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What is the most common cause of recurrent erythema multiforme?
What is the most common cause of recurrent erythema multiforme?
Erythema multiforme major typically involves only the skin.
Erythema multiforme major typically involves only the skin.
False
What is the most prevalent precipitant of erythema multiforme in cases that recur over prolonged periods?
What is the most prevalent precipitant of erythema multiforme in cases that recur over prolonged periods?
Herpes simplex infection
Which of the following is NOT a characteristic of Stevens-Johnson syndrome?
Which of the following is NOT a characteristic of Stevens-Johnson syndrome?
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Match the following clinical presentations with their corresponding skin conditions:
Match the following clinical presentations with their corresponding skin conditions:
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The Stevens-Johnson syndrome is now considered a severe form of erythema multiforme.
The Stevens-Johnson syndrome is now considered a severe form of erythema multiforme.
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The best treatment for erythema multiforme is to ______ the underlying cause.
The best treatment for erythema multiforme is to ______ the underlying cause.
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In mild cases of erythema multiforme, what is the primary treatment approach?
In mild cases of erythema multiforme, what is the primary treatment approach?
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In cases of erythema multiforme major, consultation with dermatologists is sufficient without seeking advice from specialists in other fields.
In cases of erythema multiforme major, consultation with dermatologists is sufficient without seeking advice from specialists in other fields.
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What type of treatment is indicated for oral mucosal involvement in erythema multiforme major, particularly when pain hampers swallowing?
What type of treatment is indicated for oral mucosal involvement in erythema multiforme major, particularly when pain hampers swallowing?
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What should be considered when a patient presents with recurrent or continuous erythema multiforme, particularly if the cause is unknown?
What should be considered when a patient presents with recurrent or continuous erythema multiforme, particularly if the cause is unknown?
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Long-term treatment with oral valaciclovir or famciclovir can prevent attacks of both herpes simplex and recurrent erythema multiforme.
Long-term treatment with oral valaciclovir or famciclovir can prevent attacks of both herpes simplex and recurrent erythema multiforme.
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What is a common clinical presentation of cutaneous small vessel vasculitis?
What is a common clinical presentation of cutaneous small vessel vasculitis?
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Henoch-Schönlein purpura typically affects adults with a history of heart disease.
Henoch-Schönlein purpura typically affects adults with a history of heart disease.
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What is the name of the small vessel vasculitis characterized by burning urticaria-like lesions lasting for more than 24 hours, sometimes leaving bruising and pigmentation?
What is the name of the small vessel vasculitis characterized by burning urticaria-like lesions lasting for more than 24 hours, sometimes leaving bruising and pigmentation?
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General features of vasculitis may include ______ and arthralgia.
General features of vasculitis may include ______ and arthralgia.
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Which of the following is a possible complication of cutaneous small vessel vasculitis?
Which of the following is a possible complication of cutaneous small vessel vasculitis?
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A raised, palpable purpura is a characteristic of vasculitis.
A raised, palpable purpura is a characteristic of vasculitis.
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What kind of investigation is most crucial for confirming a diagnosis of vasculitis?
What kind of investigation is most crucial for confirming a diagnosis of vasculitis?
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Treatment for vasculitis primarily focuses on managing symptoms and does not typically involve addressing the underlying cause.
Treatment for vasculitis primarily focuses on managing symptoms and does not typically involve addressing the underlying cause.
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What medication is often used as a first-line therapy for vasculitis, especially when it affects internal organs?
What medication is often used as a first-line therapy for vasculitis, especially when it affects internal organs?
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Which of the following medications may be useful for treating painful skin lesions and associated arthralgia in vasculitis, but should be avoided in cases of renal involvement?
Which of the following medications may be useful for treating painful skin lesions and associated arthralgia in vasculitis, but should be avoided in cases of renal involvement?
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What is the most common characteristic of Wegener's granulomatosis that distinguishes it from other inflammatory conditions?
What is the most common characteristic of Wegener's granulomatosis that distinguishes it from other inflammatory conditions?
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The presence of antineutrophil antibodies, specifically the c-ANCA with anti-PR3 specificity, confirms a diagnosis of Wegener's granulomatosis.
The presence of antineutrophil antibodies, specifically the c-ANCA with anti-PR3 specificity, confirms a diagnosis of Wegener's granulomatosis.
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What medication is considered the mainstay treatment for Wegener's granulomatosis and is often used in combination with systemic steroids?
What medication is considered the mainstay treatment for Wegener's granulomatosis and is often used in combination with systemic steroids?
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What are the main clinical presentations of polyarteritis nodosa?
What are the main clinical presentations of polyarteritis nodosa?
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A deficiency of α1-antitrypsin is a common cause of polyarteritis nodosa.
A deficiency of α1-antitrypsin is a common cause of polyarteritis nodosa.
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What type of infection is commonly associated with cutaneous polyarteritis nodosa, particularly in children?
What type of infection is commonly associated with cutaneous polyarteritis nodosa, particularly in children?
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Study Notes
Erythema Multiforme
- Cause: A reaction to infection (90% of cases), often herpes simplex, or a drug (50% of cases). Sometimes no provoking factor is found.
- Presentation: Upper respiratory infection symptoms may precede the eruption. Annular, non-scaling plaques appear mainly on extremities (palms, soles, forearms, legs). Individual lesions get bigger but clear in the center, creating a target appearance. Mucous membrane involvement (oral, genital, ocular, pharyngeal) occurs in more severe (major) cases, often with fever and malaise. Some lesions may blister.
- Course: New lesions appear over 1-2 weeks, until the provoking factor is gone. Individual lesions last a few days. Grey or brown patches mark the site of resolved lesions. Recurring bouts of lesions (with repeated attacks) are possible and may last years. Herpes simplex infection is often a trigger.
- Complications: Usually no complications. Severe lesions in the respiratory tract can lead to asphyxia. Eye ulcers can cause blindness. Genital ulcers can cause urinary retention and phimosis or vaginal stricture.
Stevens-Johnson Syndrome
- Relationship to Erythema Multiforme: No longer considered a severe form of erythema multiforme; it's now considered part of the toxic epidermal necrolysis (TEN) spectrum of diseases.
Erythema Nodosum
- Definition: Inflammation of subcutaneous fat (panniculitis). Specifically septal panniculitis, with inflammation confined to the septae between fat lobules.
- Presentation: Tender red nodules (alone or in groups) appear mostly on the legs and forearms, sometimes on thighs, face, breasts, or other fatty areas. Some patients experience painful joints and fever.
- Course: Individual lesions resolve over 2 weeks. New lesions can arise over a period of 6-8 weeks. Persistent lesions may be called nodular vasculitis.
- Complications: Nodules can be very painful, making walking difficult. Erythema nodosum leprosum can occur in leprosy patients with established cell-mediated immunity against Mycobacterium leprae, resulting in serious illness (severe malaise, arthralgia, and fever).
Vasculitis
- Definition: Inflammation of blood vessel walls, characterized by endothelial cell swelling, necrosis, or fibrinoid change. Clinical presentation can vary based on the size of the affected vessel.
- Causes: Immune complexes lodge in vessel walls (primarily postcapillary venules) activating complement, drawing in neutrophils that damage the vessel wall. Common antigens include drugs, autoantigens and infectious agents.
- Presentation: Painful palpable purpura is common (in dependent areas like the legs and forearms in ambulatory patients. Buttocks and flanks in bedridden ones) The lesions might have a dark center (necrosis). Henoch-Schönlein purpura, a type of vasculitis is common in children, often following a respiratory tract infection. Urticarial vasculitis is also possible, presenting as burning, raised lesions lasting >24 hours, potentially with purpuric foci in the wheals.
- Course: Course varies depending on the cause, affected vessel size, extent of involvement, and organ involvement. Some types spontaneously resolve; others can be chronic or recurrent.
- Complications: Vasculitis can affect many organs (kidneys, CNS, GI tract, lungs).
Wegener's Granulomatosis
- Cause: Granulomatous vasculitis of unknown cause.
- Presentation: Fever, weight loss, fatigue, nasorespiratory symptoms (rhinitis, hearing loss), and often symmetrical skin lesions (ulcers or papules). Internal organs (eyes, joints, heart, nerves, lungs, and kidneys) can be involved.
- Typical features: Antineutrophil antibodies (usually C-ANCA with anti-PR3 specificity).
- Treatment: Cyclophosphamide is the treatment of choice, often used together with steroids.
Polyarteritis Nodosa
- Cause: Necrotizing vasculitis affecting medium-sized vessels; the cause is often unknown or related to immune complexes, sometimes containing hepatitis B or C, or linked to certain antigens, B-cell lymphomas, and other immunotherapies.
- Presentation: Tender subcutaneous nodules along arteries, potentially ulcerating or becoming necrotic.
- Clinical Manifestations: May be systemic, involving kidneys, gut, heart, nerves, testicles, and joints. Cutaneous involvement is possible. Symptoms can include fever, weight loss, pain in muscles or joints, and abdominal pain. Renal involvement is common.
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Description
This quiz covers the essentials of Erythema Multiforme, including its causes, presentation, and course of the disease. Learn about the symptoms associated with this condition, particularly in relation to infections and drug reactions. Understand the potential complications and the typical progression of lesions.
