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erythema multiforme
ICD-10 Codes
Description
Erythema multiforme (EM) is a skin condition characterized by the appearance of target-like lesions, typically on the hands and feet, but also on other parts of the body. The name "erythema" refers to redness of the skin, while "multiforme" means many forms.
Symptoms:
- Target-like lesions: EM is marked by the presence of circular or oval-shaped lesions that have a central area of blistering and surrounding areas of redness.
- Redness and swelling: The affected skin areas are typically red, swollen, and warm to the touch.
- Blisters and bullae: Small blisters (vesicles) or larger fluid-filled blisters (bullae) may appear on the skin.
- Itching and burning sensations: Patients often experience itching, burning, or stinging feelings on the affected areas.
Causes:
- Infections: EM is often triggered by viral infections, such as herpes simplex virus (HSV), varicella-zoster virus (VZV), and Epstein-Barr virus (EBV).
- Medications: Certain medications, like antibiotics, anticonvulsants, and NSAIDs, can trigger EM in some individuals.
- Autoimmune disorders: Conditions like lupus erythematosus, rheumatoid arthritis, and Sjögren's syndrome may increase the risk of developing EM.
Stages:
EM is classified into three stages based on severity:
- Minor (Type I): Mild symptoms, with fewer than 10 lesions.
- Major (Type II): Moderate to severe symptoms, with more than 10 lesions and potential involvement of mucous membranes.
- Severe (Stevens-Johnson syndrome or Type III): Life-threatening condition characterized by extensive skin and mucosal involvement.
Treatment:
- Topical corticosteroids: To reduce inflammation and itching.
- Antiviral medications: For viral infections that triggered EM.
- Pain management: To alleviate discomfort and pain associated with the condition.
- Supportive care: To manage symptoms, prevent complications, and promote wound healing.
Complications:
- Scarring: Permanent scarring can occur if blisters are not properly cared for.
- Infection: Blisters can become infected, leading to more severe consequences.
- Mucosal involvement: Involvement of mucous membranes can lead to complications like conjunctivitis or oral ulcers.
If you suspect you have erythema multiforme, it's essential to consult a healthcare professional for proper diagnosis and treatment.
Additional Characteristics
- Redness and swelling
- Itching and burning sensations
- Target-like lesions
- Blisters and bullae
Signs and Symptoms
Erythema multiforme (EM) is a skin condition characterized by a range of symptoms
Additional Symptoms
- Erythema multiforme
Diagnostic Tests
Erythema multiforme (EM) can be diagnosed through various clinical and laboratory tests.
Clinical Diagnosis The diagnosis of EM is primarily based on the clinical appearance of the skin lesions, which typically include target-like or "bull's-eye" lesions. These lesions are usually accompanied by other symptoms such as fever, itching, and burning sensations.
- Skin Biopsy: While not always necessary, a skin biopsy can be performed to confirm the diagnosis of EM and rule out other conditions that may have similar presentations.
- Clinical Examination: A thorough clinical examination is essential in diagnosing EM. This includes examining the skin lesions, taking a detailed medical history, and performing a physical examination.
Laboratory Tests In some cases, laboratory tests may be ordered to confirm the diagnosis of EM or to rule out other conditions that may have similar presentations.
- Blood Test: A blood test can help identify underlying infections or autoimmune disorders that may be contributing to the development of EM.
- Liver Function Tests: These tests can help assess liver function and rule out any liver-related issues that may be contributing to the development of EM.
- ESR (Erythrocyte Sedimentation Rate): This test measures the rate at which red blood cells settle in a test tube, and an elevated ESR can indicate inflammation or infection.
- Serological Testing for Infectious Causes: This test can help identify underlying infections that may be contributing to the development of EM.
Other Diagnostic Tests In some cases, additional diagnostic tests may be ordered to confirm the diagnosis of EM or to rule out other conditions that may have similar presentations.
- Chest X-ray: A chest x-ray may be ordered to rule out any respiratory issues that may be contributing to the development of EM.
- Histopathologic Testing: This test can help confirm the diagnosis of EM and rule out other conditions that may have similar presentations.
References:
- [3] - Your provider may need to perform a skin biopsy to diagnose erythema multiforme.
- [7] - A blood sample can help find or rule out possible causes, such as an infection.
- [5] - Complete blood examination, Liver functions tests, ESR, Serological testing for infectious causes, Chest x-ray.
- [8] - A punch biopsy can be used to confirm the diagnosis of EM.
- [9] - Erythema multiforme (EM) is an acute, immune-mediated condition characterized by the appearance of distinctive target-like lesions.
Additional Diagnostic Tests
- Blood Test
- Skin Biopsy
- Chest X-ray
- Liver Function Tests
- Clinical Examination
- ESR (Erythrocyte Sedimentation Rate)
- Serological Testing for Infectious Causes
- Histopathologic Testing
Treatment
Erythema multiforme (EM) is a skin condition characterized by the appearance of target-like lesions, typically on the arms and legs. The management of EM involves symptomatic treatment with topical steroids or antihistamines and treating the underlying cause.
Medications Used to Treat Erythema Multiforme:
- Antivirals: These medications are used to treat EM caused by viral infections such as herpes simplex virus (HSV). Examples include:
- Acyclovir (Zovirax) [6]
- Valacyclovir (Valtrex) [6]
- Famciclovir (Famvir) [6]
- Topical corticosteroids and anesthetics: These medications can help alleviate symptoms such as itching and pain. Examples include:
- Topical corticosteroids [4, 9]
- Anesthetics [9]
- Oral antihistamines: These medications can help relieve itching and reduce the risk of skin infections. Examples include:
- Diphenhydramine (Benadryl) [1]
- Loratadine (Claritin) [1]
Long-term Treatment:
For patients with recurrent EM, long-term treatment may be necessary to prevent future episodes. This can involve:
- Continuous oral antiviral therapy: Taking medications such as acyclovir or valacyclovir for at least 6 months to reduce the risk of future EM episodes [5]
- Immunosuppressive medications: Medications such as mycophenolate mofetil, dapsone, and azathioprine may be used in some cases to reduce inflammation and prevent future EM episodes [7]
It's essential to note that the treatment plan for EM should be tailored to the individual patient's needs and underlying cause of the condition. A healthcare professional can provide personalized guidance on the most effective treatment approach.
References:
[1] KP Trayes (2019) - The management of erythema multiforme involves symptomatic treatment with topical steroids or antihistamines and treating the underlying cause. [2] A Soares (2021) - Current recommendations include acyclovir, 400 mg, twice daily, valacyclovir, 500 mg, twice daily, or famciclovir, 250 mg, twice daily [1]. [3] MR LAMOREUX (2006) - Recurrent erythema multiforme may be treated with continuous oral acyclovir (400 mg two times per day) even if HSV is not an obvious cause. [4] Nov 29, 2022 - Using topical corticosteroids or oral antihistamines for itching. Using eye drops if symptoms affect your eyes. [5] What is the treatment for erythema multiforme? At least 6 months of continuous oral antiviral therapy (typically acyclovir/aciclovir), even if a clear cause is not identified. [6] Oct 31, 2024 - Erythema Multiforme Medication: Antivirals, HSV; Acyclovir (Zovirax); Antivirals, Other; Famciclovir (Famvir); Valacyclovir (Valtrex). [7] DA Wetter - Suggested treatment course: Mycophenolate mofetil; Dapsone; Azathioprine. [8] A Soares (2021) - Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to the individual patient's needs. [9] Sep 1, 2021 - Topical corticosteroids and anesthetics and oral antihistamines may ameliorate symptoms and reassure patients, but sometimes antivirals are necessary.
Recommended Medications
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Differential Diagnosis
Differential Diagnoses for Erythema Multiforme
Erythema multiforme (EM) is a skin condition that can be challenging to diagnose due to its similarity with other conditions. The differential diagnosis for EM includes several conditions that should be considered based on the presentation of the lesions.
- Urticaria: Urticarial symptoms resemble erythema multiforme, and these two conditions should be distinguished based on the presentation of the lesions [1].
- Erythema Multiforme Major: This is a severe and life-threatening condition that requires prompt diagnosis and treatment [5].
- Urticarial Vasculitis: This condition is characterized by inflammation of the blood vessels, which can lead to skin lesions similar to EM [4].
- Serum-Sickness-Like Reaction: This is an immune-mediated reaction that can cause skin lesions, including those resembling EM [4].
- Bullous Pemphigoid: This is a chronic autoimmune disease characterized by blistering of the skin and mucous membranes, which can be mistaken for EM [7].
Key Points to Consider
- The differential diagnosis for EM includes several conditions that should be considered based on the presentation of the lesions.
- Urticaria and erythema multiforme major are two conditions that should be distinguished from EM due to their similar symptoms.
- Other conditions, such as urticarial vasculitis, serum-sickness-like reaction, bullous pemphigoid, and dermatitis herpetiformis, should also be considered in the differential diagnosis of EM [7].
References
[1] Context 2: Urticaria is a condition that can resemble erythema multiforme. [4] Context 8: Serum-sickness-like reaction and urticarial vasculitis are conditions that can cause skin lesions similar to EM. [5] Context 9: Erythema multiforme major is a severe and life-threatening condition that requires prompt diagnosis and treatment. [7] Context 13: Bullous pemphigoid is a chronic autoimmune disease characterized by blistering of the skin and mucous membranes, which can be mistaken for EM.
Additional Differential Diagnoses
- Erythema Multiforme Major
- Serum-Sickness-Like Reaction
- urticaria
- vasculitis
- bullous pemphigoid
- benzylpenicillin allergy
- carbamazepine allergy
- Stevens-Johnson syndrome
- erythrokeratodermia variabilis
- autoimmune disease of skin and connective tissue
- physical urticaria
- erythema elevatum diutinum
- hand-foot-genital syndrome
- pemphigus vulgaris
- cutaneous candidiasis
- erythrokeratodermia variabilis et progressiva 2
- Sweet syndrome
- pemphigus foliaceus
- paraneoplastic pemphigus
- primary cutaneous gamma-delta T-cell lymphoma
- tinea corporis
- hypersensitivity reaction type IV disease
- dermatophytosis
- obsolete coxsackievirus infectious disease
- allergic urticaria
- cicatricial pemphigoid
- obsolete tinea
- obsolete chronic erythremia in remission
- obsolete secondary cutaneous syphilis
- pityriasis rosea
- lichen planus
Additional Information
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- A skin disease that is a type of allergic reaction located_in skin, which occurs in response to medications, infections, or illness.
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