Y5 - Erythema Multiforme

Question 1

def

Answer 1

an acute self-limiting but often relapsing mucocutaneous inflammatory condition

Question 2

what is erythema multiforme associated with

Answer 2

hypersensitivity reaction associated with certain infections, vaccinations, medications

Question 3

what is characteristic erythema multiforme

Answer 3

target lesions

Question 4

what are target lesions

Answer 4

ring shaped lesion with an outer red ring and a central blistering area with normal skin tone

Question 5

what are features of erythema multiforme

Answer 5

symptoms of mild URTI prior to episode

skin lesions are commonly around the mouth and any mucous membranes

Question 6

epi

Answer 6

common in young adults

Question 7

aetiology

Answer 7

a hypersensitivity response in susceptible individuals which can be induced by infection, vaccinations or medications

Question 8

what infections are most commonly associated with EM

Answer 8

HSV
mycoplasma

also hep B, EBV, CMV

Question 9

what medications are most commonly associated with EM

Answer 9

aminopenicillins
docetaxel (chemo)
TNFa-inhibitors

Question 10

what vaccinations are most associated with EM

Answer 10

hep B vaccination

Question 11

what is the difference between EM minor and major

Answer 11

EM minor has no mucosal involvement only cutaneous

EM major has involvement of 1 or more mucosal sites

Question 12

risk factors

Answer 12

prior occurrence of EM
HSV
mycoplasma pneumonia

Question 13

history

Answer 13

rapid onset of target lesions (3 zones, red rim, clearance zone, central blister) of extremities
recurrence

Question 14

what is indicative of EM major

Answer 14

mucosal erosions (lips)

Question 15

what are target lesions

Answer 15

3 zones, red rim, clearance zone, central blister

Question 16

what are targetoid lesions

Answer 16

2 zones, red rim and central blister zone

Question 17

where are target lesions most commonly found

Answer 17

extremities

Question 18

where are targetoid lesions commonly found

Answer 18

trunk

Question 19

what other findings are common with EM

Answer 19

if caused by mycoplasma pneumoniae

wheeze, crackles

Question 20

investigations

Answer 20

1 bloods
-raised WCC
2 serology
-HSV 1 or 2 IgM
-cold -haemagglutination for mycoplasma pneumoniae
3 PCR
-HSV EM can be differentiated from HSV1 with positive varicella DNA

Question 21

what % of the body should lesions in both EM minor and major cover

Answer 21

<10%

Question 22

what sort of body painting is associated with EM

Answer 22

henna tattoos

Question 23

what sort of hypersensitivity reactions are involved in EM

Answer 23

Type IV

Question 24

what is the most important treatment for EM

Answer 24

symptomatic treatment (oral antihistamines, analgesics, local skincare)

Question 25

what should be done if a drug is the suspected cause of EM

Answer 25

cessation of drug

Question 26

what may prevent infection in EM

Answer 26

liquid antiseptics such as chlorhexidine during bathing

Question 27

complications of EM

Answer 27

respiratory complications and fluid imbalances
infection
scaring and strictures
eye complications

Question 28

management of mild EM

Answer 28

symptomatic treatment

• analgesics
• NSAIDs
• cold compresses
• topical steroids

Question 29

where should severe EM patients be looked after

Answer 29

in burns units

to keep environment warm

Question 30

what eye complications can occur

Answer 30

conjunctivitis

sjogren like sicca syndrome

Question 31

management for EM minor

Answer 31

emollient
corticosteroids
sterile dressings
analgesia

Question 32

what corticosteroid is used in EM minor

Answer 32

triamcinolone acteonide

Question 33

management for EM major

Answer 33

emollient
corticosteroids
sterile dressings
analgesia
topical lidocaine
IV fluids and catheterisation

Question 34

what corticosteroid is used in EM major

Answer 34

prednisolone

Question 35

management for recurrent EM

Answer 35

valaciclovir

Question 36

prognosis

Answer 36

it is normally a mild self-limiting disease with lesions healing within 3 weeks without scarring