Erythema multiforme - Multiformni Eritem
☆ U rezultatima Stiftung Warentest-a za 2022. iz Njemačke, zadovoljstvo potrošača ModelDerm-om bilo je samo nešto niže nego s plaćenim telemedicinskim konsultacijama.
Erythema multiforme minor ― Imajte na umu da centri lezija mogu poblijediti.
Urtikarija se takođe može smatrati diferencijalnom dijagnozom.
References
Erythema multiforme (EM) je stanje u kojem se karakteristične mrlje nalik na mete pojavljuju i na koži i na sluznicama zbog imunoloških reakcija. Iako ih često izazivaju virusne infekcije, posebno herpes simplex virus (HSV) ili određeni lijekovi, uzrok u mnogim slučajevima ostaje nepoznat. Liječenje akutnog EM fokusira se na ublažavanje simptoma korištenjem krema koje sadrže steroide ili antihistaminike. Upravljanje ponavljajućim EM je najefikasnije kada je prilagođeno svakom pacijentu. Početni pristupi uključuju oralne i lokalne tretmane. To uključuje kortikosteroide i antivirusne lijekove. Lokalni tretmani se sastoje od jakih steroidnih krema i rastvora za zahvaćene sluzokože. Za pacijente koji ne reagiraju na antivirusne lijekove, opcije druge linije uključuju lijekove za suzbijanje imuniteta, antibiotike, anthelmintike i antimalarike.
Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials
Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials
U mnogim slučajevima, blagi erythema multiforme nestaje sam od sebe u roku od 2 do 4 sedmice. Stevens-Johnsonov sindrom, teško stanje koje pogađa sluzokože, može trajati do 6 sedmica. Steroidi se obično ne preporučuju za blage slučajeve. Neizvjesno je da li steroide treba koristiti za teški multiformni eritem, jer nema jasnih nalaza iz randomiziranih studija koji ukazuju na to koja bi djeca imala koristi od ovog liječenja.
In most cases, mild erythema multiforme is self-limited and resolves in 2 to 4 weeks. Stevens-Johnson syndrome is a serious disease that involves the mucous membranes and lasts up to 6 weeks. There is no indication for using steroids for the mild form. Use of steroids for erythema multiforme major is debatable because no randomized studies clearly indicate which children will benefit from this treatment.
In most cases, mild erythema multiforme is self-limited and resolves in 2 to 4 weeks. Stevens-Johnson syndrome is a serious disease that involves the mucous membranes and lasts up to 6 weeks. There is no indication for using steroids for the mild form. Use of steroids for erythema multiforme major is debatable because no randomized studies clearly indicate which children will benefit from this treatment.
Predstavljamo slučaj oralnog erythema multiforme (EM) uzrokovanog TMP/SMX , koji pokazuje tipične oralne i usne čireve bez kožnih lezija. Ovo naglašava potrebu da se razlikuje od drugih oralnih ulcerativnih poremećaja. Pacijent je primao simptomatsko liječenje i tablete prednizolona, što je dovelo do poboljšanja nakon prekida terapije TMP/SMX.
We report a case of oral erythema multiforme (EM) secondary to TMP/SMX that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of distinguishing them from other ulcerative disorders involving oral cavity. The patient was treated symptomatically and given tablet prednisolone. The condition improved with stoppage of TMP/SMX therapy.
We report a case of oral erythema multiforme (EM) secondary to TMP/SMX that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of distinguishing them from other ulcerative disorders involving oral cavity. The patient was treated symptomatically and given tablet prednisolone. The condition improved with stoppage of TMP/SMX therapy.
Erythema multiforme je reakcija koja uključuje kožu, a ponekad i sluznicu, koju pokreće imuni sistem. Tipično se manifestira kao lezije nalik na metu, koje mogu izgledati izolirane, ponavljati se ili perzistirati. Ove lezije obično simetrično zahvaćaju ekstremitete, posebno njihove vanjske površine. Glavni uzroci uključuju infekcije poput herpes simplex virusa i Mycoplasma pneumoniae, kao i određene lijekove, imunizacije i autoimune bolesti. Razlikovanje erythema multiforme od urtikarije se oslanja na trajanje lezija; erythema multiforme lezije ostaju fiksirane najmanje sedam dana, dok urtikarijske lezije često nestanu u roku od jednog dana. Iako sličan, ključno je razlikovati erythema multiforme od težeg Stevens-Johnsonovog sindroma, koji obično predstavlja široko rasprostranjene eritematozne ili purpurne makule s mjehurićima. Liječenje erythema multiforme uključuje ublažavanje simptoma primjenom lokalnih steroida ili antihistaminika i rješavanje osnovnog uzroka. Za rekurentne slučajeve povezane s virusom herpes simpleksa preporučuje se profilaktička antivirusna terapija. Teška zahvaćenost sluzokože može zahtijevati hospitalizaciju radi intravenske primjene tekućine i zamjene elektrolita.
Erythema multiforme is a reaction involving the skin and sometimes the mucosa, triggered by the immune system. Typically, it manifests as target-like lesions, which may appear isolated, recur, or persist. These lesions usually symmetrically affect the extremities, particularly their outer surfaces. The main causes include infections like herpes simplex virus and Mycoplasma pneumoniae, as well as certain medications, immunizations, and autoimmune diseases. Distinguishing erythema multiforme from urticaria relies on the duration of lesions; erythema multiforme lesions remain fixed for at least seven days, while urticarial lesions often vanish within a day. Although similar, it's crucial to differentiate erythema multiforme from the more severe Stevens-Johnson syndrome, which typically presents widespread erythematous or purpuric macules with blisters. Managing erythema multiforme involves symptomatic relief with topical steroids or antihistamines and addressing the underlying cause. For recurrent cases associated with herpes simplex virus, prophylactic antiviral therapy is recommended. Severe mucosal involvement may necessitate hospitalization for intravenous fluids and electrolyte replacement.
Erythema multiforme is a reaction involving the skin and sometimes the mucosa, triggered by the immune system. Typically, it manifests as target-like lesions, which may appear isolated, recur, or persist. These lesions usually symmetrically affect the extremities, particularly their outer surfaces. The main causes include infections like herpes simplex virus and Mycoplasma pneumoniae, as well as certain medications, immunizations, and autoimmune diseases. Distinguishing erythema multiforme from urticaria relies on the duration of lesions; erythema multiforme lesions remain fixed for at least seven days, while urticarial lesions often vanish within a day. Although similar, it's crucial to differentiate erythema multiforme from the more severe Stevens-Johnson syndrome, which typically presents widespread erythematous or purpuric macules with blisters. Managing erythema multiforme involves symptomatic relief with topical steroids or antihistamines and addressing the underlying cause. For recurrent cases associated with herpes simplex virus, prophylactic antiviral therapy is recommended. Severe mucosal involvement may necessitate hospitalization for intravenous fluids and electrolyte replacement.
Stanje varira od blagog, samoograničenog osipa do teškog, po život opasnog oblika poznatog kao eritema multiforme major koji također uključuje sluzokože. Invazija sluznice ili prisustvo bula su važni znaci ozbiljnosti.
- Erythema multiforme minor: tipične mete ili izdignute, edematozne papule raspoređene akralno
Blagi oblik se obično manifestira blagim svrabom (ali svrab može biti vrlo jak), ružičasto-crvenim mrljama, simetrično raspoređenim i počinje na ekstremitetima. Nestanak osipa u roku od 7-10 dana je norma kod ovog oblika bolesti.
- Erythema multiforme major: tipične mete ili izdignute, edematozne papule raspoređene akralno sa zahvaćenošću jedne ili više sluzokoža. Odvajanje epidermisa zahvata manje od 10% ukupne površine tijela.
○ Liječenje ― OTC lijekovi
Ukoliko je praćeno povišenom temperaturom (povišenom tjelesnom temperaturom), preporučuje se što prije posjetiti bolnicu.
Lijekove za koje se sumnja da treba prekinuti. (npr. antibiotici, nesteroidni protuupalni lijekovi)
Oralni antihistaminici kao što su cetirizin i loratadin za svrab.
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]