Erythema Multiforme and Nephritis

Comaish, J.S.; Kerr, David

doi:10.1136/bmj.2.5244.84

Cited by 33 publications

(6 citation statements)

References 11 publications

(9 reference statements)

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“…Mucosal lesions may occur including mouth ulcers [1], genital ulcers and conjunctival involvement, sometimes resulting in corneal opacity [2], Extracutaneous manifestations such as arthritis, intrahepatic cholestasis [3], pneumonitis [3,4], glomerulonephritis [5] and pyrexia are pres ent infrequently.…”

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confidence: 99%

Erythema multiforme (Stevens-Johnson Syndrome) – Chart Review of 123 Hospitalized Patients

Nethercott

Choi

1985

Dermatology

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The charts of 123 patients hospitalized with erythema multiforme were reviewed. Antecedent infections and the administration of drugs were associated with 15 and 32% of the cases, respectively. Pyrexia arthralgia, photosensitivity, abnormal liver function tests and abnormal urine sediment were common findings. The length of stay in hospital was 12.6 ± 0.7 days (mean ± SE), time to initial improvement after onset was 10.3 ± 0.6 days and time to complete resolution was 23.0 ± 2.4 days. The presence of bullous skin lesions and greater overall severity were associated with longer hospitalization. Antecedent respiratory tract symptoms were related to shorter hospitalization. Steroid therapy was not associated with a shorter time for initial improvement to occur, while the average length of stay in hospital was 4.2 days longer than that for the patients not treated with corticosteroid.

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confidence: 99%

Erythema multiforme (Stevens-Johnson Syndrome) – Chart Review of 123 Hospitalized Patients

Nethercott

Choi

1985

Dermatology

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“…Erosive changes may also develop on the genitalia. The condition is also characterised by a severe constitutional disturbance and may result in death, usually from pneumonia (Finland, 1958) or renal failure (Comaish and Kerr, 1961). The usual outcome is spontaneous resolution in two to three weeks, but there may be residual damage due to scarring, especially in the eyes, which Received May 7,1981/Accepted July 5,1981 occasionally leads to blindness (Duke-Elder, 1965).…”

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confidence: 99%

Vaginal Stenosis Due to Bullous Erythema Multiforme (Stevens‐johnson Syndrome)

Graham‐Brown

Cochrane

Swinhoe

et al. 1981

BJOG

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Summary Bullous erythema multiforme is a disorder in which oral and genital erosions, ocular inflammation and cutaneous bullae may follow a viral or bacterial infection or the ingestion of certain drugs, such as sulphonamides. Unpleasant sequelae have been reported including residual scarring, and death may occasionally result from infection or renal failure; severe scarring can cause blindness and infrequently the genital tract is involved. We report a patient who developed complete vaginal stenosis following bullous erythema multiforme in pregnancy.

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“…The ocular lesions may be controlled by adequate care, but at times corneal opacities and blindness may result (Arstikaitis 1973). Pneumonias and renal failure are also not infrequent sequelae, especially in fatal cases (Ashby & Lazar 1951;Comaish & Kerr 1961;Finland et al 1948). The degree ofmucosal involvement is the distinguishing characteristic of erythema multiforme major: it is a matter of opinion whether this and toxic epidermal neerolysis are 2 different entities.…”

Section: Clinical Featuresmentioning

confidence: 96%

Clinical Features and Management of Severe Dermatological Reactions to Drugs

1990

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Cutaneous adverse drug reactions are a frequent occurrence and have been reported in more than 2% of hospitalised patients. Among the most commonly involved drugs are sulphonamides, penicillins, anticonvulsants and non-steroidal anti-inflammatory drugs. Two groups of mechanisms are involved in the pathogenesis of drug reactions: immunological, with all 4 types of hypersensitivity reactions described; and non-immunological, accounting for at least 75% of all drug reactions. Besides minor skin reactions like urticaria, maculopapular rash, fixed eruptions or erythema nodosum, which are generally self-limited, severe life-threatening manifestations also occur. Erythema multiforme is secondary to drugs in half the cases; the minor form is characterised by typical target and iris lesions and is usually benign. However, a much more severe condition, erythema multiforme major or Stevens-Johnson syndrome, is associated with mucosal, ocular and visceral involvement, and carries a mortality of 5 to 15% if untreated. Toxic epidermal necrolysis, which could represent an even more dramatic form of the same disease, is characterised by severe widespread erythema, blisters and loss of skin in sheets, with denudation of more than 10% of the body surface area. This entity is frequently due to drugs. Mortality is 25 to 70%, and 90% of the survivors will have sequelae. Exfoliative dermatitis is an erythematous scaling disease often produced by drugs and carrying significant mortality. Photodermatitis may at times present with severe eczematous features. For clinical and epidemiological reasons it is important to try to identify the culprit drug following an approach based on previous experience with the drug, timing of events, patient reaction to dechallenge, patient reaction to rechallenge (if feasible), alternative aetiological candidates, and drug concentration or evidence of overdose. Management of severe skin reactions to drugs should require admission to a burn unit, where patients should be placed in warmed air-fluidised beds, receive excellent nursing care, analgesics and tranquillisers. Peeling necrotic epidermis should be removed and denuded dermis covered with biological grafts or synthetic dressings. Fluid balance must be adequately maintained; nutritional support and careful monitoring of early signs of skin infections is mandatory to ensure immediate antimicrobial treatment. Ocular care must be excellent to avoid serious sight-threatening sequelae. Steroids are presently not recommended. With these therapeutic modalities, morbidity and mortality can be markedly decreased.

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Erythema Multiforme and Nephritis

Cited by 33 publications

References 11 publications

Erythema multiforme (Stevens-Johnson Syndrome) – Chart Review of 123 Hospitalized Patients

Erythema multiforme (Stevens-Johnson Syndrome) – Chart Review of 123 Hospitalized Patients

Vaginal Stenosis Due to Bullous Erythema Multiforme (Stevens‐johnson Syndrome)

Clinical Features and Management of Severe Dermatological Reactions to Drugs

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