Eritema multiforme pdf 2011

Dermatologa Rev Mex Eritema polimorfo. Abstract: The term Erythema Multiforme EM includes a wide and controversial variety of clinical expressions at the. O espectro do eritema multiforme eritema multiforme. Schulz, J. Eritema multiforme. Aproximadamente 18 meses de evolucin, diagnosticado finalmente como eritema multiforme EM.

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El Eritema Multiforme EM es una reaccin aguda que afecta a la piel y a veces a las. PDF texto completo en http:scielo. One of the most common predisposing factors for erythema multiforme is infection with.

Resumen: El eritema multiforme es una enfermedad de la piel y las mucosas que. El eritema multiforme es un tipo de reaccin de hipersensibilidad que se presenta en respuesta a medicamentos, infecciones o enfermedad.

Los medicamentos. El eritema edirol ua 25ex manual pdf multiforme o eritema polimorfo es una enfermedad de la piel de presentacin aguda o crnica recurrente, de naturaleza inmunolgica, que se. El eritema multiforme EM o eritema polimorfo es economic text book pdf un sndrome de. Las reacciones de hipersensibilidad Eritema Multiforme, Stevens-Jonhson, Necrolisis Epidrmica Txica, las erupciones fijas y las vasculitis entre otras.

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Explora Documentos. Eritema Multiforme. Este documento obra en poder del autor de correspondencia. Inicio Medicina de Familia. ISSN: DOI: Erythema multiforme: Description of cases and phenotypic variants. Descargar PDF. Molina-Leyva a ,. Autor para correspondencia. Tabla 1. Texto completo. Figura 1. Grosber, M. Alexandre, E.

Revuz, J. Recurrent erythema multiforme in association with recurrent Mycoplasma pneumoniae infections. J Am Acad Dermatol, 56 , pp. Gonzalez-Delgado, M. Blanes, V. Soriano, D. Montoro, C. It classically presents as numerous targetoid lesions with concentric rings of distinct color variation in an acral distribution [ 1 , 2 , 3 , 4 , 5 ]. Target lesion appearance can differ from patient to patient, and frequently, both typical lesions with three concentric rings and atypical lesions with only two concentric rings lesions are seen.

Prodromal symptoms usually do not accompany EM; however, in cases where there is mucocutaneous involvement, prodromal symptoms have been observed [ 1 , 2 , 3 , 4 , 5 , 6 ]. There can be occasional mucosal involvement in EM, which is what splits the condition into its two broad categories: EM minor a form with no mucosal involvement and EM major a form that includes mucosal membrane involvement [ 1 , 6 , 7 ].

The most common mucous membranes that are involved include the lips, tongue, and the buccal oral mucosa. Genital or ocular mucosal lesions have also been observed, as well as any combination of the mucosal sites listed [ 1 , 6 , 7 ]. However, clinical literature over the past decade has provided significant evidence that supports EM major as a completely separate condition from SJS that share similar mucosal lesions but distinctly different cutaneous lesions [ 6 , 7 ].

It is important to note that EM as a condition is not associated with any specific immunologic pattern or serologic abnormalities typically found in autoimmune diseases [ 8 ]. While acute disease is usually self-limiting, some patients experience recurrent disease. Identifying the etiology of EM is crucial in developing a successful treatment modality [ 1 , 2 ].

A more recent association between EM and severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 pathogen, the novel coronavirus responsible for the recent pandemic, has been described [ 9 , 10 ]. Medications that have been implicated in causing EM include nonsteroidal anti-inflammatory drugs NSAIDs , sulfonamides, antiepileptics, and antibiotics [ 1 , 2 , 3 ].

Recurrent cases of EM have also been likened to HSV and Mycoplasma pneumoniae infections, as well as to hepatitis C infections, and vulvovaginal candidiasis [ 1 , 2 ]. Other associations include menstruation, complex apthosis, and a high dietary intake of benzoic acid a food preservative [ 1 , 4 , 11 ]. It is unclear how many cases of EM that are initially determined to be idiopathic actually have an underlying or subclinical infection with HSV [ 12 , 13 , 14 ].

A few studies have put forth the possibility that a subclinical infection is likely in many cases of idiopathic recurrent EM [ 1 , 12 , 13 , 14 ]. A rarer type of EM is known as persistent EM, which is defined by the continuous appearance of EM lesions with marked resistance to therapy. Lesions are typically widespread and are, by definition, uninterrupted [ 1 , 15 , 16 ]. Cases of persistent EM have been associated with underlying malignancies, inflammatory bowel disease, as well as infections with Epstein—Barr virus, cytomegalovirus, hepatitis C virus, and influenza [ 15 , 16 ].

A summary of well-documented trigger factors is outlined in Table 1. A summary of the well-documented trigger factors for Erythema multiforme identified in Sokumbi et al.

Treatment modalities differ for acute and recurrent disease. In acute disease, treatment is rarely needed as the lesions will typically regress over the course of several weeks, and supportive treatment is focused on improving symptoms [ 1 , 2 , 3 ].

In recurrent EM, treatment focuses on addressing the etiology through systemic antiviral prophylactic therapy. Refractory or resistant disease is more difficult to treat, generally relying on systemic immunosuppression [ 1 ]. A schematic on how to approach the clinical treatment of EM is outlined in Figure 1. This review will provide an overview on the treatment of EM, focusing on the newest evidence limited to clinical studies published after This flowchart details the clinical approach to treating each type of EM based on the clinical features of mucosal involvement, severity of disease, and infection or drug association.

Most of the treatment recommendations for EM are based on small case series or expert opinion. There have been few clinical trials [ 17 ]. Prior to treatment, the etiology should be determined. If there is evidence of a recent infection, then treating the infection is the first step in management. Similarly, if there is evidence that the EM is caused by a medication, discontinuing the medication is the initial step [ 1 , 2 , 17 ].

Once the etiology has been addressed, acute EM can be managed with topical steroids or antihistamines, if needed to improve symptoms. In the case of HSV-induced EM, some experts recommend early intervention with oral acyclovir to reduce disease duration and symptomaticity [ 1 , 2 , 3 , 17 ].

However, current evidence is limited in supporting the hypothesis that early antiviral therapy reduces the time to symptom and lesion resolution [ 17 , 18 ]. Table 2 provides an overview of the first-line therapy for each type of EM and the special considerations that need to be evaluated in every case.

A summary of the first-line treatment for each type of EM as well as special considerations that need to be evaluated in each case. Treatment for acute or isolated cases of EM typically do not need intervention, but in cases where patients are experiencing uncomfortable symptoms, topical steroids, antiseptics, and oral antihistamines are recommended.

In acute HSV-induced EM, antiviral suppressive therapy can be used, however, several studies have suggested that the administration of antiviral therapy in this context does not alter the clinical course of the disease [ 4 , 5 ]. In EM preceded by an M. However, in most of the cases reported, the medications used to treat the underlying infection could not be excluded as potential causes for the EM-like lesions [ 9 , 10 ].

Treatment in these cases consisted of stopping viral drug therapy and starting a tapered course of methylprednisolone [ 19 ]. Treatment for EM with mucosal involvement largely depends on the degree of severity. In mild or moderate disease, high-potency topical corticosteroid gel is used along with oral antiseptic washes and oral anesthetic solutions [ 1 , 2 ].

In severe disease with extensive mucosal involvement, hospitalization is generally recommended due to limited oral intake. Administration of intravenous fluids and electrolyte replacement are recommended. If ocular involvement is suspected, then ophthalmologic consultation is necessary to prevent serious future complications. Ophthalmologists may prescribe ophthalmic medications, such as antibiotic eyedrops, corticosteroid eyedrops, and topical ophthalmic lubricants to aid in recovery and symptom resolution [ 20 ].

Recurrent EM is the most difficult type of EM to treat due to its refractory nature. Current recommendations include acyclovir, mg, twice daily, valacyclovir, mg, twice daily, or famciclovir, mg, twice daily [ 1 ]. These medications can be administered orally in either a continuous or intermittent fashion [ 12 , 18 ]. A randomized controlled trial from outlined that the most effective approach to treatment was continuous oral antiviral therapy for a period greater than six months [ 18 ].

The greatest efficacy of antiviral therapy is observed in patients whose disease has a clear association with HSV infection. The goal of treatment is to reduce the number of recurrences and to induce remission, which is difficult to maintain.

Recurrence is frequent once antiviral therapy is stopped [ 1 , 2 ]. One study showed that out of 15 patients diagnosed with HSV-associated recurrent EM, only 4 remained in remission after the 6-month continuous antiviral therapy was discontinued [ 18 ].

Patients who are responsive to antiviral therapy should be treated for a minimum of 1 to 2 years before the therapy is discontinued.

If there is recurrence after therapy discontinuation, the medication should be initiated again at the lowest effective dose. Discontinuation can be trialed again after 6—12 months of restarting therapy [ 1 ].

Patients with recurrent EM that are unresponsive to antiviral therapy can try other antiviral drugs or double the dosage of the current drug. Additionally, other systemic agents may be used [ 1 ]. These treatments are outlined in Table 3. This table is an overview of the current recommendations for each type of treatment indicated in the literature [ 1 , 20 ]. Both generic names and brand names, when applicable, are provided.

Antibiotics, azithromycin, and dapsone specifically, have both produced clinical improvement in patients with recurrent EM. Complete response to dapsone was observed in 6 out of 13 patients in a case series from [ 22 ].