Erythema multiforme
☆ I 2022 Stiftung Warentest-resultaterne fra Tyskland var forbrugernes tilfredshed med ModelDerm kun lidt lavere end med betalte telemedicinske konsultationer.
Erythema multiforme minor ― Bemærk, at centrene af læsionerne kan blanchere.
Nældefeber kan også betragtes som en differentialdiagnose.
References
Erythema multiforme (EM) er en tilstand, hvor markante mållignende pletter opstår på både hud og slimhinder på grund af immunreaktioner. Selvom det ofte udløses af virale infektioner, især herpes simplex virus (HSV) , eller visse medikamenter, forbliver årsagen ukendt i mange tilfælde. Behandling af akut EM fokuserer på at lindre symptomer ved hjælp af cremer, der indeholder steroider eller antihistaminer. Håndtering af tilbagevendende EM er mest effektiv, når den er skræddersyet til hver patient. Indledende tilgange involverer både orale og topiske behandlinger. Disse omfatter kortikosteroider og antiviral medicin. Topiske behandlinger består af stærke steroidcremer og opløsninger til angrebne slimhinder. For patienter, der ikke reagerer på antivirale lægemidler, omfatter andenlinje-muligheder 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 til 4 uger. Stevens-Johnsons syndrom, en alvorlig tilstand, der påvirker slimhinderne, kan vare op til 6 uger. Steroider anbefales typisk ikke til milde tilfælde. Hvorvidt steroider bør anvendes til svær erythema multiforme er usikkert, da der ikke er klare resultater fra randomiserede undersøgelser, der indikerer, 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 , der viser typiske mund- og læbesår uden hudlæsioner. Dette understreger behovet for at differentiere det fra andre orale ulcerative lidelser. Patienten fik symptomatisk behandling og prednisolon-tabletter, hvilket førte til bedring efter ophør med TMP/SMX-behandling.
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 det sig som mållignende læsioner, som kan forekomme isolerede, 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. At skelne erythema multiforme fra urticaria afhænger af varigheden af læsioner; erythema multiforme læsioner forbliver faste i mindst syv dage, mens urticarielle læsioner ofte forsvinder inden for en dag. Selvom det ligner, er det afgørende at skelne erythema multiforme fra det mere alvorlige Stevens-Johnson syndrom, som typisk præsenterer udbredte erytematøse eller purpuriske makuler med blærer. Håndtering af erythema multiforme involverer symptomatisk lindring med topiske steroider eller antihistaminer og afhjælpning 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, der også involverer slimhinder. Invasion af slimhinden eller tilstedeværelsen af bullaes er vigtige tegn på sværhedsgrad.
- Erythema multiforme minor: typiske mål eller hævede, ødematøse papler fordelt acralt
Den milde form viser sig normalt med let kløende (men kløe kan være meget alvorlig), lyserøde pletter, symmetrisk arrangeret og starter på ekstremiteterne. Opløsning af udslæt inden for 7-10 dage er normen i denne form for sygdommen.
- Erythema multiforme major: typiske mål eller hævede, ødematøse papler fordelt acralt med involvering af en eller flere slimhinder. Epidermal løsrivelse involverer mindre end 10 % af det samlede kropsoverfladeareal.
○ Behandling ― OTC-lægemidler
Hvis det er ledsaget af feber (stigende kropstemperatur), anbefales det at besøge hospitalet så hurtigt som muligt.
Mistænkt medicin bør seponeres. (fx antibiotika, ikke-steroide antiinflammatoriske lægemidler)
Orale antihistaminer såsom cetirizin og loratadin mod kløe.
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]