erythema multiforme / steven johnson syndrome / toxic epidermal necrolysis

Question 1

what causes erythema multiforme ?

Answer 1

herpes simplex virus
orf - parapox virus skin disease of sheep and goat

bacteria - mycoplasma , streptococcus

drugs - penicillin , sulphonamides , carbamezapine , allopurinol , NSAIDS , oral contraceotive pills

SLE

sarcoidosis

malignancy

Question 2

how is erythema multiforme treated ?

Answer 2

self limiting disease
- spontaneously resolves in 2-4 weeks

symptomatic relief - analgesia

Question 3

how to differentiate erythema multiforme for SJS?

Answer 3

erythema multiforme lesions are typically confined to skin with one or more mucous membranes

lesions appear as macules , papules , target lesions covering <10 percent of the body
systemic symptoms such as fever and malaise - typically mild

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SJS - severe
widespread erythema multiforme like skin lesions
several mucosal involvemneyt - oral , occula , genital
10-30 percent of BSA affected
systemic symptoms more pronounced

Question 4

cause of steven johnson syndrome

Answer 4

almost always caused by a drug

penicillin
sulphonamides
lamotrigine ,, carbamazepine , phenytoin , allopurinol
NSAIDs
oral contraceptive pill

Question 5

features of steven johnson syndrome ?

Answer 5

typical maculopapular lesions
- may develop into vesicles or bullae

nikolsky sign is positive in erythematous areas - when rubbing the erythematous zone listers and erosions appear

mucosal involvemnet

systemic - fever , arthralgia

Question 6

mx of steven johnson syndrome ?

Answer 6

stop the causative agent

supportive care with cleaning and emollients and non adherent dressing

Question 7

SJS is common in young what is common in old ?

Answer 7

TEN

Question 8

how to differentiate TEN from SJS ?

Answer 8

TEN > 30 percent of skin involvement

Question 9

what are features of TEN ?

Answer 9

pyrexia
tacycardia
nikolsky sign - epidermis seperates with mild lateral pressure

Question 10

managmnet of TEN ?

Answer 10

volume loss and electrolyte derangement

Iv immunoglobulin has been shown to be effective and used first line

immunosuppressants - ciclosporin , cyclophosphamide ,

plasmapheresis