Erythema multiforme
https://en.wikipedia.org/wiki/Erythema_multiforme
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References
Recent Updates in the Treatment of Erythema Multiforme 34577844 NIH
Erythema multiforme (EM) is 'n toestand waarin kenmerkende teikenagtige kolle op beide die vel en die slymvliese voorkom as gevolg van immuunreaksies. Alhoewel dit dikwels veroorsaak word deur virale infeksies, veral herpes simplex-virus (HSV), of sekere medikasie, bly die oorsaak in baie gevalle onbekend. Die behandeling van akute EM fokus op die verligting van simptome met behulp van ys‑kompressies wat steroïede of antihistamiene bevat. Die bestuur van herhalende EM is die doeltreffendste wanneer dit vir elke pasiënt aangepas word. Aanvanklike benaderings behels beide mondelinge en topiese behandelings, soos kortikosteroïede en antivirale medikasie. Topiese behandelings bestaan uit sterk steroïedrome en oplossings vir die aangetaste slymvliese. Vir pasiënte wat nie op antivirale middels reageer nie, sluit tweede‑lyn‑opsies immuunonderdrukkende middels, antibiotika, wurmmiddels en antimalariamiddels in.
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
Use of steroids for erythema multiforme in children 16353829 NIH
In baie gevalle gaan ligte erythema multiforme van self binne 2 tot 4 weke weg. Stevens-Johnson-sindroom, 'n ernstige toestand wat slymvliese aantas, kan tot 6 weke duur. Steroïede word nie tipies aanbeveel vir ligte gevalle nie. Of steroïede gebruik moet word vir ernstige erythema multiforme, is onseker, aangesien daar geen duidelike bevindinge van gerandomiseerde studies is wat aandui watter kinders by hierdie behandeling sal baat vind nie.
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.
Drug-induced Oral Erythema Multiforme: A Diagnostic Challenge 29363636 NIH
Ons bied 'n geval van orale erythema multiforme (EM) wat veroorsaak word deur TMP/SMX, wat tipiese mond‑ en lipseere sonder velletsels toon. Dit beklemtoon die noodsaaklikheid om dit van ander orale ulseratiewe afwykings te onderskei. Die pasiënt het simptomatiese behandeling en prednisoloon‑tablette ontvang, wat tot verbetering gelei het nadat die TMP/SMX‑terapie gestaak is.
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: Recognition and Management. 31305041Erythema multiforme is 'n reaksie wat die vel en soms die slymvlies betrek, en deur die immuunstelsel veroorsaak word. Tipies manifesteer dit as teikenagtige letsels, wat geïsoleerd kan voorkom, herhaal of voortduur. Hierdie letsels beïnvloed gewoonlik die ledemate simmetries, veral hul buitenste oppervlaktes. Die hoofoorsake sluit in infeksies soos herpes simplex-virus en Mycoplasma pneumoniae, sowel as sekere medikasie, inentings en outo-immuun siektes. Om erythema multiforme van urtikaria te onderskei, berus op die duur van die letsels; erythema multiforme‑letsels bly vir ten minste sewe dae vas, terwyl urtikariese letsels dikwels binne 'n dag verdwyn. Alhoewel soortgelyk, is dit van kardinale belang om erythema multiforme te onderskei van die meer ernstige Stevens‑Johnson‑sindroom, wat tipies wydverspreide eritematiese of purpuriese makules met blase vertoon. Die bestuur van erythema multiforme behels simptomatiese verligting met huidige steroïede of antihistamiene en die aanspreek van die onderliggende oorsaak. Vir herhalende gevalle wat verband hou met herpes simplex-virus, word profilaktiese antivirale terapie aanbeveel. Erge mukosale betrokkenheid kan hospitalisasie noodsaak vir binne‑ en vloeistowwe‑ en elektrolietvervanging.
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.
Die toestand wissel van ’n ligte, selfbeperkte uitslag tot ’n ernstige, lewensgevaarlike vorm, bekend as erythema multiforme major, wat ook die slymvlies betrek. Indringing van die slymvlies of die teenwoordigheid van bulle is belangrike tekens van erns.
- Erythema multiforme minor: tipiese teikenlesies of verhoogde, edematiese papules wat akraal versprei is. Die ligte vorm kom gewoonlik voor met effense jeuk (maar die jeuk kan baie erg wees), pienk‑rooi vlekke, simmetries gerangskik en begin op die ledemate. Resolusie van die uitslag binne 7‑10 dae is die norm in hierdie vorm van die siekte.
- Erythema multiforme major: tipiese teikenlesies of verhoogde, edematiese papules wat akraal versprei word met betrokkenheid van een of meer slymvliese. Epidermale loslating behels minder as 10 % van die totale liggaamsoppervlakte.
○ Behandeling – OTC-dwelms
As dit gepaard gaan met koors (stygende liggaamstemperatuur), word dit aanbeveel om die hospitaal so gou moontlik te besoek.
Vermeende dwelms moet gestaak word (bv. antibiotika, nie‑steroïdale anti‑inflammatoriese middels).
Orale antihistamiene soos setirizien en loratadien vir jeuk.
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]