Transcript Dermatology Case 2:

Erythema Multiforme
 an acute, self-limiting, inflammatory skin eruption.
 Most common cause is Herpes Simplex
 Occurs in response to medications, infections
 Medications include:
 Barbiturates
 Penicillins
 Phenytoin
 Sulfonamides
 Infections include:
 Herpes simplex
 Mycoplasma
 Erythema
Multiforme
Data
EG 43 y/o F
Begin as sharply marginated,
 erythematous ill-defined
 (brief
description
of pathology)
erythematous
macules, which
become
asymptomatic patches
raised, edematous papules over 24 to
 (epidemiology,
incidence, etc.) (upper extremities, with
48 hours
tingling sensation,
“target” or “iris” lesion with 3 zones –
numbness of the hands)
central dusky purpura; an elevated,
into multiple
edematous, pale ring; and surrounding
erythematous to skinmacular erythema
colored plaques and
nodules 1.5x 3.5 to 2.0 x
 Age of Predilection
4.0 cm (malar area, helix
Young adults
of ears, upper extremities,
thighs)
 Site of predilection
 (+) leonine facies
dorsal hands, dorsal feet, extensor
limbs, elbows and knees, and
 (-) madarosis

Lesion
 Patient’s
palms and soles

There are two types of EM:
 EM minor and EM major.
 EM minor comprises nearly 70% of the cases.
 Most cases of EM minor resolve in one to three
weeks
 EM major might take three to six weeks to resolve.
 Recurrences are more commonly seen in EM minor,
but are rare in EM major.
 Traditionally, Stevens- Johnson syndrome (SJS) and
toxic epidermal necrolysis (TEN) were included in
the same spectrum as EM.
EM MINOR
 Most patients with EM minor present with new-
onset mucocutaneous lesions which are usually
symmetrical and rapidly progressing in nature.
 These lesions may be pruritic or may be associated
with a burning sensation.
EM MAJOR
 EM major is usually preceded by prodromal
symptoms such as fatigue, fever, headaches, and
myalgias.
 These symptoms can appear up to two weeks prior to
the mucocutaneous manifestations.
 Oral mucosal involvement may lead to difficulty in
drinking and eating.
 Ocular involvement may lead to complaints of
redness, discharge and ocular pain.
Treatment
 Prevention is cornerstone of treatment if HSV can be
demonstrated as the trigger.
 Antiherpetic antibiotic