About erythema multiforme exudativum

What is erythema multiforme exudativum?

Until recently the relationship of Stevens-Johnson syndrome to other severe blistering disorders was a matter of some debate. Now a consensus seems to be evolving that describes SJS as a rare disorder involving lesions of the mucous membranes along with small blisters on the reddish or purplish, flat, thickened patches of skin. As a result, SJS is now distinguished as a separate disorder from erythema multiforme major (EMM). SJS is now considered to be a less severe variant of toxic epidermal necrolysis (TEN).

SJS and TEN appear to be characterized by identical clinical signs and symptoms, identical treatment approach and identical prognosis. Patients diagnosed with TEN can present with symptoms ranging from 10% skin involvement and severe threat to the patient's sight to a presentation involving 90% of the skin but only a modest threat to the patient's sight.

SJS (and TEN) is an inflammatory disorder of the skin triggered by an allergic reaction to certain drugs including antibiotics, such as some sulfonamides, tetracycline, amoxicillin, and ampicillin. In some cases, nonsteroidal anti-inflammatory medications and anticonvulsants, such as Tegretol and phenobarbital have also been implicated. Over-the-counter medications may act as triggers as well. In some cases, it is also possible that the disorder may be traced to a reaction to an infection.

One report suggests that the term SJS be limited to cases in which less than 10% of the total body surface area is involved. The authors suggest that the term TEN be limited to cases in which 30% or more of the total body surface area is involved. The term SJS/TEN Overlap is used to describe patients in whom between 10-30% of the total body surface area involved.

What are the symptoms for erythema multiforme exudativum?

Soles of feet and face symptom was found in the erythema multiforme exudativum condition

Onset of erythema multiforme is usually sudden in an otherwise healthy individual. Red spots (macules or papules), or ridges (wheals), and sometimes Blisters appear on the tops of the hands and forearms. Other areas of involvement may include the face, neck, palms, soles of feet, legs, and trunk. The Lesions continue to erupt for two or three days. Some spots, especially on the hands and forearms, may evolve into concentric circles that resemble a target, with a grayish discoloration in the center. A crust may develop over the center. In about half of the cases, Lesions may develop on the lips and the mucous membranes in the mouth. The skin Lesions are usually distributed on both sides of the body. Itching can also occur.

Systemic symptoms vary, but malaise, Pain in the joints (arthralgia), muscular stiffness and Fever are frequent. Additional symptoms may include vision abnormalities; dry or bloodshot eyes; and eye pain, itching, or burning.

Attacks usually last two to four weeks, and may recur. Classic EM tends to recur two or three times a year for several years after its first appearance.

What are the causes for erythema multiforme exudativum?

The cause of erythema multiforme is unknown, but it appears to be an allergic reaction that occurs in response to medications, infections, or illness. As noted above, it often appears in association with herpes simplex virus or with infectious organisms such as Mycoplasma pneumoniae.

In approximately half of the cases, it appears that the triggering agent is a medication. Drugs that have been associated with erythema multiforme include anticonvulsants, sulfonamides, nonsteroidal anti-inflammatory drugs, and other antibiotics.

What are the treatments for erythema multiforme exudativum?

When a cause for erythema multiforme can be found, it should be treated, eliminated, or avoided (e.g. drugs or other substances to which the patient is allergic). Local treatment depends on the type of lesion.

Most people with classic erythema multiforme can be treated as outpatients with therapy, such as antihistamines, addressing their symptoms. Sometimes, no treatment is required.

For blisters and erosive lesions, intermittent moist compresses may be helpful. Over-the-counter antihistamines usually take care of whatever itching may be present. Infections of the lips and mouth usually can be managed with topical anesthetics but may, in some cases, require special care.

What are the risk factors for erythema multiforme exudativum?

Erythema Multiforme Exudativum is a form of reoccurring skin condition usually mild and happens due to viral infection or medicinal reaction.

Though this is a curable disease scars are not the thing to worry about. It heals without leaving marks and with no further problems. But the risk of EME coming back is there as follows:

  • If the disease is from the virus Herpes Simplex.
  • Antiviral Medicine can prevent coming back

Possible complications if the disease goes severe are:

  • Permanent skin damage
  • Skin infection
  • Inflammation of internal organs (liver or lungs)
  • Permanent eye damage

Risk factors:
Mostly caused by viral infections, EME can spread for various reasons. Following are a few of them:

  • It can be due to the reaction of any medicine to some other disease.
  • The infection of cold sore virus (Herpes Simplex Virus).
  • The virus remains in the body but stays inactive. Due to some cases, it becomes reactive from time to time.
  • Rashes are visible after a few days of a cold sore in the case of some patients.
  • The disorder can also be triggered by mycoplasma bacteria. It is a bacteria that causes chest infections.
  • Most of the symptoms are visible, which helps in diagnosing and starting treatment as soon as possible.

Fever,Fatigue,Red patches and blisters on palms of hands, soles of feet and face
Itching,Round flat reds,Cold Sores,Joint pains
Antibiotics,NSAIDs,Ibuprofen, nticonvulsants,Sulfonamides,Tetracyclines,Amoxicillin and Ampicillin,Antihistamines,Steroid Creams,Emollients

Is there a cure/medications for erythema multiforme exudativum?

A typical skin condition with atypical signs and the spots like target or “bulls-eye” with a dark red center is Erythema Multiforme Exudativum. These rashes are itchy and uncomfortable but heal in two to three weeks if they are mild. But if the disease is severe, it needs effective medical care and attention as soon as possible.

The treatment in EME is provided to reduce the severe infection and stop the cause from affecting other organs. They are as follows:

  • Soft liquid diet if the mouth is affected with ulcers and drip in case nothing is possible to intake orally.
  • Steroid tabs for controlling swellings.
  • Dressings of wounds to stop sores from becoming infected.
  • Eye drops or ointment if the eyes are affected.
  • Antibiotics for curing bacterial infections.
  • Stopping other medicines which are responsible for triggering the infection.

Few measures are possible with the admission in hospital under a doctor’s care:

  • Antiviral tabs for viral infection
  • Creams and ointments to dry the wounds soon for fast recovery.
  • Mouthwash has anesthetic properties to control pain from intaking food or saliva.
  • Moisturizers for reducing itching or the itch goes stronger and uncontrollable. The action of itching increases the infection and leaves marks and scars post-healing.
  • Strong painkillers for rest and relief.
  • Intravenous methods or drips are used for prescribed medicines for fast recovery.

The caution to be mentioned in the case of EME is that no medicine or ointments without a doctor’s prescription or else it can deduce the condition.

Fever,Fatigue,Red patches and blisters on palms of hands, soles of feet and face
Itching,Round flat reds,Cold Sores,Joint pains
Antibiotics,NSAIDs,Ibuprofen, nticonvulsants,Sulfonamides,Tetracyclines,Amoxicillin and Ampicillin,Antihistamines,Steroid Creams,Emollients

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