Date post: | 22-May-2015 |
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Health & Medicine |
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ERYTHEMA MULTIFORME
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INTRODUCTION
Erythema – Redness ; Multiforme – Polymorphic
First Classified by Bastuji – Garin et al to separate from SJS / TEN in 1922
described by Hebra in 1866 as Erythema exudativum Multiforme
DEFINITION
Acute, Recurrent, self-limiting Cutaneous and/or Mucocutaneous eruptions characterised by target –shaped plaques commonly over extremities and face.
Assoc with HSV / Mycoplasma pneumonia infections
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EPIDEMIOLOGY
Male : Female = 3:2
Occurs in the young / adoloscents
Recurrent in 30 %
Familial clustering s/o Infective Etiology
Assoc with HLA – DQB1 * 0301 Allele
AETIOLOGY
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CLASSIFICATION
EM Minor : Cutaneous without Mucous inv
EM Major (EMM) : Cutaneous + Mucous inv
Mucosal EM : Fuch’s Ectodermosis Pluriorificialis
HAEM
MPAEM
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CLINICAL FEATURES
Prodromal Features
Prev Attack (30%)
Preceding Infection
Fever (T>103.1 deg C)
Cutaneous Lesions
Mucous Lesions
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CUTANEOUS LESIONS
Symmetrical, Acral, Centripetal Rash
Extensor aspect : Extremities > Face > Neck > Trunk
Predilection to Sun-Exposed Areas / Koebnerization
Well-defined, circular, blanching papule / plaque that persists for 01 week – Self-limiting in 04 weeks – Persistent / Continuous EM
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CUTANEOUS LESIONS
Typical Target Lesion :-
1. Dusky Central Disk / Bulla
(later Violaceous / Purpuric)
2. Infiltrated Pale Ring
3. Erythematous edematous halo
Larger lesions show Central
Bulla and Marginal ring of vesicles -
- Herpes Iris of Bateman
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TARGET LESIONS
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CUTANEOUS LESIONS
Raised Atypical Target lesions / Targetoid lesions
SJS-TEN lesions – mostly Macular
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MUCOSAL LESIONS
70% Cases
Lips – Cutaneous
Target Lesions
Serous Crusting
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MUCOSAL LESIONS
LIPS – Mucosal (Erosions / Vesicles / Bullae)GINGIVAL / Ventral TongueHard Palate – SparedPharynx / Larynx / Trachea / BronchiConjunctivitis B/L with Vesicles / ErosionsNasal / Urethral / Anal Mucosae
2/3 Mucosal Sites sans Cutaneous inv
– FUCH’s SYNDROME
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aa
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DDx
ss
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TREATMENT
Treating underlying Etiology
Reducing morbidity – Oral CS
Anti-Virals ?
Macrolides / Quinolones for MPAEM
Oral EM – Topical CS / Anesthetics / Antacids
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RECURRENT EM
Anti-Virals
Topical Acyclovir ?
Azathioprine
Thalidomide
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THANK YOU