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In dermatology, erythema multiforme major is a form of rash with skin loss or epidermal detachment. The term "erythema multiforme majus" is sometimes used to imply a bullous (blistering) presentation. [2] According to some sources, there are two conditions included on a spectrum of this same disease process: Stevens–Johnson syndrome (SJS)
The condition varies from a mild, self-limited rash (E. multiforme minor) [4] to a severe, life-threatening form known as erythema multiforme major (or erythema multiforme majus) that also involves mucous membranes. [5] Consensus classification: [6] Erythema multiforme minor—typical targets or raised, edematous papules distributed acrally
Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. [1] Together with toxic epidermal necrolysis (TEN) and Stevens–Johnson/toxic epidermal necrolysis (SJS/TEN) overlap, they are considered febrile mucocutaneous drug reactions and probably part of the same spectrum of disease, with SJS being less severe.
Target lesions are the typical lesions of erythema multiforme, in which a vesicle is surrounded by an often hemorrhagic maculopapule. Erythema multiforme is often self-limited, of acute onset, resolves in three to six weeks, and has a cyclical pattern. Its lesions are multiform (polymorphous) and include macules, papules, vesicles, and bullae.
Erythema multiforme (EM) is generally considered a separate condition. [6] Treatment typically takes place in hospital such as in a burn unit or intensive care unit. [3] [7] Efforts include stopping the cause, pain medication, and antihistamines. [3] [4] Antibiotics, intravenous immunoglobulins, and corticosteroids may also be used.
Erythema annulare centrifugum (deep gyrate erythema, erythema perstans, palpable migrating erythema, superficial gyrate erythema) Erythema gyratum repens (Gammel's disease) Erythema migrans (erythema chronicum migrans) Erythema multiforme; Erythema multiforme minor (herpes simplex-associated erythema multiforme) Erythema palmare; Generalized ...
Erythema multiforme, Toxic epidermal necrolysis Apoptotic and necrotic cells, absence of acantholytic cells A Tzanck smear may be a rapid test to distinguish toxic epidermal necrolysis from SSSS III. Genodermatoses: Hailey-Hailey disease: Acantholytic cells without direct immunofluorescence positivity
Drug eruptions are diagnosed mainly from the medical history and clinical examination. However, they can mimic various other conditions, thus delaying diagnosis (for example, in drug-induced lupus erythematosus, or the acne-like rash caused by erlotinib). A skin biopsy, blood tests or immunological tests can also be useful.