Erythema Multiforme / Stevens Johnson Syndrome

“Erythema” means redness and “Multi” means many and “Forme” means shapes. Erythema multiforme is the hypersensitivity reaction of skin, which is usually due to infection such as herpes simplex virus (HSV). It is presented mainly as skin lesion; mucous membranes may also be involved.  If it’s acute and self-limiting, it resolves without complications.

erythema multiforme

Alternate names:
Lyell’s syndrome; Erythema multiforme minor; Erythema multiforme major; Dermatostomatitis; Herpes iris.

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Age / Sex of Erythema Multiforme

Erythema multiforme affects people of 20-40 years; it can affect infant and young children. Male and female are equally affected.

Causes of Erythema Multiforme

• Damaged immune system
• Mycoplasma pneumonia
• Herpes simplex
• Infection
• Fungal infection
• Medications
• Nonsteroidal anti-inflammatory drugs

Erythema Multiforme Signs and Symptoms

• Fever
• Itching of the skin
• General ill feeling
• Joints pain
• Multiple skin lesions which appears quickly and may return and spread
• Lesions appears as nodule, papule, macule or hives
• Mouth sores
• Bloodshot eyes
• Eyes pain
• Vision problem
• Dry eyes
• Eye burning, itching and discharge

Investigations for Erythema Multiforme

• Complete case history
• Physical examination
• Skin lesion biopsy
• Skin examination under microscope
• Nikolshy’s sign

Treatment for Erythema Multiforme

• Antihistamines/ topical corticosteroids
• Antiseptic
• Antiviral medicines
• Antipyretics
• Tropical anesthesia
• Antibiotics
• Severe cases can be treated in intensive care unit
• See ophthalmologist
• Good hygiene level

Prognosis of Erythema Multiforme

Prognosis of mild erythema mutliforme is good as it gets better in 2-6 weeks, but problem may return where as its hard to treat severe forms.

Complications of Erythema Multiforme

• Sepsis
• Permanent skin damage and scarring
• Cellulitis
• Shock
• Myocarditis
• Pneumonitis
• Nephritis
• Hepatitis
• Blood poisoning
• Permanent eye damage

Differential diagnosis of Erythema Multiforme

• Autoimmune bullous disease
• Drug eruption
• Figurate erythema
• Lupus erythematosus
• Pityriasis rosea
• Polymorphic light eruption
• Urticaria
• Urticarial vasculitis
• Vasculitis
• Viral exanthema
• Other hypersensitivity reaction
• Behcet’s disease
• Drug reaction

Diet / management of Erythema Multiforme

• Keep proper hygiene level.
• Withdraw drugs which are known responsible for disease
• Antiviral therapy is administered if person has history of HSV.
• Person is asked to take well nutritious diet
• Drink plenty of fluids
• Quit alcohol and smoking

Homeopathic treatment for Erythema Multiforme

Arsenicum album:
• Intense itching, burning and scratching till it becomes raw
• When burning stops itching returns
• Skin dry and paper flaky
• Worse after midnight , cold air or bath
• Better in hot, bathing , warm room

Apis mellifica:
• Skin rashes that feel hot and dry
• Skin sensitive to touch
• Skin complaints associated with sore throat
• Relieved by cold drinks and baths
• Worse by heat and warm liquids

Rhus toxicodendron:
• Blister and vesicles formation
• Intense itching which is worse at night
• Itching better by heat application
• Patient restless and uncomfortable throughout the night.

Sepia officinalis:
• Itching in the face, on arms, hands, hips, feet burning with scratching
• Soreness of skin and humid places in bends of the joints
• Brown spots, or claret-colored, tetter spots
• Ulcers, painless or itching, stinging and burning
• Humid tetter with itching and burning

• Skin disorder accompanied by fever and intense itching
• Person thirsty, irritable while sick, lazy and messy under ordinary circumstances
• Sensation of internal heat and burning
• Better in open, cold air
• Worse in warmth

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