How to treat Chronic Erythema Multiforme

Erythema multiforme (EM): Causes, Symptoms, Diagnosis, Treatment and Management

Erythema multiforme (EM) is an acute, self-limiting mucocutaneous disorder characterized by a pleomorphic eruption. It is the disorder of variable severity and it is very common in aldolescents and young adults. It is an inflammatory condition with herpes simplex virus being the main precipitating factor. In EM, mucosal involvement is absent or may be limited to only one mucosal surface. It consist of lesions that are erythematous macules that become raised and develop into characteristic targeted lesions.

What are the causes of Erythema multiforme?

The most common cause of EM is hepes simplex virus(1 or 2) which usually represents a cold sore on lips or sores o the genitals. Other infectious triggers include Mycoplasma pneumonia , hemolytic Strptococcus (upper respiratory tract infection) adenovirus, coxsackievirus, Epstein-Barr virus, parovirus B19, viral hepatitis, Niesseria meningitides and borreliosis. Another trigger for EM is the adverse reactions to medications. The other main cause include drugs such as sulphunamides, allopurinol, and phenytoin.

Forms of Erythema multiforme(EM)

EM is commonly divided into major and minor forms. All forms of EM are thought to represent differ points in a spectrum of disease severity. The forms are simply divided into major and minor depending on whether there is a mucosal involvement when Stevens-Johnson syndrome is also collaborated.

Sign and Symptoms of Erythema multiforme(EM)

What are the common symptoms of Erythema multiforme?

Formation of indurated annular lesions with central clearing on the palms and soles but these ca occur at any site on the body.
Lesions appear within 7-14 days and resolve spontaneously.
Lesions at the site of prior trauma to the skin is well recognized.
In major form there is more extensive skin involvement and lesions can coalesce with development of central blisters.
Conjunctival ivolvement and mucosal involvement may leads to corneal ulceration and keratitis.
Variable degrees of a perivascular lymphohistocytic inflammatory infiltrate, dermal oedema and basal cell vacuolation with keratinocye necrosis.

Diagnosis of Erythema multiforme

Target lesions appear on the skin is the main characteristic of EM. Among the differential diagnosis to be considered are primary herpes simp0lex infection, immune-bullous disorders, and cutaneous lupus.

Bullous impetigo is recognized by positive microbacterial swab. Herpes simplex virus is an antecedent infectious trigger for the development of EM. HSV is important in differential diagnosis. If there is mucosal involvement then immunobullous disorders such as pemphigus vulgaris and pemphigoid should be considered. Immunobullous disorders can be diagnosed by histro-pathological examination. It is also diagnosed by direct immunofluorescence and the presence of circulating anti-epidermal antibodies. Lupus is excluded due to the absence of antinuclear antibodies and antibodies to the extractable nuclear antigens.

Treatment and management of Erythema multiforme

How to treat Erythema Multiforme(EM)?

Erythema multiforme(EM) is a self-limiting condition and it simply needs to be treated symptomatically. The involvement of eye should be referral to ophthalmology. If condition become more recurrent as compared to HSV, then long term prophylactic aciclovir can be used. Full supportive care should be provided to maintain haemodynamic equilibrium.

Complications in Erythema Multiforme(EM)

In EM, mortality rates are 5-10% with SIS and >30% with TEN. The death is often due to sepsis, electrolye imbalance or multisystem organ failure.