The Spectrum of Erythema Multiforme

1996 ◽  
Vol 17 (2) ◽  
pp. 63-64
Author(s):  
Daniel Rauch
Keyword(s):  
Hypersensitivity Reaction ◽  
Toxic Epidermal Necrolysis ◽  
Erythema Multiforme ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Major Type ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Johnson Syndrome

Erythema multiforme (EM) is an acute hypersensitivity reaction characterized by distinctive skin lesions and mucous membrane involvement that has a spectrum of severity. It occurs in two forms: the more common "minor" type and the more severe "major" type, also called Stevens-Johnson syndrome (SJS). Sometimes EM includes toxic epidermal necrolysis (TEN) or Lyell disease. EM minor first was described completely by von Hebra in 1866; Stevens and Johnson described the major variant in 1922. EM occurs more often in males, and 20% to 50% of cases occur in the pediatric age group, although rarely in those younger than age 3 years.

scholarly journals Stevens-Johnson Syndrome

KYAMC Journal ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 31-35
Author(s):  
Arpan Kumar Basak ◽  
Joya Debnath
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Erythema Multiforme ◽  
Primary Care Physicians ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Unknown Etiology ◽  
Initial Report ◽  
Johnson Syndrome ◽  
Erythema Multiforme Major ◽  
Mucous Membranes

Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and mucous membranes. While minor presentations may occur, significant involvement of oral, nasal, eye, vaginal, urethral, gastrointestinal, and lower respiratory mucous membranes may develop in the course of the illness. GI and respiratory involvement may progress to necrosis. Stevens-Johnson syndrome is a serious systemic disorder with the potential for severe morbidity and even death. The syndrome was first described in 1922, when the American pediatricians Albert Mason Stevens and Frank Chambliss Johnson reported the cases of 2 boys aged 7 and 8 years with "an extraordinary, generalized eruption with continued fever, inflamed buccal mucosa, and severe purulent conjunctivitis". Both cases had been misdiagnosed by primary care physicians as hemorrhagic measles. Erythema multiforme (EM), originally described by Von Hebra in 1866, was part of the differential diagnosis in both cases but was excluded because of the 'character of skin lesions, the lack of subjective symptoms, the prolonged high fever, and the terminal heavy crusting". Despite the presence of leucopenia in both cases, Stevens and Johnson in their initial report suspected an infectious disease of unknown etiology as the cause. In 1950, Thomas divided EM into 2 catagories: erythema multiforme minor (Von Hebra) and Erythema multiforme major (EMM). Since 1983, erythema multiforme major and Stevens-Johnson syndrome had been considered synonymous. In the 1990s, however, Bastuji and Roujeau each proposed that Erythema multiforme major and Stevens-Johnson syndrome are 2 distinct disorders. Several investigators propose that Stevens-Johnson syndrome and Toxic epidermal necrolysis (TEN) represent the same disease at different levels of severity. Although several classification schemes have been reported, the simplest breaks the disease down as follows: * Stevens-Johnson syndrome-A "minor form of TEN", with less than 10% body surface area (BSA) detachment. * Overlapping Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN)-Detachment of 10-30% BSA. * Toxic epidermal necrolysis-Detachment of more than 30%BSA.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 31-35

Head and Neck Manifestations of Erythema Multiforme in Children

1994 ◽  
Vol 111 (3P1) ◽  
pp. 236-242 ◽  
Author(s):  
Michael G. Stewart ◽  
Newton O. Duncan ◽  
Daniel J. Franklin ◽  
Ellen M. Friedman ◽  
Marcelle Sulek
Keyword(s):  
Oral Cavity ◽  
Toxic Epidermal Necrolysis ◽  
Head And Neck ◽  
Erythema Multiforme ◽  
Medication Use ◽  
Stevens Johnson Syndrome ◽  
Striking Increase ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Mucous Membranes

Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are related disorders of skin and mucous membranes, which are typically associated with antecedent medication use or infection. We review 108 cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis from Texas Children's Hospital, Houston, Texas, from 1981 to 1991, and illustrate the characteristic skin and mucosal lesions. In addition, we describe in detail two unusual cases requiring intensive airway management. Head and neck manifestations were present in 4 of 79 patients (5%) with erythema multiforme and 26 of 28 patients (93%) with Stevens-Johnson syndrome. In Stevens-Johnson syndrome, mucosal involvement of the lip (93%), conjunctiva (82%), oral cavity (79%), and nose (36%) were most common. Antecedent medication use was identified in 59% of erythema multiforme patients and 68% of Stevens-Johnson syndrome patients. We note a striking increase in the number of cases in our series caused by cephalosporins. Fifty percent of Stevens-Johnson syndrome patients required supplemental hydration or alimentation because of the severity of the oral cavity involvement. The head and neck mucosal manifestations largely respond to local care, and the routine use of prophylactic antibiotics or systemic steroids is not recommended.

scholarly journals Erythema Multiforme Versus Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: Subtle Difference in Presentation, Major Difference in Management

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1847-e1850
Author(s):  
Russell E Newkirk ◽  
Daren A Fomin ◽  
Mary M Braden
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Erythema Multiforme ◽  
Management Strategies ◽  
Stevens Johnson Syndrome ◽  
Subtle Difference ◽  
Medical Evacuation ◽  
Johnson Syndrome ◽  
Clinical Presentations ◽  
Review Management ◽  
The Military

Abstract Erythema multiforme and Stevens–Johnson syndrome/toxic epidermal necrolysis are immune-mediated epidermal conditions with variable clinical presentations. Although their clinical presentations often overlap, they have distinct etiologies and potential outcomes, which necessitate specific management strategies. This case is presented to highlight the subtle differences and review management given that Stevens–Johnson syndrome/toxic epidermal necrolysis can rapidly become life-threatening. The need for astute diagnostic work-up and accuracy is magnified in the military setting given operations in austere environments and availability of medical and medical evacuation resources. Herein, we present a less common case of bullous erythema-multiforme, the diagnostic approach, and clinical differential with special attention to the importance of the military physician.

Sign in / Sign up

Export Citation Format

Share Document