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| Erythema multiforme Classification and external resources |
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| ICD-10 | L51. |
|---|---|
| ICD-9 | 695.1 |
| DiseasesDB | 4450 |
| MedlinePlus | 000851 |
| eMedicine | derm/137 |
| MeSH | D004892 |
Erythema multiforme is a skin condition of unknown etiology, possibly mediated by deposition of immune complex ( mostly IgM ) in the superficial microvasculature of the skin and oral mucous membrane that usually follows an antecedent infection or drug exposure. It is a common disorder, with peak incidence in the second and third decades of life.
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Presentation
The condition varies from a mild, self-limited rash (E. multiforme minor)1 to a severe, life-threatening form known as erythema multiforme major (or erythema multiforme majus) that also involves mucous membranes. This severe form may be related to Stevens-Johnson syndrome. The mild form is far more common than the severe form. Diagnosis is confirmed by biopsy.
The mild form usually presents with mildly itchy, pink-red blotches, symmetrically arranged and starting on the extremities. It often takes on the classical "target lesion" appearance,2 with a pink-red ring around a pale center. Resolution within 7-10 days is the norm.
Individuals with persistent (chronic) erythema multiforme often have a sore form at an injury site, eg. a minor scratch or abrasion, within a week. Irritation or even pressure from clothing will cause the erythema sore to continue to expand along its margins for weeks or months, long after the original sore at the center heals. One sore grew in this way for 7 months, involving 90% of the calf of the leg.
Causes
The most common predisposing infection is Herpes simplex, but bacterial infections (commonly Mycoplasma) and fungal diseases are also implicated.
Other causes include drug reactions, most commonly to sulfa drugs, phenytoin, barbiturates, penicillin, and allopurinol, or a host of internal ailments.
The human form of orf can also cause erythema multiforme.
Persistent (chronic) erythema multiforme has been linked to ingestion of benzoates in both natural and artificial forms, including benzoic acid, which occurs naturally in some fruit, and sodium benzoate, a common food preservative.
Treatment
Minimizing or excluding ingestion of benzoates, along with sugar, chocolate and alcohol eliminated symptoms in some cases. When ingestion was resumed in moderate levels, erythema multiforme sores recurred.
The appropriateness of glucocorticoid therapy can be uncertain, because it is difficult to determine if the course will be self-limiting.3
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References
- ^ erythema multiforme at Dorland's Medical Dictionary
- ^ Lamoreux MR, Sternbach MR, Hsu WT (December 2006). "Erythema multiforme". Am Fam Physician 74 (11): 1883–8. PMID 17168345. http://www.aafp.org/afp/20061201/1883.html.
- ^ Yeung AK, Goldman RD (November 2005). "Use of steroids for erythema multiforme in children". Can Fam Physician 51: 1481–3. PMID 16353829. PMC: 1479482. http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=16353829.
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Wikipedia content modification information:
- This page was last modified on 17 December 2008, at 19:06.
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