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What is Erythema Multiforme ?

Erythema multiforme (EM) causes profound raised skin rashes that resemble hives but develop faster and have scabs or watery blisters on the center. They are usually visible on the hands, arms, feet and legs. The rashes may also develop on the lips, face, neck and even inside the mouth. Affected individuals may also complain joint and muscle pain as well as fever. EM has been found to affect more children and young adults than any other age groups.

Treating erythema multiforme is not always necessary because it is a self-limited ailment that clears on its own. However, it may recur with certain forms of infection and medication. Mild EM resolves in several weeks, whereas severe EM needs more intensive treatment. If left untreated, severe EM may aggravate into life-threatening conditions.

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What are the causes of Erythema Multiforme?        

Scientists still do not know the root cause of EM. However, they believe that it arises when a person has hypersensitivity to some types of medications or infections.  When this appends, damage to the tiny blood vessels in the skin, and consequently to the skin tissues result.

Erythema multiforme could be triggered by the following infections:

  • Herpes labialis (oral herpes)
  • Genital herpes
  • Shingles or chickenpox
  • Mycoplasma pneumonia
  • Milkers’ nodules
  • HIV
  • Tinea
  • Adenovirus
  • Cytomegalovirus

EM could also be brought forth by certain drugs, like:

  • Penicillin
  • Sulfonamides
  • Barbiturates
  • Phenothiazines
  • NSADs
  • Anticonvulsants

It should be noted that erythema multiforme is not infectious. EM triggered by an infection is usually mild, but those cases resulting from hypersensitivity to medications have been found to cause severe form of EM and have been closely associated to Stevens-Johnson syndrome. Severe EM can result in life-threatening conditions and even death if not addressed promptly.

How many people suffer from Erythema Multiforme?

EM is a rare condition which makes up about 1% of outpatient visits to dermatologists. The same can also be said about severe EM which roughly occurs in 1 to 6 out of 1 million people every year. Studies showed that children as well as young adults, specifically in their 20s and 30s, are mostly affected by erythema multiforme. Minor EM is 2-3 times more common in men than women. However, the severe form of EM affects both genders equally. The chances of catching EM, be it minor or major, are high among individuals taking the aforementioned medications and suffering from the associated infections.

What are the symptoms of Erythema Multiforme?

A person with EM will initially notice pinkish or reddish blotchy rashes on the hands, elbows and feet. These rashes quickly develop into bulls-eye raised patches that are 1 to 3 centimeters in diameter that feel hot and itchy. Surface skin changes appear in the middle of the patches which darken and eventually crust over. The rashes may turn brownish when they are on their way to healing. This usually happens in minor forms of EM.

On the other hand, the severe form of erythema multiforme is the one that develops on the mucus membranes of the eyes, nose, mouth or genitals. The lesions that form are red and swollen with blisters. They break quickly, leaving large and irregularly-shaped painful ulcers. Sufferers should immediately go to the doctor for proper diagnosis and timely treatment of the problem.

How is Erythema Multiforme diagnosed?

The doctor can immediately diagnose erythema multiforme through its appearance. However, he or she may want to conduct a skin biopsy, Nikolsky’s sign and other diagnostic tests to determine the cause. The doctor may also want to know the medical history of the patient, including recent illnesses, symptoms suffered and medications taken.

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Most cases of EM are mild but they can recur and aggravate into serious health complications if not treated. Among the complications of recurrent and untreated erythema multiforme are:

  • Meningitis
  • Blindness
  • Renal damage
  • Myocarditis
  • Hepatitis
  • Nephritis
  • Pneumonitis
  • Cellulitis
  • Sepsis
  • Systemic infection
  • Stevens-Johnson syndrome
  • Shock

What are the available treatment options for Erythema Multiforme?

EM is a self-limited disease and disappears on its own over time. However, if it recurs, treatment is recommended to aid the patient deal with the uncomfortable symptoms that come with it. EM is treated according to its underlying cause. If a virus caused it, treatment may involve taking anti-viral medications.  Meanwhile, antibiotics are required if the causative agent is bacteria. If EM is triggered by a particular drug, the patient should stop taking the said medication. Those with the severe form of EM will require hospitalization and treated under the burn care or intensive care unit of the hospital. These patients are usually given IVIG to prevent the disease from progressing further.

EM lesions are remarkably itchy and certain steps can help deal with them, such as:

  • Taking antihistamines to reduce itchiness
  • Applying moist compress
  • Applying topical creams or corticosteroids to ease the soreness
  • Taking acetaminophen for discomfort and fever

Keep in mind that these steps will only reduce the intensity of the itchiness and relieve other symptoms and not cure the ailment itself.

Erythema Multiforme Pictures

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