VESICOLOBULLOU LESIONS (IMMUNOLOGIC DISEASES - ERYTHEMA MULTIFORME - EM)

Question 1

CONCEPT

Answer 1

• ACUTE OR SUBACUTE INFLAMMATORY DISEASE
• POSITIVE NIKOLSKY SIGN MAY BE FOUND

Question 2

TARGET

Answer 2

YOUNG ADULTS

Question 3

FORMS

Answer 3

1) EM MINOR
2) CHROMIC EM MINOR
3) EM MAJOR (STEVENS-JOHNSON SYNDROME)

Question 4

EM MINOR

Answer 4

• ASSOCIATED WITH VIRAL DISEASES (HERPES SIMPLEX)
• PRODROMAL SIGNS (LOW GRADE FEVER, MALAISE, HEADACHES BEFORE LESION APPEAR SKIN)
• PRIMARILY AFFECTS SKIN (75%): ERYTHEMATOUS, FLAT, ROUND PAPULES OR PLAQUES - TAGET LESIONS (IRIS LESIONS, BULL’S EYE)
• ORAL LESIONS: COALESCENCE OF SMALL VESICLES (RUPTURE FEW DAYS LATER INTO A PAINFUL EROSION WITH A PSEUDOMEMBRANE
• HEMORRHAGIC CRUSTING VERMILION ZONE LIPS

Question 5

CHRONIC EM MINOR

Answer 5

• MILDEST FORM OF THE DISEASE
• LESIONS: SMALL (SIZE)/SHORT DURATION)
• INDIVIDUAL LESIONS: DISAPPEAR RATHER THAN DEVELOPING INTO LARGE “TARGET” LESIONS

Question 6

EM MAJOR (STEVENS-JOHNSON SYNDROME

Answer 6

• SEVERE FORM OF EM (MUCOUS MEMBRANE)
• USUALLY TRIGGERED BY A DRUG (SULPHONAMIDES)
• ORAL LESIONS: MAINLY ON NON-KERATINIZED MUCOSA, ALWAYS PRESENT, EXTENSIVE VESICLE FORMATION (PAINFUL ULCERS COVERED WITH PSEUDOMEMBRANES)
• SKIN TOO

Question 7

TIME

Answer 7

GENERALLY SELF-LIMITING (USUALLY LASTING 2-6 WEEKS), EXCEPT IN SOME CHRONIC FORMS

Question 8

TREATMENT

Answer 8

• IF TRIGGERED BY HERPES SIMPLEX: CONTINUOUS ORAL ACYCLOVIR OR VALACYCLOVIR THERAPY (PREVENT RECURRENCES)
• DRUGS CAUSE IDENTIFIED: DISCONTINUED IMMEDIATELY
• MILD CASES: SYMPTOMATIC, ANTIHISTAMINES, ANALGESICS, ANTIPYRETICS COMBINED WITH ORAL RINSES OF ANTIHISTAMINE
• TOPICAL/SYSTEMIC CORTICOSTEROIDS: VALID BUT CONTROVERSIAL