Erythema multiforme by aseem

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Erythema multiforme by aseem

  1. 1. 1 ERYTHEMA MULTIFORME 12/29/2013
  2. 2. INTRODUCTION 2  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 12/29/2013
  3. 3. DEFINITION 3  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 12/29/2013
  4. 4. EPIDEMIOLOGY 4  Male : Female = 3:2  Occurs in the young / adoloscents  Recurrent in 30 %  Familial clustering s/o Infective Etiology  Assoc with HLA – DQB1 * 0301 Allele 12/29/2013
  5. 5. AETIOLOGY 5 12/29/2013
  6. 6. CLASSIFICATION 6  EM Minor : Cutaneous without Mucous inv  EM Major (EMM) : Cutaneous + Mucous inv  Mucosal EM : Fuch’s Ectodermosis Pluriorificialis  HAEM  MPAEM 12/29/2013
  7. 7. CLINICAL FEATURES 7 Prodromal Features Prev Attack (30%) Preceding Infection Fever (T>103.1 deg C) Cutaneous Lesions Mucous Lesions 12/29/2013
  8. 8. CUTANEOUS LESIONS 8  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 12/29/2013
  9. 9. CUTANEOUS LESIONS 9  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 12/29/2013
  10. 10. TARGET LESIONS 10 12/29/2013
  11. 11. CUTANEOUS LESIONS 11  Raised Atypical Target lesions / Targetoid lesions  SJS-TEN lesions – mostly Macular 12/29/2013
  12. 12. MUCOSAL LESIONS 12  70% Cases  Lips – Cutaneous Target Lesions Serous Crusting 12/29/2013
  13. 13. MUCOSAL LESIONS 13  LIPS – Mucosal (Erosions / Vesicles / Bullae)  GINGIVAL / Ventral Tongue  Hard Palate – Spared  Pharynx / Larynx / Trachea / Bronchi  Conjunctivitis B/L with Vesicles / Erosions  Nasal / Urethral / Anal Mucosae  2/3 Mucosal Sites sans Cutaneous inv – FUCH’s SYNDROME 12/29/2013
  14. 14. 14 12/29/2013
  15. 15. 15  aa 12/29/2013
  16. 16. DDx 16 ss 12/29/2013
  17. 17. 17 12/29/2013
  18. 18. TREATMENT 18  Treating underlying Etiology  Reducing morbidity – Oral CS  Anti-Virals ?  Macrolides / Quinolones for MPAEM  Oral EM – Topical CS / Anesthetics / Antacids 12/29/2013
  19. 19. RECURRENT EM 19  Anti-Virals  Topical Acyclovir ?  Azathioprine  Thalidomide 12/29/2013
  20. 20. 20 THANK YOU 12/29/2013

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