Erythema multiforme - 多形紅斑
Erythema multiforme minor ― 請注意，病變中心可能會變白。
蕁麻疹也可被視為鑑別診斷。
References
Erythema multiforme (EM) 是一種由於免疫反應而在皮膚和黏膜上出現獨特的靶狀斑點的情況。儘管通常由病毒感染（尤其是單純皰疹病毒 (HSV) ）或某些藥物引發，但在許多情況下其原因仍不清楚。治療急性 EM 的重點是使用含有類固醇或抗組織胺的乳膏來緩解症狀。針對每位患者量身訂做治療復發性 EM 的方法最為有效。最初的方法包括口服和局部治療。這些包括皮質類固醇和抗病毒藥物。局部治療包括強效類固醇乳膏和針對受影響黏膜的溶液。對於抗病毒藥物無反應的患者，第二線選擇包括免疫抑制藥物、抗生素、驅蟲藥和抗瘧藥。
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
在許多情況下，輕度 erythema multiforme 會在 2 至 4 週內自行消失。史蒂文斯-約翰遜症候群是一種影響黏膜的嚴重疾病，可持續長達 6 週。對於輕度病例，通常不建議使用類固醇。類固醇是否應該用於治療嚴重的多形紅斑尚不確定，因為隨機研究沒有明確的結果表明哪些兒童會從這種治療中受益。
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.
我們介紹一例由 TMP/SMX 引起的口腔 erythema multiforme (EM) 病例，表現為典型的口腔和唇部潰瘍，無皮損。這強調了將其與其他口腔潰瘍性疾病區分開來的必要性。患者接受症狀治療及潑尼松龍片治療，停止 TMP/SMX 治療後病情好轉。
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 是一種涉及皮膚、有時涉及黏膜的反應，由免疫系統觸發。通常，它表現為靶樣病變，可能是孤立的、復發的或持續存在的。這些病變通常對稱地影響四肢，特別是其外表面。主要原因包括單純皰疹病毒和肺炎黴漿菌等感染，以及某些藥物、免疫接種和自體免疫疾病。 erythema multiforme 與蕁麻疹的差異取決於病灶的持續時間； erythema multiforme 病灶至少維持固定 7 天，而蕁麻疹病變通常在一天內消失。儘管相似，但將 erythema multiforme 與更嚴重的史蒂文斯-約翰遜症候群區分開來至關重要，後者通常表現為廣泛的紅斑或紫斑，伴隨水皰。 erythema multiforme 的治療包括使用局部類固醇或抗組織胺來緩解症狀並解決根本原因。對於與單純皰疹病毒相關的復發病例，建議預防性抗病毒治療。嚴重的黏膜受累可能需要住院進行靜脈輸液和電解質補充。
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.
病情從輕微的自限性皮疹到嚴重的危及生命的多形性紅斑（也涉及黏膜）不等。侵犯黏膜或出現大皰是嚴重程度的重要指標。
- Erythema multiforme minor：典型的目標或分佈在肢端的凸起、水腫性丘疹
輕度形式通常表現為輕度搔癢（但搔癢可能非常嚴重）、粉紅色斑點，對稱排列，從四肢開始。這種疾病的正常情況是皮疹在 7-10 天內消退。
- Erythema multiforme major：典型的目標或凸起、水腫性丘疹，分佈於肢端，涉及一層或多層黏膜。表皮脫離涉及不到身體表面積的10%。
○ 治療 - 非處方藥
如果伴隨發燒（體溫升高），建議盡快到醫院就診。
可疑藥物應停用。 （例如抗生素、非類固醇抗發炎藥）
口服抗組織胺藥，如西替利嗪和氯雷他定止癢。
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]