Erythema Multiforme and Stevens Johnson Syndrome

August 14 20:16 2019 Print This Article

Stevens-Johnson syndrome also called erythema multiforme major is a rare, serious disorder of the skin and mucous membranes. There is agreement in the medical literature that Stevens-Johnson syndrome can be considered milder form of toxic epidermal necrolysis. However, there is debate whether it falls on a spectrum of disease that includes erythema multiforme many consider erythema multiforme to be unrelated to SJS and TEN. Some classify SJS as a severe expression of erythema multiforme, and it occasionally referred to as erythema multiforme major.

Erythema multiforme mostly affects young adults but may occur in children or older people. It causes a characteristic rash and often blisters in the mouth and elsewhere. It is sometimes called erythema multiforme minor to distinguish it from a related but more serious condition, Stevens Johnson syndrome, which is sometimes known as erythema multiforme major.

The patient with erythema multiforme may be mildly unwell, but recovers in a few days or up to three weeks. The rash may recur from time to time. Most cases are caused by a reaction to infection with the herpes simplex virus. This viral infection is apparent as visible cold sores in about two thirds of people before the erythema multiforme appears. Doctors are not sure whether other infectious diseases cause a few cases of erythema multiforme. Doctors are unsure exactly how herpes simplex causes this disorder, but a type of immune reaction is suspected.

Erythema multiforme is an acute, self-limiting, inflammatory skin eruption. It has been so named because of macules, papules, or subdermal vesicles presenting a multiform appearance. It is associated with many infections, collagen disease, drug sensitivities, allergies, and pregnancy. A severe form of this condition is Stevens-Johnson Syndrome. This condition can be associated with fever, muscle aches, and not feeling well. It often also affects the mouth, eyes and other moist surfaces.

Erythema multiforme has been so named because of the “multiple forms” it appears in; there is a large degree of variety in its clinical presentation. This variation has led to EM being divided into two overlapping subgroups (EM minor and Stevens-Johnson syndrome). These are different faces of the same disease. EM is relatively common problem for a dermatologist. Half the cases are in young people (under 20). It rare both under the age of 3 and over the age of 50. Erythema multiforme often starts as a red rash on the palms, soles, and back of the hands. It can spread to the trunk, face, and mouth in severe cases. As the skin lesions age they often look like small targets with purple to dusky centers surrounded by red rings. The disease is due to a hypersensitive reaction to one of a number of immunologic stimuli including drugs and infectious agents.

Causes of Erythema Multiforme and Stevens Johnson Syndrome

Find common causes and risk factors of Erythema Multiforme and Stevens Johnson Syndrome:

  • The most common causes of erythema multiforme are Mycoplasma pneumonia, cold sores, herpes of the genitals, and as a reaction to medication (sulfa drugs).
  • It is mainly induced by allergic reactions to drugs, such as valdecoxib, penicillins, barbiturate, sulfas, phenytoin, lamotrigine and evirapine.
  • The erythema multiforme, may be caused by some viral infections such as herpes simplex virus, influenza, mumps, cat-scratch fever,
  • The damage to the blood vessels of the skin with subsequent damage to skin tissues, cause erythema multiforme.
  • Certain bacterial infections, are also responsible in the formation of erythema multiforme.
  • Some people have recurrent episodes of erythema multiforme, usually due to cold sores or herpes infection.

Signs and Symptoms of Erythema Multiforme and Stevens Johnson Syndrome

Sign and symptoms may include the following:

  • Fever.
  • Joint aches.
  • A red or purple skin rash that spreads.
  • Sore throat.
  • Itching of the skin may be present.
  • Cough.
  • Burning eyes.
  • Hives.

Treatment for Erythema Multiforme and Stevens Johnson Syndrome

Treatment may include:

  • Cool compresses, are very helpful in the treatment of EM. Apply it tot he skin lesions.
  • Oral antihistamines.
  • An oral steroids, such as prednisone, also is still useful in some cases.
  • If painful mouth blisters make eating difficult, a topical anesthetic, such as lidocaine Some Trade Names XYLOCAINE may be applied.
  • Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort.
  • Certain antibiotics, may be suitable to get recover from erythema multiforme.
  • If itching is bothersome, standard treatments may be used. Corticosteroids given by mouth may be helpful.