Erythema multiforme
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Erythema multiforme minor ― Bemærk, at centrene af læsionerne kan blanchere.
Nældefeber kan også betragtes som en differentialdiagnose.
relevance score : -100.0%
ReferencesErythema multiforme (EM) er en tilstand, hvor markante mållignende pletter opstår på både hud og slimhinder som følge af immunreaktioner. Selvom den ofte udløses af virale infektioner, især herpes simplex virus (HSV), eller af visse medikamenter, er årsagen ukendt i mange tilfælde. Behandling af akut EM fokuserer på at lindre symptomer med cremer, der indeholder kortikosteroider eller antihistaminer. Håndtering af tilbagevendende EM er mest effektiv, når den tilpasses den enkelte patient. Indledende tilgange omfatter både orale og topiske behandlinger, herunder kortikosteroider og antivirale lægemidler. Topiske behandlinger består af stærke steroidcremer og opløsninger til de berørte slimhinder. For patienter, der ikke responderer på antivirale lægemidler, kan andenlinjemuligheder omfatte immunundertrykkende lægemidler, antibiotika, anthelmintika og antimalariamidler.
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
I mange tilfælde går mild erythema multiforme over af sig selv inden for 2–4 uger. Stevens-Johnsons syndrom, en alvorlig tilstand som påvirker slimhinderne, kan vare op til 6 uger. Steroider anbefales typisk ikke ved milde tilfælde. Det er usikkert, om steroider bør anvendes ved svær erythema multiforme, da der ikke foreligger klare resultater fra randomiserede undersøgelser, som viser, hvilke børn der ville have gavn af denne behandling.
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.
Vi præsenterer et tilfælde af oral erythema multiforme (EM) forårsaget af TMP/SMX, som viser typiske mund‑ og læbesår uden hudlæsioner. Dette understreger behovet for at differentiere tilstanden fra andre orale ulcerative lidelser. Patienten fik symptomatisk behandling samt prednisolon‑tabletter, hvilket førte til bedring efter ophør af TMP/SMX‑behandlingen.
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 er en reaktion, der involverer huden og nogle gange slimhinden, udløst af immunsystemet. Typisk viser den sig som mållignende læsioner, som kan forekomme isoleret, gentage sig eller vedvare. Disse læsioner påvirker normalt symmetrisk ekstremiteterne, især deres ydre overflader. De vigtigste årsager omfatter infektioner som herpes simplex-virus og Mycoplasma pneumoniae samt visse medikamenter, immuniseringer og autoimmune sygdomme. Skelnen mellem erythema multiforme og urticaria afhænger af læsionernes varighed; erythema multiforme‑læsioner forbliver faste i mindst syv dage, mens urticarielle læsioner ofte forsvinder inden for en dag. Selvom de kan ligne hinanden, er det afgørende at adskille erythema multiforme fra det mere alvorlige Stevens‑Johnson‑syndrom, som typisk præsenterer udbredte erytematøse eller purpuriske makuler med blærer. Håndtering af erythema multiforme indebærer symptomatisk lindring med topiske steroider eller antihistaminer samt behandling af den underliggende årsag. For tilbagevendende tilfælde forbundet med herpes simplex-virus anbefales profylaktisk antiviral behandling. Alvorlig slimhindepåvirkning kan nødvendiggøre hospitalsindlæggelse for intravenøs væske‑ og elektrolytterstatning.
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.
Tilstanden varierer fra et mildt, selvbegrænset udslæt til en alvorlig, livstruende form kendt som erythema multiforme major, som også involverer slimhinder. Involvering af slimhinder eller tilstedeværelsen af bullae er vigtige tegn på sværhedsgrad.
- Erythema multiforme minor: typiske mål‑læsioner eller hævede, ødematøse papler fordelt acralt.
Den milde form viser sig normalt med let kløende (men kløen kan være meget intens) lyserøde pletter, symmetrisk arrangeret og starter på ekstremiteterne. Opløsning af udslættet inden for 7–10 dage er normen for denne sygdomsform.
- Erythema multiforme major: typiske mål‑læsioner eller hævede, ødematøse papler fordelt acralt med involvering af en eller flere slimhinder. Epidermal løsrivelse involverer mindre end 10 % af den samlede kropsoverflade.
○ Behandling ― OTC‑lægemidler
Hvis der er feber (stigende kropstemperatur), bør man søge hospitalsbehandling så hurtigt som muligt.
Mistænkt medicin bør seponeres (fx antibiotika, ikke‑steroide antiinflammatoriske lægemidler).
Orale antihistaminer såsom cetirizine(cetirizin) og loratadine(loratadin) mod kløe.
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]