Pdf erythema multiforme em is an acute, selfhealing inflammatory. The type of erythema multiforme exudativum which i wish to present is the acute, severe, bullous, malignant type, affecting the skin and orificial mucous membranes. It is acute and selflimiting, usually resolving without complications. Experts once believed that erythema multiforme em, stevensjohnson syndrome sjs, and toxic epidermal necrolysis ten were all one disease on a spectrum of severity, with em the mildest form and ten the most severe. Cyclosporine therapy for bullous erythema multiforme. Bullous erythema multiforme is a disorder in which oral and genital erosions, ocular inflammation and cutaneous bullae may follow a viral or bacterial infection or the ingestion of certain drugs, suc.
Idiopathic labd and druginduced labd are clinically indistinguishable and can resemble bullous pemphigoid, dermatitis herpetiformis, or bullous erythema multiforme. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. In addition to peculiar intercellular epidermal oedema, subepidermal separation and a lymphohistiocytic inflammatory infiltrate in the papillary dermis, epidermal cell necrosis was observed in a variable percentage of the lesions. Labd also has been reported as a druginduced reaction. Erythema multiforme pictures, treatment, causes, symptom. In this case report, we presented a 36yearold woman with history of contact with sheep, developing a typical orf lesion that is complicated with erythema multiforme and bullous pemphigoidlike eruptions. In these diseases, fatalities may result from various causes, including secondary infection or visceral organ damage to lung, liver, or kidneys.
Em is selflimiting, usually resolving without complications, and. This material may not otherwise be downloaded, copied, printed. Usually it will disappear on its own, but sometimes treatment may be. Four cases of herpes zosterinduced bullous erythema multiforme em are reported. More recently, however efforts to link disease morphology with cause have led to reconsideration of that dogma. Bullous erythema multiforme is a disorder in which oral and genital erosions, ocular inflammation and cutaneous bullae may follow a viral or bacterial. It is an uncommon disorder, with peak incidence in the second and third decades of. Druginduced erythema multiformelike bullous pemphigoid article pdf available in acta dermato venereologica 793. Here you can read posts from all over the web from people who wrote about bullous pemphigoid and erythema multiforme, and check the relations between bullous pemphigoid and erythema multiforme.
Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening. The reported use of cyclosporine for treatment of dermatological disease is increasing in frequency, and favorable responses have been observed in the treatment of psoriasis, behcets disease, bullous pemphigoid, pemphigus vulgaris. Erythema multiformelike bullous pemphigoid actas dermo. Histologically, each shows varying degrees of dermal and epidermal inflammation and injury. Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. He did not present with any abdominal pain, blood pressure was 179 mm hg and urinary protein. Its pathogenesis is unclear, but most cases are considered to be infection related or drug related. A 9yearold boy presented with a 1day history of a palpable purpuric rash on his lower limbs 3 days after a viral illness. Its caused by generally, again, drug sensitivity or infection and its immunemediated, often about 1 to 3 weeks after the exposure. Clinical features, diagnosis, and treatment of erythema. A recent update article pdf available in biomedical and pharmacology journal 111.
Em is selflimiting, usually resolving without complications. July i96i the hlstoloaical diagnosis of dermatitis herpetiformis, bullous pemphkiotd and erythema multiforme. Labd is diagnosed with direct immunofluorescence dif, and idiopathic labd can be distinguished from druginduced labd with a careful medication history. Bullous erythema multiforme after treatment with malarone, a combination antimalarial composed of atovaquone and proguanil hydrochloride shon a remich, walter otieno, mark e polhemus, bernhards ogutu, douglas s walsh, 2008. Their roofs are relatively thick and so they tend to be tense and intact. Here you can read posts from all over the web from people who wrote about bullous pemphigoid and erythema multiforme, and check the relations. Erythema multiforme, stevensjohnson syndrome, toxic. Erythema multiforme and bullous pemphigoid have been associated with parapoxvirus infections and they are rare complications of orf disease. Histologic examinations of skin biopsy from a patient with.
By stressing the importance of acantholysis in the histology of true pemphigus, civatte 1943, 1949 and the belgian authors dupont and pierard, 1938, 1949. Download hires image download ppt paraneoplastic pemphigus is a rare subtype of pemphigus characterised by polymorphous mucocutaneous lesions, mimicking pemphigus vulgaris, bullous pemphigoid, and erythema multiforme. Erythema multiformelike bp is a rare variant, with only 8 cases reported in the literature, 49 including 5 women and 3 men aged between 16 and 80 years. Dec 01, 2006 erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages. A case of orf disease complicated with erythema multiforme. Cf jrdermatitis herpetiformis, erythema multiforme and bullous pemphigoid. Histopathological spectrum of erythema multiforme bedi. It is estimated that 2040% of cases of erythema multiforme are secondary to herpes simplex virus infection. Dermatitis herpetiformis, erythema multiforme and bullous.
In erythema multiforme of the multilocular type, the basement membrane was attached to the epidermis figs. Erythema multiforme introduction and epidemiology erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the use of medications, such as phenytoin, sulfonamides, penicillins, and barbiturates. Bp is an autoimmune process that can be induced, though rarely, by medications. Target lesions vesiculobullous disorder download this article as.
Druginduced linear immunoglobulin a bullous dermatosis. Erythema multiforme majus em is an acute eruptive syndrome, rare in children, and almost nonexistent in infants. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome 3. These bullous lesions resolved in 2 weeks, but an inflammatory hyperpigmentation of the skin remained by 6 weeks postexposure. The mucosal lesions in rings, associated with bullous and postbullous lesions precede the cutaneous involvement, coinsized annular erythemas with central dusky red areas. Erythema multiforme mainly affects adults under 40. Cyclosporine therapy for bullous erythema multiforme jama. Keywords erythema multiforme major, minor, recurrent, persistent immunemediated hypersensitivity reaction mucocutaneous syndrome herpes simplex virus mycoplasma pneumoniae stevensjohnson syndrome toxic epidermal necrolysis acral distribution polymorphous rash mucosal involvement target lesion targetoid lesion irislike lesion mucosal erosion bullous lesion negative nikolskys sign.
Erythema multiforme em has been divided into a minor simplex form and a major bullous form. Erythema multiforme em is an acute, selflimited cutaneous or mucocutaneous. Erythema multiforme, especially em major and sjs can occur after. In herpes simplex virus hsvassociated em, the findings are thought to result from cellmediated immune reaction against viral antigenpositive cells that contain the hsv dna polymerase gene pol. Cicatricial pemphigoid and erythema multiforme sciencedirect. We report on a kenyan woman who developed bullous erythema multiforme, in association with malarone treatment. Diagnosis, classification, and management of erythema. Methods a retrospective analysis of 77 paediatric cases of em or sjs admitted to the. Three patients presented with widespread skin lesions 10 to 14 days after an episode of thoracic herpes zoster. Em primarily affects apparently healthy young adults. Bullous dermatitis occurred in 50% of subjects as a delayed reaction. Summary erythema multiforme majus em is an acute eruptive syndrome, rare in children, and almost nonexistent in infants. In these patients a high increase in varicellazoster virus vzv antibody titer was detected, indicating secondary vzv infection.
We present a series of cases managed by one group of physicians. Subepidermal blisters occur between the dermis and the epidermis. Druginduced bp often has atypical clinical presentation, which requires. Bullous pemphigoid epidermolysis bullosa dermal papilla erythema multiforme dermatitis herpetiformis these keywords were added by machine and not by the authors. Background in adults, erythema multiforme em is thought to be mainly related to herpes infection and stevensjohnson syndrome sjs to drug reactions.
Amlodipineassociated bullous pemphigoid with erythema multiforme like clinical features. Both hsv 1 and hsv 2 trigger the erythema multiforme lesions. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome. It can be disabling when associated with severe mucosal involvement. This process is experimental and the keywords may be updated as the learning algorithm improves. In stevensjohnson syndrome, patients develop severe bullous form of erythema multiforme with widespread mucous membrane involvement and skin involvement and it can be life threatening. Linear immunoglobulin a iga bullous dermatosis labd is a rare autoimmune disorder characterized by vesiculobullous mucocutaneous eruptions. Drugs adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1% 14. Vzv antigen was not detected in the bullous fluid by elisa technique. The minor form is additionally subdivided into papular and vesiculobullous variants, and all three have been considered a continuum of the same process.
Bullous dermatitis an overview sciencedirect topics. It has a favorable prognosis, but with a significant risk of recurrence. By stressing the importance of acantholysis in the histology of true pemphigus, civatte 1943, 1949 and the. Bullous erythema multiforme after treatment with malarone, a.
Nonbullous erythema multiforme in hospitalized children. This type of erythema multiform is characterized by bullous lesion formation. Pierard dermatological department, state university, ghent, belgium. Clinically, em is characterised by macular, papular or urticated lesions, as well as the classical target lesions distributed preferentially on the distal extremities. Erythema multiforme primary care dermatology society uk. Erythema multiforme em is an acute, immunemediated mucocutaneous condition that characteristically presents with acrally distributed targetoid lesions. Generalized erythema multiforme and remnants of herpes zoster at the lower, right part of the back. Diagnosis and particularly the management of erythema multiforme and stevensjohnson syndrome are controversial in medical textbooks and thus in individual cases. Erythema multiforme em is a hypersensitivity reaction which tends to develop suddenly. I suggest the title erythema bullosum malignans for this disease because all of the symptoms of the mild type of erythema multiforme are greatly intensified and the prognosis is grave.
Erythema multiforme and stevensjohnson syndrome chest. Cicatricial pemphigoid cp and erythema multiforme em are bullous diseases that involve the skin and mucous membranes including the conjunctiva. Minor erythema multiforme case report medcrave online. Keller n1, gilad o1, marom d1, marcus n1, garty bz1. Get your full text copy in pdf american journal of case. One week later, he developed arthralgia in his lower limbs, facial oedema and progression of the rash to his buttocks and lower arms.
A polymorphous bullous dermatosis the lancet oncology. Suspected triggering factors include orf virus infection, furosemide, citalopram, thioridazine, flupentixol, amoxicillin, and. Erythema multiforme is a skin condition considered to be a. Erythema multiforme is a rare autoimmune mucocutaneous disorder that is acute in onset, recurrent in nature and is usually selflimiting. It presents with a skin eruption characterised by a typical target lesion. Nonbullous erythema multiforme nbem is an acute, immunemediated, selflimiting skin disease with distinctive target lesions. Bullous erythema multiforme jama dermatology jama network. Clinically, em is characterised by macular, papular or urticated lesions, as well as the classical target lesions distributed preferentially on the distal extremeties. Vesicles and bullae are accumulations of fluid within or under the epidermis. Differences in individual sensitivities are due to skin pigmentation, complexion, and susceptibility to sunburns hellreich et al. Erythema multiforme british association of dermatologists. Bullous erythema multiforme following herpes zoster and. Pdf druginduced erythema multiformelike bullous pemphigoid. Bullous erythema multiforme following topical diphenylcyclopropenone application ci.
Nonbullous erythema multiforme in hospitalized children pediatric dermatology. A bullous lesion is a type of a large lesion that contains fluid. Drugs induced bullous erythema multiforme request pdf. Methods a retrospective analysis of 77 paediatric cases of em or sjs admitted to the childrens hospital in bordeaux between. Erythema multiforme em is a skin condition of unknown cause. Aug 17, 2012 erythema multiforme em is an uncommon, immunemediated disorder that presents with cutaneous or mucosal lesions or both. Suspected triggering factors include orf virus infection, furosemide, citalopram, thioridazine, flupentixol, amoxicillin, and penicillin. The incidence of em has been estimated to be between 0. Immunosuppressive therapy with cyclosporine introduced in the 1970s dramatically improved the survival of kidney, liver, and heart transplants. In bullous erythema multiform, the rash may initially appear small and flat. Amlodipineassociated bullous pemphigoid with erythema. Herpes associated erythema multiformea diagnostic dilemma. Keywords erythema multiforme major, minor, recurrent, persistent immunemediated hypersensitivity reaction mucocutaneous syndrome herpes simplex virus mycoplasma pneumoniae stevensjohnson syndrome toxic epidermal necrolysis acral distribution polymorphous rash mucosal involvement target lesion targetoid lesion irislike lesion. Amlodipineassociated bullous pemphigoid with erythema multiformelike clinical features.
Erythema multiforme em is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Dermatitis herpetiformis, erythema multiforme and bullous pemphigoid 293 herpetiformis and bullous pemphigoid figs. Erythema multiforme majus caused by a double infection. The clinical presentation began initially with typical bullous erythema multiforme. This progressed to the picture of toxic epidermal necrolysis.
449 422 641 1572 688 1050 1325 479 406 1220 1392 878 961 888 688 973 765 307 727 672 686 1189 1014 1217 47 1063 106 861 422 670 101 193 181 1483 1380 121 805 1127 1435