Erythema multiforme
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Erythema multiforme minor ― Ambil perhatian bahawa bahagian tengah lesi mungkin pudar.
Urtikaria juga boleh dianggap sebagai diagnosis pembezaan.
References
Erythema multiforme (EM) ialah keadaan di mana bintik-bintik seperti sasaran yang tersendiri muncul pada kedua-dua kulit dan membran mukus akibat tindak balas imun. Walaupun sering dicetuskan oleh jangkitan virus, terutamanya virus herpes simplex (HSV) , atau ubat-ubatan tertentu, puncanya masih tidak diketahui dalam banyak kes. Merawat EM akut tertumpu kepada meredakan gejala menggunakan krim yang mengandungi steroid atau antihistamin. Menguruskan EM berulang adalah paling berkesan apabila disesuaikan dengan setiap pesakit. Pendekatan awal melibatkan kedua-dua rawatan lisan dan topikal. Ini termasuk kortikosteroid dan ubat antivirus. Rawatan topikal terdiri daripada krim steroid yang kuat dan penyelesaian untuk membran mukus yang terjejas. Bagi pesakit yang tidak bertindak balas terhadap antivirus, pilihan baris kedua termasuk ubat penindas imun, antibiotik, anthelmintik dan antimalaria.
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
Dalam banyak keadaan, erythema multiforme ringan hilang dengan sendirinya dalam masa 2 hingga 4 minggu. Sindrom Stevens-Johnson, keadaan teruk yang menjejaskan membran mukus, boleh bertahan sehingga 6 minggu. Steroid biasanya tidak disyorkan untuk kes ringan. Sama ada steroid harus digunakan untuk eritema multiforme yang teruk adalah tidak pasti kerana tiada penemuan jelas daripada kajian rawak yang menunjukkan kanak-kanak mana yang akan mendapat manfaat daripada rawatan ini.
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.
Kami membentangkan kes erythema multiforme (EM) mulut yang disebabkan oleh TMP/SMX , menunjukkan ulser mulut dan bibir biasa tanpa lesi kulit. Ini menekankan keperluan untuk membezakannya daripada gangguan ulseratif mulut yang lain. Pesakit menerima rawatan simptomatik dan tablet prednisolon, yang membawa kepada peningkatan selepas menghentikan terapi 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 ialah tindak balas yang melibatkan kulit dan kadangkala mukosa, yang dicetuskan oleh sistem imun. Biasanya, ia menjelma sebagai lesi seperti sasaran, yang mungkin kelihatan terpencil, berulang atau berterusan. Luka-luka ini biasanya memberi kesan simetri pada bahagian kaki, terutamanya permukaan luarnya. Punca utama termasuk jangkitan seperti virus herpes simplex dan Mycoplasma pneumoniae, serta ubat-ubatan tertentu, imunisasi dan penyakit autoimun. Membezakan erythema multiforme daripada urtikaria bergantung pada tempoh lesi; erythema multiforme lesi kekal diperbaiki selama sekurang-kurangnya tujuh hari, manakala lesi urtikaria sering hilang dalam masa sehari. Walaupun serupa, adalah penting untuk membezakan erythema multiforme daripada sindrom Stevens-Johnson yang lebih teruk, yang biasanya menunjukkan makula eritematous atau purpura yang meluas dengan lepuh. Menguruskan erythema multiforme melibatkan kelegaan gejala dengan steroid topikal atau antihistamin dan menangani punca asas. Untuk kes berulang yang dikaitkan dengan virus herpes simplex, terapi antiviral profilaksis disyorkan. Penglibatan mukosa yang teruk mungkin memerlukan kemasukan ke hospital untuk cecair intravena dan penggantian elektrolit.
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.
Keadaan ini berbeza-beza daripada ruam yang ringan dan terhad kepada bentuk yang teruk dan mengancam nyawa yang dikenali sebagai erythema multiforme major yang turut melibatkan membran mukus. Pencerobohan membran mukus atau kehadiran bula adalah tanda-tanda keterukan yang penting.
- Erythema multiforme minor: sasaran tipikal atau timbul, papul edematous diedarkan secara akra
Bentuk ringan biasanya muncul dengan sedikit gatal (tetapi gatal-gatal boleh menjadi sangat teruk), tompok merah jambu-merah, tersusun secara simetri dan bermula pada bahagian kaki. Penyelesaian ruam dalam masa 7-10 hari adalah norma dalam bentuk penyakit ini.
- Erythema multiforme major: sasaran tipikal atau timbul, papul edematous diedarkan secara akraal dengan penglibatan satu atau lebih membran mukus. Detasmen epidermis melibatkan kurang daripada 10% daripada jumlah luas permukaan badan.
○ Rawatan - Ubat OTC
Sekiranya disertai dengan demam (suhu badan meningkat), adalah disyorkan untuk melawat hospital secepat mungkin.
Dadah yang disyaki harus dihentikan. (cth. antibiotik, ubat anti-radang bukan steroid)
Antihistamin oral seperti cetirizine dan loratadine untuk gatal-gatal.
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]