Erythema Multiforme

Erythema multiforme is a mucocutaneous inflammatory disorder, but sometimes the mouth is the only site of involvement [1, 8]. It can be relatively mild or manifest with fever, malaise and extensive skin, mucosal and ocular lesions when it is sometimes called Stevens Johnson syndrome or erythema multiforme major. It is thought to be an immunologically mediated disorder, but in many cases no precipitating factor is found. Triggering agents that have been implicated include infections with Herpes simplex virus [7] and Mycoplasma pneumoniae [99] and a wide range of drugs including sulphonamides, anticonvulsants, non-steroidal anti-inflammatory medications and antibiotics. Although patients may suffer a single episode, it is often recurrent.

Erythema multiforme is usually seen in young adults (20-40 years) and is more common in males. Oral lesions may be the only feature of the disease or cutaneous involvement may follow several attacks of oral ulceration. The lips are the most frequently involved site and typically show swelling and extensive haemorrhagic crusting. Within the mouth there are usually diffuse erythematous areas and superficial ulcers on the buccal mucosa, floor of the mouth, tongue, soft palate and fauces. It is uncommon for the gingiva to be involved and this sometimes helps to distinguish erythema multiforme from primary herpetic gingivostomatitis, where gingival inflammation is a conspicuous feature. The areas of mucosa involved frequently break down to form painful, shallow, irregular ulcers on a background of more generalised erythema. It is unusual to see intact blisters in the mouth.

The classical cutaneous manifestation of erythema multiforme is the development of so-called target or bull's eye lesions. These begin as dark red macules, usually 1-3 cm in diameter. They become slightly elevated and develop a characteristic bluish centre. These lesions are seen most frequently on the hands and lower limbs. In erythema multiforme major there may be ocular and genital involvement together with constitutional symptoms. A very severe and potentially lethal variant is toxic epidermal necrolysis, when there is widespread cutaneous and mucosal involvement with extensive blistering and epidermal loss leading to fluid and electrolyte loss and secondary infection.

Microscopy shows variable features and early epithelial breakdown of oral lesions frequently masks any characteristic features [25]. In the early lesions there is apoptosis and necrosis of keratinocytes, intercellular oedema and inflammatory infiltration of the epithelium. This leads to intra- and sub-epithelial vesiculation and ultimately loss of the roof of the blister to form an ulcer. There is lymphohistiocytic and polymorphonuclear infiltration of the superficial corium and the inflammatory infiltrate can extend more deeply, often in a perivascular distribution. Patchy deposits of C3 and IgM may be found in the walls of blood vessels, but there is no frank vasculitis and the immune complex deposition appears to be non-specific.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

Get My Free Ebook


Post a comment