
lesions appear as macules , papules , target lesions covering <10 percent of the body
systemic symptoms such as fever and malaise - typically mild
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SJS - severe
widespread erythema multiforme like skin lesions
several mucosal involvemneyt - oral , occula , genital
10-30 percent of BSA affected
systemic symptoms more pronounced
cause of steven johnson syndrome
almost always caused by a drug
penicillin
sulphonamides
lamotrigine ,, carbamazepine , phenytoin , allopurinol
NSAIDs
oral contraceptive pill
features of steven johnson syndrome ?
typical maculopapular lesions
- may develop into vesicles or bullae
nikolsky sign is positive in erythematous areas - when rubbing the erythematous zone listers and erosions appear
mucosal involvemnet
systemic - fever , arthralgia
mx of steven johnson syndrome ?
stop the causative agent
supportive care with cleaning and emollients and non adherent dressing
SJS is common in young what is common in old ?
TEN
how to differentiate TEN from SJS ?
TEN > 30 percent of skin involvement
what are features of TEN ?
pyrexia
tacycardia
nikolsky sign - epidermis seperates with mild lateral pressure
managmnet of TEN ?
volume loss and electrolyte derangement
Iv immunoglobulin has been shown to be effective and used first line
immunosuppressants - ciclosporin , cyclophosphamide ,
plasmapheresis
