1. BCOM Otolaryngology - Erythema MutliformeSee An Article On Erythema Multiforme A Erythema Exsudativum Multiforme, Minor Form / images http://www.bcm.tmc.edu/oto/grand/22092.html

Grand Rounds Archives The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at The Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature. ERYTHEMA MULTIFORME AND TOXIC EPIDERMAL NECROLYSIS Michael G. Stewart, MD February 20, 1992 Clinical Features The diagnostic criteria for erythema multiforme (EM) is individual "target" skin lesions less than 3 cm in diameter, less than 20% of body surface area involved, with minimal mucous membrane involvement, and biopsy compatible with EM. The cutaneous lesions are typically symmetric, and involve the extremities, with the dorsal hands and extensor aspects most commonly involved. Many authors use the designation erythema multiforme minor and major, with EM minor meaning skin lesions only, and EM major being synonymous with Stevens-Johnson syndrome.

2. MEDLINEplus Medical Encyclopedia: Erythema Multiforme erythema multiforme. necrolysis. Definition Return to top erythema multiformeis a skin disorder resulting from an allergic reaction. http://www.nlm.nih.gov/medlineplus/ency/article/000851.htm

Skip navigation Medical Encyclopedia Other encyclopedia topics: A-Ag Ah-Ap Aq-Az B-Bk ... Z Erythema multiforme Contents of this page: Illustrations Alternative names Definition Causes, incidence, and risk factors ... Calling your health care provider Illustrations Erythema multiforme on the hands Erythema multiforme, circular lesions - hands Erythema multiforme, target lesions on the palm Erythema multiforme on the leg ... Exfoliation following erythroderma Alternative names Return to top Lyell's syndrome; Stevens-Johnson syndrome; Toxic epidermal necrolysis Definition Return to top Erythema multiforme is a skin disorder resulting from an allergic reaction Causes, incidence, and risk factors Return to top Erythema multiforme is a type of hypersensitivity (allergic) reaction that occurs in response to medications, infections, or illness. Medications associated with erythema multiforme include sulfonamides, penicillins, barbiturates, and phenytoin. Associated infections include herpes simplex and mycoplasma infections. The exact cause is unknown. The disorder is believed to involve damage to the blood vessels of the skin with subsequent damage to skin tissues. Approximately 90% of erythema multiforme cases are associated with herpes simplex or Mycoplasma infections. The disorder occurs primarily in children and young adults.

3. THE MERCK MANUAL, Sec. 10, Ch. 118, Inflammatory Reactions Simple erythema often needs no treatment. erythema multiforme associated with mycoplasmal pneumonia should be treated http://www.merck.com/pubs/mmanual/section10/chapter118/118d.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 10. Dermatologic Disorders Chapter 118. Inflammatory Reactions Topics [General] Drug Eruptions Toxic Epidermal Necrolysis Erythema Multiforme ... Granuloma Annulare Erythema Multiforme (Erythema Multiforme Exudativum Or Bullosum) An inflammatory eruption characterized by symmetric erythematous, edematous, or bullous lesions of the skin or mucous membranes. Mycoplasma pneumoniae, The mechanism by which infectious agents, drugs, or vaccines cause erythema multiforme is unknown, but it is generally considered a hypersensitivity reaction. Symptoms, Signs, and Diagnosis Onset is usually sudden, with erythematous macules, papules, wheals, vesicles, and sometimes bullae appearing mainly on the distal portion of the extremities (palms, soles) and on the face; hemorrhagic lesions of the lips and oral mucosa can also occur (see Oral Erythema Multiforme in Ch. 105). The skin lesions (target or iris lesions) are symmetric in distribution and often annular, with concentric rings, central purpura, and grayish discoloration of the epidermis or vesicle (see Plate 118-1 ). Itching is variable. Systemic symptoms vary; malaise, arthralgia, and fever are frequent. Attacks sometimes last 2 to 4 wk and recur in the fall and spring for several years.

4. EMedicine - Erythema Multiforme : Article By James Foster, MD, MS erythema multiforme erythema multiforme (EM) is an acute mucocutaneous hypersensitivityreaction of variable severity characterized by a symmetrically http://www.emedicine.com/EMERG/topic173.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Emergency Medicine Dermatology Erythema Multiforme Last Updated: April 20, 2001 Rate this Article Email to a Colleague Synonyms and related keywords: EM major, EM minor, Stevens-Johnson syndrome AUTHOR INFORMATION Section 1 of 11 Author Information Introduction Clinical Differentials ... Bibliography Author: James Foster, MD, MS , Consulting Staff, Department of Emergency Medicine, Palomar Medical Center, Alvarado Hospital Medical Center James Foster, MD, MS, is a member of the following medical societies: Alpha Omega Alpha American College of Emergency Physicians , and Phi Beta Kappa Editor(s): Debra Slapper, MD , Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital; Francisco Talavera, PharmD, PhD , Senior Pharmacy Editor, Pharmacy, eMedicine; Mark W Fourre, MD , Program Director, Department of Emergency Medicine, Maine Medical Center, Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine; John Halamka, MD

5. EMedicine - Erythema Multiforme : Article By Chulabhorn Pruksachatkunakorn, MD erythema multiforme erythema multiforme (EM) is an acute self-limited eruptioncharacterized by a distinctive clinical eruption, the hallmark of which is the http://www.emedicine.com/DERM/topic137.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Dermatology Reactive And Inflammatory Dermatoses Erythema Multiforme Last Updated: November 5, 2001 Rate this Article Email to a Colleague AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography Author: Chulabhorn Pruksachatkunakorn, MD , Chief, Division of Dermatology, Associate Professor, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand Coauthor(s): Lawrence Schachner, MD , Director of Pediatric Dermatology, Professor, Departments of Dermatology and Pediatrics, University of Miami School of Medicine Chulabhorn Pruksachatkunakorn, MD, is a member of the following medical societies: American Academy of Dermatology Editor(s): Evan Farmer, MD , Dean and Provost, Professor, Departments of Pathology, Anatomy, and Internal Medicine, Division of Dermatology, Eastern Virginia Medical School; Michael J Wells, MD

6. Erythema Multiforme Target Rash erythema multiforme. I. Definition erythema multiforme is an allergic reaction with many different causes. http://www.capederm.com/info_erythema_multiforme.htm

Erythema Multiforme I. Definition: Erythema multiforme is an allergic reaction with many different causes. It can affect people of all ages and is often more severe in children and young adults. Erythema multiforme often starts as a red rash on the palms, soles, and back of the hands. It can spread to the trunk, face, and mouth in severe cases. Some people only have erythema multiforme in the mouth. As the skin lesions age they often look like small targets with purple to dusky centers surrounded by red rings. The condition can be associated with fever, muscle aches, and not feeling well. II. Causes: There are many causes of erythema multiforme. These include allergic reactions to viral, bacterial, and fungal infections; sensitivity to food or drugs; immunizations; or sometimes it occurs in association with other disorders. The most common causes of erythema multiforme are Mycoplasma pneumonia, cold sores, herpes of the genitals, and as a reaction to medication (sulfa drugs). Erythema multiforme is not contagious.

7. MEDLINEplus Medical Encyclopedia: Erythema Multiforme On The Leg Medical Encyclopedia. erythema multiforme on the leg. The red spotson this person’s back appear where blisters (bullae) caused http://www.nlm.nih.gov/medlineplus/ency/imagepages/2413.htm

Skip navigation Medical Encyclopedia Erythema multiforme on the leg The red spots on this person’s back appear where blisters (bullae) caused by Erythema multiforme have ruptured and the overlying skin removed (denuded). The resulting lesions are yellow-crusted ulcers (erosions). Erythema multiforme may be associated with herpes simplex infection, mycoplasma pneumonia, or other medical conditions such as streptococcal infection, tuberculosis (TB), or may result from exposure to chemicals or medications. Health Topics Drug Information Encyclopedia Dictionary ... National Institutes of Health Page last updated: 10 January 2003

8. Erythema Multiforme erythema multiforme is part of a spectrum of diseases beginning with a selflimited rash of the skin and mucous http://www.dermnet.org.nz/dna.erythema.multiform/ermulti.html

Home Patient information Erythema Multiforme Erythema multiforme is the name given to a short-lasting illness, which sometimes recurs. It causes a characteristic rash and often blisters in the mouth and elsewhere. Target lesions Blistering lesions Erythema multiforme minor This results in uncomfortable round skin lesions on the forearms, hands, knees and feet. Some of the skin patches appear like a target, i.e. rings of red and pink. Often the centre of the patch forms a fluid-filled blister. Sometimes, the rash is accompanied by sores and blisters on the lips. The patient may be mildly off colour, but recovers in a few days or up to three weeks. Erythema multiforme major In this less common form, the mouth, eyes and genitals are red, blistered and sore. In such cases, the patient usually feels unwell with a high temperature, and may find it difficult to eat and drink. This is sometimes called Stevens-Johnson syndrome, and may require admission to hospital. Toxic epidermal necrolysis (TEN) TEN is serious but luckily rare. The patient is very ill, and the skin over large parts of the body peels off in sheets, like a serious burn. TEN is often a severe allergic reaction to a medicine, which must NEVER be taken again.

9. Erythema Multiforme erythema multiforme information for patients. NZ DermNet is an online dermatologyresource for patients, GPs and dermatologists. erythema multiforme. http://www.dermnetnz.org/dna.erythema.multiform/ermulti.html

Home Patient information Erythema Multiforme Erythema multiforme is the name given to a short-lasting illness, which sometimes recurs. It causes a characteristic rash and often blisters in the mouth and elsewhere. Target lesions Blistering lesions Erythema multiforme minor This results in uncomfortable round skin lesions on the forearms, hands, knees and feet. Some of the skin patches appear like a target, i.e. rings of red and pink. Often the centre of the patch forms a fluid-filled blister. Sometimes, the rash is accompanied by sores and blisters on the lips. The patient may be mildly off colour, but recovers in a few days or up to three weeks. Erythema multiforme major In this less common form, the mouth, eyes and genitals are red, blistered and sore. In such cases, the patient usually feels unwell with a high temperature, and may find it difficult to eat and drink. This is sometimes called Stevens-Johnson syndrome, and may require admission to hospital. Toxic epidermal necrolysis (TEN) TEN is serious but luckily rare. The patient is very ill, and the skin over large parts of the body peels off in sheets, like a serious burn. TEN is often a severe allergic reaction to a medicine, which must NEVER be taken again.

10. Erythema Multiforme erythema multiforme. Alternative names StevensJohnson syndrome; toxic epidermal necrolysis; Lyell'ssyndrome http://user.chollian.net/~yunheon/erythema.html

Erythema multiforme Alternative names: Stevens-Johnson syndrome; toxic epidermal necrolysis; Lyell'ssyndrome Definition: A skin disorder resulting from an allergic reaction. Causes, incidence, and risk factors: Erythema multiforme is a type of hypersensitivity (allergic)reaction that occurs in response to medications, infections, or illness.Medications associated with erythema multiforme include sulfonamides,penicillins, barbiturates, and phenytoin. Associated infections includeherpes simplex and mycoplasma infections. The exact cause is unknown. The disorder is believed toinvolve damage to the blood vessels of the skin with subsequent damage toskin tissues. Approximately 90% of erythema multiforme cases are associatedwith herpes simplex or Mycoplasma infections. The disorder occurs primarilyin children and young adults. Erythema multiforme may present with a classic skin lesionwith or without systemic (whole body) symptoms. In Stevens-Johnson syndrome,the systemic symptoms are severe and the lesions are extensive, involvingmultiple body areas (especially the mucous membranes). Toxic epidermalnecrolysis (TEN syndrome, or Lyell's syndrome) involves multiple large blisters(bullae) that coalesce, followed by sloughing of all or most of theskin and mucous membranes. Prevention: No prevention is known. Avoidance of known allergens (substancesthat cause allergic reaction) may reduce the risk.

11. Erythema Multiforme American Osteopathic College of Dermatology skin disease database erythema multiforme(EM) is an acute, selflimiting, inflammatory skin eruption.The rash is http://www.aocd.org/skin/dermatologic_diseases/erythema_multiform.html

[ click a disease picture to see larger view ] Erythema Multiforme Erythema multiforme (EM) is an acute, self-limiting, inflammatory skin eruption. The rash is made of spots that are red welts, sometimes with purple or blistered areas in the center. It often also affects the mouth, eyes and other moist surfaces. Erythema multiforme has been so named because of the "multiple forms" it appears in; there is a large degree of variety in its clinical presentation. This variation has led to EM being divided into two overlapping subgroups (EM minor and Stevens-Johnson syndrome). These are different faces of the same disease. EM is relatively common problem for a dermatologist. Half the cases are in young people (under 20). It rare both under the age of 3 and over the age of 50. Males are slightly more affected than females and there is no racial predilection. One third of EM sufferers will have a recurrence of the disease. Seasonal epidemics are common. Erythema multiforme minor : EM minor as the name suggests is the less severe of the two types and accounts for 80% of EM. The rash appears over a few days, however in some patients several crops follow each other during one attack. There may be minor burning or itch. It is most intense over the backs of the hands and feet. There are usually round "bulls eye" target shaped rings on the palms. In severe cases some blisters may be present both on the skin and lips. The rash lasts for 1 to 2 weeks and then recedes leaving residual brown pigmentation.

12. Erythema Multiforme - 1 Dept. of Dermatology University of Iowa College of Medicine. erythema multiforme- Left Foot - Annular Target Lesions. Return to Image Index page. http://tray.dermatology.uiowa.edu/EMult001.htm

Dept. of Dermatology - University of Iowa College of Medicine Erythema Multiforme - Left Foot - Annular Target Lesions Return to Image Index page. Return to Image Index page. Return to Dermatology's Home page. September, 1995

13. Erythema Multiforme - 3 Dept. of Dermatology University of Iowa College of Medicine. erythema multiforme- Left Medial Foot - Annular Bullous Lesions. Return to Image Index page. http://tray.dermatology.uiowa.edu/EMult003.htm

Dept. of Dermatology - University of Iowa College of Medicine Erythema Multiforme - Left Medial Foot - Annular Bullous Lesions Return to Image Index page. Return to Image Index page. Return to Dermatology's Home page. September, 1995

14. Erythema Multiforme, Stevens-Johnson Syndrome, And Toxic Epidermal Necrolysis Volume 4 Number 11, November 1998. erythema multiforme, StevensJohnson Syndrome,and Toxic Epidermal Necrolysis. Kate M. Petersen, Pharm.D. erythema multiforme. http://hsc.virginia.edu/cmc/pedpharm/v4n11.htm

Pediatric Pharmacotherapy A Monthly Review for Health Care Professionals of the Children's Medical Center Volume 4 Number 11, November 1998 Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis Kate M. Petersen, Pharm.D. Introduction Erythema multiforme Stevens Johnson Syndrome Toxic epidermal necrolysis ... References Pharmacology Literature Reviews Adverse Effects from Anesthetics Frequency of Adverse Drug Reactions Grapefruit Juice with Carbemazepine Formulary Update Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are mucocutaneous disorders that are thought to be related, constituting a spectrum of reactions. Erythema multiforme (EM) has the most benign presentation, and is followed in severity by Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Additionally, EM is generally a postinfectious process, while SJS and TEN are drug-induced reactions. As a result, SJS and TEN will therefore be discussed in greater detail than EM in this newsletter article. Erythema multiforme EM, first described in 1860 by von Hebra

15. Erythema Multiforme erythema multiforme, Book, Home antigens. Types erythema multiformeMinor; erythema multiforme Major (Stevens Johnson Syndrome). Causes http://www.fpnotebook.com/DER12.htm

Home About Links Index ... Editor's Choice Paid Advertisement (click above). Please see the privacy statement Dermatology Allergy Dermatitis ... Rhus Dermatitis Assorted Pages Erythema Annulare Centrifugum Erythema Multiforme Erythema Multiforme Major Erythema Multiforme Minor ... Dermatographism Erythema Multiforme Book Home Page Cardiovascular Medicine Dental Dermatology Emergency Medicine Endocrinology Gastroenterology General Medicine Geriatric Medicine Gynecology Hematology and Oncology HIV Infectious Disease Jokes Laboratory Neonatology Nephrology Neurology Obstetrics Ophthalmology Orthopedics Otolaryngology Pediatrics Pharmacology Prevention Psychiatry Pulmonology Radiology Rheumatology Sports Medicine Surgery Urology Chapter Dermatology Index Acne Allergy Bacteria Blister Cardiovascular Medicine Dermatitis Dry Endocrinology Environmental Injury Examination Ophthalmology Fungus Hair Hematology and Oncology Hyperplasia Infectious Disease Laboratory General Nails Parasite Pediatrics Pharmacology Pigment Prevention Procedure Psychiatry Rheumatology Sebaceous Sports Medicine Sweat Symptom Evaluation Wart Page Allergy Index Dermatitis Contact Dermatitis Contact Latex Dermatitis Contact Rhus Erythema Annulare Centrifugum Erythema Multiforme Background Erythema Multiforme Major Erythema Multiforme Minor Erythema Nodosum Urticaria Urticaria Papular Pathophysiology Self limited mucocutaneous reaction Hypersensitivity Reaction to various antigens Types Erythema Multiforme Minor Erythema Multiforme Major (Stevens Johnson Syndrome) Causes Idiopathic (50%) Herpes Simplex Virus Occurs 10 days after acute eruption

16. Erythema Multiforme Major erythema multiforme Major Steven's Johnson Syndrome. Book, PathophysiologySevere clinical variant of erythema multiforme. Symptoms http://www.fpnotebook.com/DER13.htm

Home About Links Index ... Editor's Choice Paid Advertisement (click above). Please see the privacy statement Dermatology Allergy Dermatitis ... Rhus Dermatitis Assorted Pages Erythema Annulare Centrifugum Erythema Multiforme Erythema Multiforme Major Erythema Multiforme Minor ... Dermatographism Erythema Multiforme Major Steven's Johnson Syndrome Book Home Page Cardiovascular Medicine Dental Dermatology Emergency Medicine Endocrinology Gastroenterology General Medicine Geriatric Medicine Gynecology Hematology and Oncology HIV Infectious Disease Jokes Laboratory Neonatology Nephrology Neurology Obstetrics Ophthalmology Orthopedics Otolaryngology Pediatrics Pharmacology Prevention Psychiatry Pulmonology Radiology Rheumatology Sports Medicine Surgery Urology Chapter Dermatology Index Acne Allergy Bacteria Blister Cardiovascular Medicine Dermatitis Dry Endocrinology Environmental Injury Examination Ophthalmology Fungus Hair Hematology and Oncology Hyperplasia Infectious Disease Laboratory General Nails Parasite Pediatrics Pharmacology Pigment Prevention Procedure Psychiatry Rheumatology Sebaceous Sports Medicine Sweat Symptom Evaluation Wart Page Allergy Index Dermatitis Contact Dermatitis Contact Latex Dermatitis Contact Rhus Erythema Annulare Centrifugum Erythema Multiforme Background Erythema Multiforme Major Erythema Multiforme Minor Erythema Nodosum Urticaria Urticaria Papular Pathophysiology Severe clinical variant of Erythema Multiforme Symptoms Prodrome Fever Malaise Prostration Sudden widespread skin eruption Signs Target lesions (See Erythema Multiforme Widespread skin involvement

17. HealthlinkUSA Erythema Multiforme Links medical and health related topics. FindWhat. Click here for page 1 oferythema multiforme information from the HealthlinkUSA directory. http://www.healthlinkusa.com/436ent.htm

18. Erythema Multiforme; Treatment, Prevention, Cure erythema multiformeSearch information from many of the best ErythemaMultiforme health sites. Quickly find information treatments http://www.healthlinkusa.com/content/436.html

Latest Health News Find Drug Information Health Calculators All Words Any Words A B C D ... Z Sunday, March 30, 2003 Alternative therapy struggles to bridge East-West divide Click here to read more Doctors are not following guidelines recommending flu and pneumonia vaccinations for hospitalized adults, leaving millions of elderly patients vulnerable to potentially deadly ailment Click here to read more A helping hand for uninsured; Agencies find ways to provide health care for area children Click here to read more The government has approved the first generic version of the acne drug, Accutane Click here to read more Gates to give India $100m for AIDS; Microsoft CEO begins controversy-laced trip to fight virus Click here to read more Allergies and Asthma Alternative Medicine Arthritis and Your Health ... Women's Health Sunday March 30, 2003 Spina Bifida: Spina Bifida is a rare birth disorder, affecting approximately 1 in 12-1400 live births. Click here to learn more Craniosynostosis: Sagittal Synostosis...males are affected about three times as often as females. Click here to learn more Spinal Cord Injury: Acts of violence have now overtaken falls as the second most common source of spinal cord injury.

19. Erythema Multiforme - Dermatology Health Guide Dermatology. erythema multiforme. What is erythema multiforme? Erythema certainvaccines. What are the symptoms of erythema multiforme? The http://www.umm.edu/dermatology-info/emulit.htm

Dermatology Health Guide Anatomy of the Skin Skin Tests Describing a Skin Condition ... Glossary Related Resources Within UMM Dept. of Dermatology Dermatology Erythema Multiforme What is erythema multiforme? Erythema multiforme is a skin disorder characterized by symmetrically placed, red, raised skin areas all over the body. These patches often look like "targets" (dark circles with purple-grey centers). The skin condition may be chronic and usually lasts for two to four weeks each time. Most often, this disorder is caused by the herpes simplex virus. Other causes may include: an interaction with a certain medication other infectious diseases certain vaccines What are the symptoms of erythema multiforme? The following are the most common symptoms of erythema multiforme. However, each individual may experience symptoms differently: sudden, red patches and blisters, usually on the palms of hands, soles of feet, and face flat, round red "targets" (dark circles with purple-grey centers) itching cold sores fatigue joint pains fever The symptoms of erythema multiforme may resemble other dermatologic conditions. Consult a physician for diagnosis.

20. Smallpox Vaccination – Adverse Reactions: Erythema Multiforme erythema multiforme General. Some are local skin reactions, while othersappear to be hypersensitivity reactions, like erythema multiforme. http://www.bt.cdc.gov/training/smallpoxvaccine/reactions/ery_multi.html

Erythema Multiforme: General of document.write(totalImages) Zoom View All Click on image to enlarge Many vaccinees develop skin rashes after vaccination, almost all of which are benign, if occasionally frightening in appearance. Some are local skin reactions, while others appear to be hypersensitivity reactions, like erythema multiforme. These rashes require only symptomatic therapy. Rarely, a more serious eruption, Stevens Johnson Syndrome may occur, requiring more aggressive therapy which may include steroids. If possible, a dermatology consultation should be obtained before initiating steroid therapy.

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