GENERAL INTERNAL MEDICINE
Identify erythema multiforme and Stevens Johnson's syndrome
Erythema Multiforme - A distinctive cutaneous reaction of the skin and, sometimes, the mucus membranes (making it Stevens Johnson syndrome if mucosa is involved). Patterns may be a manifestation of immune complex deposition.
Three forms, listed in order of increasing integumentary damage:
1. Iris Type - commonest type (target lesion) - round, red or purple lesions on extremities (palms, back of hands, forearms, dorsa of feet, soles, and legs)- annular lesions with raised, cyanotic center (target lesion)
2. Vesiculobullous Type - eruption more widespread- trunk and mucus membranes may be involved - center of lesions become vesicles or bullae, which break and lead to painful ulcers
3. Stevens-Johnson Syndrome - MUCOSAL & multisystem involvement & patient often febrile and ill oral ulcers may prevent ability to eat ADMIT TO HOSPITAL IF STEVENS JOHNSONS and treat supportively, give steroids and remove initiating stimulus if possible.
Commonest Causes :
Viruses -Herpes simplex, vaccinia, infectious mononucleosis, orf, hepatitis B
Mycoplasma - atypical pneumonia
Fungi - Histoplasmosis
Drugs - penicillin barbiturates sulfonamides Rifampicin Salicylates
Autoimmune/Connective Tissue Disease - SLE Polyarteritis nodosa Wegeners granulomatosis