hi i have had these red spots all over my face when winter started, i know its not Erythema, more like acne or something but i have nothing above my chin just my cheeks and forehead. what could it be? i gave up searching online can't find anything
22 yrs man skin problems?
Hi,
I don't know what could be causing this sudden outbreak but I do know what might really help:
Sea Buckthorn Oil - I buy mine from the following site because it is not diluted as with everwhere else I've tried to find some
http://www.rosacea-remedy.com/remedy.htm...
It has some incredible healing properties which nourish your skin and re-balance it if you know what I mean. Ever since I've been using it my skin has been way better than it was. I just apply the intensive oil whenever I feel likemy skin needs a boost or when I can feelspots coming. It seriously stops the spots in their tracks that they never reallycome to anything ! I don't know how it works but instead of turning into a full blown zit, the spots just stay as tiny little bumps - dry up and flakes away the next day!
I think everyone should have some of this oil in their first aid cabinet because I haven't ever encountered anything like it and I must've tried everything over the years.
Good luck :)
Monday, November 16, 2009
Small bump on skin turned into swelling and pain of surrounding area - what is it?
I had a very small bump on the top of the lower section of my finger. It didn't have any discoloration, pain, or itching - it was about the size and shape of a wart (but not 'crusty' like a wart). I didn't think anything of it, until after about 4 days a perfectly-shaped red circle started to develop around it (no texture, only a color change), and the skin between the bump and the circle was pale. It also hurt - not sharp pain, but deep throbbing that felt like it was coming from inside my finger instead of the skin. It swelled a bit but didn't itch.
A few days later, both the surrounding joints are quite swollen (can hardly move the finger as the base joint is so big) and the spot where the original bump was has a circle of itchy, blistered skin around it. The whole finger hurts; the skin problem is near the base, but if i press on something with the tip of the finger that also hurts.
Doctor said erythema multiforme - though it doesn't look right, as the swelling isn't explained
Small bump on skin turned into swelling and pain of surrounding area - what is it?
I'm sure he asked you a bunch of questions like could it be a bug bite? Could you have accidentally pricked yourself with something?
Try going to another doctor if you are not satisfied with this answer you got before. That condition is associated with herpes simplex, maybe you should check more into it and try to get some tests to make sure. You definitely should follow up on this one.
If it is a bug bite it could have gotten infected and could need a serious round of antibiotics. The swelling could definitely indicate you had some sort of allergic reaction and maybe only a hospital could help. They could put you on some very strong antibiotics and maybe some anti-inflammatory drugs or an anti-histamine. If you leave this be, it could definitely become disastrous. Check it out!
Reply:Could it be MRSA? If you work, or are around someone who does, in a hospital, prison, school, or any other place where a lot of people are in one place you may have a methicillin resistant staphylococcus aureus infection. Also known as MRSA. If there is a pus like substance that you can extract from the site I would go to the Doc immediately for a culture. This is highly contagious and difficult to get rid of. Bactrim and Hibi-cleanse will usually do the trick but sometimes it comes back. Its Bad news. Ill post an info link below: (Ive been dealing with these "bumps" for 3 years and just got them to go away for good!)
Reply:I would try harder to find a doctor. I'm scared. I you have a spider bite it could be so serious. Go to a doctor who doesn't speak English and let him look at it. It may be something he sees alot. Can you get someone else to translate?
Reply:ok, im not sure what it is however, if it is a bite of some kind there is a burn cream called silvadene cream. You can try that just put it on a wrap it up and give it a couple days and you will see improvement. There is also a salve that draws things to the top of the skin and it is called Prid. It is really dark brown and all you need is a little bit. Wrap it with a bandaid and leave it there for a couple of days and if there is anything in it you will see it on the bandaid. Hope this helps and goodluck.
Reply:Lyme disease is a tick-transmitted infection caused by Borrelia burgdorferi. Symptoms include an erythema migrans rash, which may be followed weeks to months later by neurologic, cardiac, or joint abnormalities. Diagnosis is primarily clinical, but acute and convalescent antibody titers may be helpful. Treatment is with antibiotics such as doxycycline or, for serious infections, ceftriaxone.
Please note that I am not a medical professional.
Please see the web page for more details and images on Lyme disease.
A few days later, both the surrounding joints are quite swollen (can hardly move the finger as the base joint is so big) and the spot where the original bump was has a circle of itchy, blistered skin around it. The whole finger hurts; the skin problem is near the base, but if i press on something with the tip of the finger that also hurts.
Doctor said erythema multiforme - though it doesn't look right, as the swelling isn't explained
Small bump on skin turned into swelling and pain of surrounding area - what is it?
I'm sure he asked you a bunch of questions like could it be a bug bite? Could you have accidentally pricked yourself with something?
Try going to another doctor if you are not satisfied with this answer you got before. That condition is associated with herpes simplex, maybe you should check more into it and try to get some tests to make sure. You definitely should follow up on this one.
If it is a bug bite it could have gotten infected and could need a serious round of antibiotics. The swelling could definitely indicate you had some sort of allergic reaction and maybe only a hospital could help. They could put you on some very strong antibiotics and maybe some anti-inflammatory drugs or an anti-histamine. If you leave this be, it could definitely become disastrous. Check it out!
Reply:Could it be MRSA? If you work, or are around someone who does, in a hospital, prison, school, or any other place where a lot of people are in one place you may have a methicillin resistant staphylococcus aureus infection. Also known as MRSA. If there is a pus like substance that you can extract from the site I would go to the Doc immediately for a culture. This is highly contagious and difficult to get rid of. Bactrim and Hibi-cleanse will usually do the trick but sometimes it comes back. Its Bad news. Ill post an info link below: (Ive been dealing with these "bumps" for 3 years and just got them to go away for good!)
Reply:I would try harder to find a doctor. I'm scared. I you have a spider bite it could be so serious. Go to a doctor who doesn't speak English and let him look at it. It may be something he sees alot. Can you get someone else to translate?
Reply:ok, im not sure what it is however, if it is a bite of some kind there is a burn cream called silvadene cream. You can try that just put it on a wrap it up and give it a couple days and you will see improvement. There is also a salve that draws things to the top of the skin and it is called Prid. It is really dark brown and all you need is a little bit. Wrap it with a bandaid and leave it there for a couple of days and if there is anything in it you will see it on the bandaid. Hope this helps and goodluck.
Reply:Lyme disease is a tick-transmitted infection caused by Borrelia burgdorferi. Symptoms include an erythema migrans rash, which may be followed weeks to months later by neurologic, cardiac, or joint abnormalities. Diagnosis is primarily clinical, but acute and convalescent antibody titers may be helpful. Treatment is with antibiotics such as doxycycline or, for serious infections, ceftriaxone.
Please note that I am not a medical professional.
Please see the web page for more details and images on Lyme disease.
Who to seek if I have been biten by a spider and how do I know it is a spider bite?
I live in Ontario Canada. I was sitting in my living room three days ago (Thursday) and felt something crawl up my hand. I had my hand underneath a laptray working on my laptop pc. Before I got my hand out from under the tray something stung me (thumb). I thought it was a bee (it is winter here). A luggage bag had been brought up from the basement earlier in the day. It was so painful and sharp I was sure it was a hornet of some kind. I could not find one. We took the couch apart...lifted it up...vacummed the entire thing...swept the hardwood and the curtains and never found the supposed 'bee' culprit. I had a dot looking like a bee sting, surrounded by a white elevated ring, surrounded by redness. This subsided by the next day...completely. Then Sat night the area became hot and red and looked as if I was just bitten or stung again. The white edges are now gone(Monday) but the dot came up to a blister and opened. It is still has erythema around it and a hard area around it.
Who to seek if I have been biten by a spider and how do I know it is a spider bite?
It IS probably a spider bite. It does not sound like a brown recluse, so it's really nothing to worry about. If it should get more cruddy and infected, you could see a doc, but right now it sounds like it's gonna be ok.
Reply:You can go to you regular doctor and get it checked out - you may need an antibiotic.
Since you are still alive and have not lost your arm to gangrene yet, suffice it to say you have not been bitten by one of the dangerous species of spiders such as black widow or brown recluse. Anything else is the same as if you were bit by another non-poisonous insect.
If you find that you can now climb walls and shoot webs from your wrists, then you were likely bitten by a radioactive spider that had escaped from a research lab.
Reply:ya get it checked out by a doctor
its definately not poisenous because within 24 hours you would of at least seen your arm start to "rot" away and you would of definately freaked out and seen a docter :P
anyways its not to serious in fact it may be a fire ant they tend to do that (pain, more pain, itchy, blister, itchier, blister opens, pain, then its gone; in that order for me anyways)
Reply:Apply hydrogen peroxide to clean the area and apply some neosporin to keep away infection. It could have been a spider bite...probably a wolf spider, or European house spider, as they are very common in Ontario...it would not be the poisonous hobo spider or brown recluse because they are not found in Ontario. Resist the urge to pick or squeeze! And if you are worried about it, or it seems to worsen, or if you come down with flu like symptoms such as fever or nausea then see your doctor.
Also, if it were a tick bite...the tick would be visible...you won't get Lyme disease if the tick didn't latch on...I doubt the person below is a real EMT. And a spider bite does not always present with two distinct fang punctures, due to the fact that the spider is so small and his fangs so close together...a snake bite would show two punctures.
Reply:This is hard to tell if it is a spider bite. what i am worried about is possibly a tick because spider bite usually presents with two not one puncture mark. your description also greatly matches that of a tick bite. IF YOU DEVELOP FLU LIKE SYMTOMS SEE A DOCTOR IMMEDIATELY this is an indication of lime disease a very bad disease carried by ticks and can cause paralysis.
peacock plant
Who to seek if I have been biten by a spider and how do I know it is a spider bite?
It IS probably a spider bite. It does not sound like a brown recluse, so it's really nothing to worry about. If it should get more cruddy and infected, you could see a doc, but right now it sounds like it's gonna be ok.
Reply:You can go to you regular doctor and get it checked out - you may need an antibiotic.
Since you are still alive and have not lost your arm to gangrene yet, suffice it to say you have not been bitten by one of the dangerous species of spiders such as black widow or brown recluse. Anything else is the same as if you were bit by another non-poisonous insect.
If you find that you can now climb walls and shoot webs from your wrists, then you were likely bitten by a radioactive spider that had escaped from a research lab.
Reply:ya get it checked out by a doctor
its definately not poisenous because within 24 hours you would of at least seen your arm start to "rot" away and you would of definately freaked out and seen a docter :P
anyways its not to serious in fact it may be a fire ant they tend to do that (pain, more pain, itchy, blister, itchier, blister opens, pain, then its gone; in that order for me anyways)
Reply:Apply hydrogen peroxide to clean the area and apply some neosporin to keep away infection. It could have been a spider bite...probably a wolf spider, or European house spider, as they are very common in Ontario...it would not be the poisonous hobo spider or brown recluse because they are not found in Ontario. Resist the urge to pick or squeeze! And if you are worried about it, or it seems to worsen, or if you come down with flu like symptoms such as fever or nausea then see your doctor.
Also, if it were a tick bite...the tick would be visible...you won't get Lyme disease if the tick didn't latch on...I doubt the person below is a real EMT. And a spider bite does not always present with two distinct fang punctures, due to the fact that the spider is so small and his fangs so close together...a snake bite would show two punctures.
Reply:This is hard to tell if it is a spider bite. what i am worried about is possibly a tick because spider bite usually presents with two not one puncture mark. your description also greatly matches that of a tick bite. IF YOU DEVELOP FLU LIKE SYMTOMS SEE A DOCTOR IMMEDIATELY this is an indication of lime disease a very bad disease carried by ticks and can cause paralysis.
peacock plant
Part-Time Job Seeking 18 Year Old Male?
I'm trying to get out of Stop %26amp; Shop Grocery Meat Department, as I'm getting sick and my hands have random red target lesions (Erythema Multiformis) on them from being allergic to something. I've been looking everywhere, but I don't see anyone hiring. I've checked Craig's List, Monster.com, and all the other job search functions. Anyone know anyone in the Boston area who needs someone for computer work? I'd rather do computer work considering I'm going to college for Multimedia.
Part-Time Job Seeking 18 Year Old Male?
Your college should be able to help you find a part-time job. Most schools have an office that helps students find employment or at least a job board. You may be able to find a paid internship in your field.
Reply:why don't you try a temp agency or employment agency? in the boston area, there's bound to be tons of them.
Reply:You should join both http://www.treasuretrooper.com/137569 and http://www.*************/index.php?ref=5... to earn money online. Both sites require no upfront costs, and are legit. I've received many checks from them before. You earn money by filling out surveys, and joining trials such as Netflix Get a few friends to join up as your referrals and earn 20% of whatever they earn, plus $1 bonus on CashCrate. I've made as much as $75 a day! Here is some proof of members earnings on TreasureTrooper: http://forum.treasuretrooper.com/index.p... Try it out.
Reply:You may also look out for an option to work online to make extra cash in your spare time. I am a part time worker doing work online at home, so I would like to share a link where you can make $600-$1500 in a month working at home. The work need to be done is posting/answering a discussion and uploading any photo/image of your interest. For details visit
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I will publish few more genuine site in couple of weeks, where you can earn money. You may also write to me at talkofmoney@rediffmail.com (Note: When u are planning for a home based online work, be careful because most of them are scam and ask you to pay initial money. never pay money to any such site.)
Part-Time Job Seeking 18 Year Old Male?
Your college should be able to help you find a part-time job. Most schools have an office that helps students find employment or at least a job board. You may be able to find a paid internship in your field.
Reply:why don't you try a temp agency or employment agency? in the boston area, there's bound to be tons of them.
Reply:You should join both http://www.treasuretrooper.com/137569 and http://www.*************/index.php?ref=5... to earn money online. Both sites require no upfront costs, and are legit. I've received many checks from them before. You earn money by filling out surveys, and joining trials such as Netflix Get a few friends to join up as your referrals and earn 20% of whatever they earn, plus $1 bonus on CashCrate. I've made as much as $75 a day! Here is some proof of members earnings on TreasureTrooper: http://forum.treasuretrooper.com/index.p... Try it out.
Reply:You may also look out for an option to work online to make extra cash in your spare time. I am a part time worker doing work online at home, so I would like to share a link where you can make $600-$1500 in a month working at home. The work need to be done is posting/answering a discussion and uploading any photo/image of your interest. For details visit
http://ommc.blogspot.com
I will publish few more genuine site in couple of weeks, where you can earn money. You may also write to me at talkofmoney@rediffmail.com (Note: When u are planning for a home based online work, be careful because most of them are scam and ask you to pay initial money. never pay money to any such site.)
I've been feeling nauseous for the past year, but I'm not pregnant. What's causing it?
I saw GI doc and he found mild antral erythema but didn't give me much to soothe my discomfort. He insist that there is nothing wrong with my GI tract. What else can be wrong with me that's making me nauseous for a year now? Please help.
I've been feeling nauseous for the past year, but I'm not pregnant. What's causing it?
First - a person can NOT feel "nauseous", because that word means "causing nausea". A person CAN feel nauseated.
One possibility is a chronic ear infection, either in the middle or inner ear. These can cause nausea and/or dizziness. It's worth visiting an ENT specialist to find out.
Reply:Maybe you are just anemic,try with some vitamins.And visit a doctor for some blood tests.
I've been feeling nauseous for the past year, but I'm not pregnant. What's causing it?
First - a person can NOT feel "nauseous", because that word means "causing nausea". A person CAN feel nauseated.
One possibility is a chronic ear infection, either in the middle or inner ear. These can cause nausea and/or dizziness. It's worth visiting an ENT specialist to find out.
Reply:Maybe you are just anemic,try with some vitamins.And visit a doctor for some blood tests.
Does anyone have any experience with IPL laser treatments?
I have had 2 IPL (intense pulsed light) laser treatments on my face and arms for redness (erythema). I was wondering if anyone out there has had this procedure done, and what your results were like. I have one treatment left, and so far I am not noticing much difference in my face, but minor differences on my arms.
Does anyone have any experience with IPL laser treatments?
my god...it hurts like hell!!!!!!I dunno bout u but my specialist increases the pulse rate and the final one stings like hell...I also do get tremedous nausiating headaches the next day...I've stopped going to her ever since...
Does anyone have any experience with IPL laser treatments?
my god...it hurts like hell!!!!!!I dunno bout u but my specialist increases the pulse rate and the final one stings like hell...I also do get tremedous nausiating headaches the next day...I've stopped going to her ever since...
What is this lump on my leg?
I have a doc appointment for monday, but what might this be?
its about half the size of an egg and seems to be getting bigger, i have had it about 3 weeks, not painful unless i press it. its on my right leg on my calf muscle, towards the back but a little bit on the side. i had erythema nodosom when i was pregnant, could it be this? i am not pregnant.
What is this lump on my leg?
This lump, at half the size of an egg and getting bigger, must be checked by your GP, especially because it's increased in size in only 3 weeks.
Every new 'lump and bump' anyone gets must be checked by their doctor no matter where it is, and especially if it seems to be getting bigger. It's unlikely to be your Erythema Nodosum which usually attacks the shins at the front of the leg.
This may, more likely be a lipoma, a lump of fatty tissue, and even (though rare) to be a protrusion or herniation (pushing out) of muscle fibres from your calf muscle - it's hard to tell without examining you! Neverthless, get your GP's opinion - soon.
Reply:Sounds like a big lump to me.
Reply:I bet it is erythema nodosom but I am so glad you are going to get it checked out with the Dr. Good Luck....
Reply:It could just be a cyst because they do increase in size due to the jelly substance that they are filled with. It is great that you have a doctors appointment because he or she can examine it and let you know what has to be done.
Reply:As a woman it is probably your brain..else a cyst
Reply:Like a bruies or a tangled skin tissue. I dunno, maybe a small tumor. I know a girl who had one on her jaw and had to get it removed. We always joked it was a tumor but it wasn't.
Reply:might be your knee cap?
Reply:not enough info given in question,
is it red, warm or is the swelling spreading?have you run a fever?do you have all sensation intact to the extremitie lower to it, that is any numbness or tingling? can you walk on that leg?
you could have a bloot clot and that is a potentionally like threating situation beause ifit breaks off and goes to your lung or heart or brain you could have a pulmonary embolism or a stroke. do not massage the area, most importantly because ifit a clot that could cause it to break apart.
I would call you doc back and let him know it is getttind bigger.
the only other thing i can think it might be is maybe you got a bug bite or scratch and it got infected with staph. in which case you need antiboptics and it needs to be drained and the fulid or cells removed need to be tested. insist on a culture of the fluid remover so you know what it is. this also tells the doctor what antiobotis is appropriate to use.
Reply:The symptoms of Erythema multiforme are;
* Fever, malaise and itching of skin
* Sudden eruption of spots, bumps, and lesions
* Concentrated lesions
* Rashes on the face and arms
These are the symptoms of Erythema nosdosum :
* Tiredness, malaise and flu kind of symptoms
* Clusters of nodules and lesions on shins, forearms, thighs, and trunk
* Joint pain
... if you have two or more of these, you might have E. nodosum. But it appears, from your description, that you have not. It is best to consult the doctor as soon as possible so the worst can be prevented. =] I'm guessing it's a sebaceous cyst, a type of generally non-cancerous skin problem. BEst regards!
Reply:I also say a cyst. Dont worry about it to much pet. X Glad your sensible enough to go to the GP.
pink
its about half the size of an egg and seems to be getting bigger, i have had it about 3 weeks, not painful unless i press it. its on my right leg on my calf muscle, towards the back but a little bit on the side. i had erythema nodosom when i was pregnant, could it be this? i am not pregnant.
What is this lump on my leg?
This lump, at half the size of an egg and getting bigger, must be checked by your GP, especially because it's increased in size in only 3 weeks.
Every new 'lump and bump' anyone gets must be checked by their doctor no matter where it is, and especially if it seems to be getting bigger. It's unlikely to be your Erythema Nodosum which usually attacks the shins at the front of the leg.
This may, more likely be a lipoma, a lump of fatty tissue, and even (though rare) to be a protrusion or herniation (pushing out) of muscle fibres from your calf muscle - it's hard to tell without examining you! Neverthless, get your GP's opinion - soon.
Reply:Sounds like a big lump to me.
Reply:I bet it is erythema nodosom but I am so glad you are going to get it checked out with the Dr. Good Luck....
Reply:It could just be a cyst because they do increase in size due to the jelly substance that they are filled with. It is great that you have a doctors appointment because he or she can examine it and let you know what has to be done.
Reply:As a woman it is probably your brain..else a cyst
Reply:Like a bruies or a tangled skin tissue. I dunno, maybe a small tumor. I know a girl who had one on her jaw and had to get it removed. We always joked it was a tumor but it wasn't.
Reply:might be your knee cap?
Reply:not enough info given in question,
is it red, warm or is the swelling spreading?have you run a fever?do you have all sensation intact to the extremitie lower to it, that is any numbness or tingling? can you walk on that leg?
you could have a bloot clot and that is a potentionally like threating situation beause ifit breaks off and goes to your lung or heart or brain you could have a pulmonary embolism or a stroke. do not massage the area, most importantly because ifit a clot that could cause it to break apart.
I would call you doc back and let him know it is getttind bigger.
the only other thing i can think it might be is maybe you got a bug bite or scratch and it got infected with staph. in which case you need antiboptics and it needs to be drained and the fulid or cells removed need to be tested. insist on a culture of the fluid remover so you know what it is. this also tells the doctor what antiobotis is appropriate to use.
Reply:The symptoms of Erythema multiforme are;
* Fever, malaise and itching of skin
* Sudden eruption of spots, bumps, and lesions
* Concentrated lesions
* Rashes on the face and arms
These are the symptoms of Erythema nosdosum :
* Tiredness, malaise and flu kind of symptoms
* Clusters of nodules and lesions on shins, forearms, thighs, and trunk
* Joint pain
... if you have two or more of these, you might have E. nodosum. But it appears, from your description, that you have not. It is best to consult the doctor as soon as possible so the worst can be prevented. =] I'm guessing it's a sebaceous cyst, a type of generally non-cancerous skin problem. BEst regards!
Reply:I also say a cyst. Dont worry about it to much pet. X Glad your sensible enough to go to the GP.
pink
I have swollen brown lines all over my face?1?!?!!?! 10 POINTS?
my doctor prescribed me Erythromycin Benzoyl Peroxide Topical Gel for my acne...after using it only 2 times i stopped because all these bumpy thin brown lines appeared on my face and my skin peeled and itched like crazy...
i think this is Erythema...i'm not sure what it is...
but i don't want this anymore!!!=(
i'm so scared!!!
why did she do this to me and how can i fix this!?
thnx
:(
I have swollen brown lines all over my face?1?!?!!?! 10 POINTS?
The same thing happened to me. Stop using the perscribed stuff and put a non-oil lotion on your face everyday and make an appointment with your doctor ASAP. Its not fun!
Reply:Im not a doctor but this is my best suggestion. Go to ER. They cant not admit you, another doctor will have to figure out what is going on. Might suggest something else. But in this case if the other doctor totally messed up you have a record.
Reply:Sounds like you may be having an allergic reaction to it.
Especially if your face is swelling and itching.
Stop taking the Erythromycin Benzoyl Peroxide Topical Gel and call your doctor ASAP.
Even if it's after hours, your doc should have an answering system where they can page him and have him call you back.
If it get so bad that your eyes swell too, you may want to go to the ER to get an antibiotic shot to help sooth the swelling.
I hope it goes away quickly!!
Reply:According to a website I found off of a Google search, side effects can be sever skin swelling and blistering, skin rash, itching, dry peeling skin, burning, and irritated eyes. So, it could be that. You could also be having an allergic reaction to it. I would stop using it immediatley, wash your face to get it off, and contact your doctor ASAP...or I guess they say STAT in the medical world : )
Reply:First off, stop using it. Don't freak out , it will be fine. It sounds like you had allergic reaction to it. Go to the drug store and get hydrocortizone ( its a topical gel) and put some of that on it, until it goes away. Use something called Cetyphil cleanser until it goes away, you can get it at any drug store. Finally, make an appointment at the same doctor and see what they say, chances are they aren't a bad doctor-just had a bad reaction.
Reply:Allergic reaction. Stop using immediately. Drink lots of water to flush out of your system. Maybe hydrocortisone cream (don't use until you see a dermatologist)
Reply:I believe that you are allergic to this medication. Most acne medicines have a drying and peeling effect. Tell your doctor so she can change your medication and take a look at the browns thin lines. If it itches I would use cortizone cream. It is very good for itchy rashes, They make it in a creme form that soaks in, and it also, has an ingredient for pain and aloe and vitimin E
i think this is Erythema...i'm not sure what it is...
but i don't want this anymore!!!=(
i'm so scared!!!
why did she do this to me and how can i fix this!?
thnx
:(
I have swollen brown lines all over my face?1?!?!!?! 10 POINTS?
The same thing happened to me. Stop using the perscribed stuff and put a non-oil lotion on your face everyday and make an appointment with your doctor ASAP. Its not fun!
Reply:Im not a doctor but this is my best suggestion. Go to ER. They cant not admit you, another doctor will have to figure out what is going on. Might suggest something else. But in this case if the other doctor totally messed up you have a record.
Reply:Sounds like you may be having an allergic reaction to it.
Especially if your face is swelling and itching.
Stop taking the Erythromycin Benzoyl Peroxide Topical Gel and call your doctor ASAP.
Even if it's after hours, your doc should have an answering system where they can page him and have him call you back.
If it get so bad that your eyes swell too, you may want to go to the ER to get an antibiotic shot to help sooth the swelling.
I hope it goes away quickly!!
Reply:According to a website I found off of a Google search, side effects can be sever skin swelling and blistering, skin rash, itching, dry peeling skin, burning, and irritated eyes. So, it could be that. You could also be having an allergic reaction to it. I would stop using it immediatley, wash your face to get it off, and contact your doctor ASAP...or I guess they say STAT in the medical world : )
Reply:First off, stop using it. Don't freak out , it will be fine. It sounds like you had allergic reaction to it. Go to the drug store and get hydrocortizone ( its a topical gel) and put some of that on it, until it goes away. Use something called Cetyphil cleanser until it goes away, you can get it at any drug store. Finally, make an appointment at the same doctor and see what they say, chances are they aren't a bad doctor-just had a bad reaction.
Reply:Allergic reaction. Stop using immediately. Drink lots of water to flush out of your system. Maybe hydrocortisone cream (don't use until you see a dermatologist)
Reply:I believe that you are allergic to this medication. Most acne medicines have a drying and peeling effect. Tell your doctor so she can change your medication and take a look at the browns thin lines. If it itches I would use cortizone cream. It is very good for itchy rashes, They make it in a creme form that soaks in, and it also, has an ingredient for pain and aloe and vitimin E
My son has a hard lump on his shin!!!?
my 4 yo son has a had a hard not round but sort if longish lump on his shin for around 3 weeks now.We had a n ultrasound done on friday but i was wondering if anyone could shed some light or has had a similar thing happen.He has a history of erythema nodosum and got this particular lump around the time he had a cold. whe we got the ultrasound done he initially said it looks like a fatty lump but when he had finished he said nothing more about what it could be..... it hurts him when you touch it.... there is no marking on the skin, hope somone cab help
My son has a hard lump on his shin!!!?
When I was a kid, I had something similar to what you describe. It was an osteochondroma (bone tumor). Not as big a deal as it sounds. I had it removed, and that was that.
Reply:Since you have had tests run, best to wait until the results show something definitive especially since no one here has seen it.
Reply:i do not think it is a bone tumour, i think it could just be a bump on the leg or a side affect to a drug he might have taken since he had a cold. best to see what the test shows. please tell what they are when you get them thanks! for now i highly suggest no sports and lots of vegatbles.
My son has a hard lump on his shin!!!?
When I was a kid, I had something similar to what you describe. It was an osteochondroma (bone tumor). Not as big a deal as it sounds. I had it removed, and that was that.
Reply:Since you have had tests run, best to wait until the results show something definitive especially since no one here has seen it.
Reply:i do not think it is a bone tumour, i think it could just be a bump on the leg or a side affect to a drug he might have taken since he had a cold. best to see what the test shows. please tell what they are when you get them thanks! for now i highly suggest no sports and lots of vegatbles.
Can Lyme Disease stay dorment for 7 years, or are there other disease's that have similer symptoms???
a tick bite me in the summer of 01 or 00 on my head, i cant remember exactly when, but lately I began to loose my train of thought, memory, my concentration or focus, %26amp; my neck has been hearting me since 02 %26amp; i'm only 24 years old! now that i think about it, since i have been back from Ethiopia(went there on an 8 month vacation %26amp;just came back this past November)i have been deeply depressed, fatigue, %26amp; i have been having problems with concentration and memory loss. %26amp; for a long time now i have been having heart beet jumps %26amp; heart pains that interfere with my breathing, also i have been feeling dizzy, %26amp;once or twice each month i have severe headaches that last 1 to 2days. i think the only things i dont have from the lyme disease symptoms descriptions are the joint swelling, %26amp; the 1st sign which is the circular rash called erythema migrans,or maybe i had this %26amp; never sow it, cause i was bite on my head were it was covered by my hair
Can Lyme Disease stay dorment for 7 years, or are there other disease's that have similer symptoms???
Many people report experiences similar to yours. It appears that your body was capable of holding the Lyme disease at bay for a period of years--and then something happened which upset the balance and allow the illness to assert itself. It's also possible that in addition to Lyme you could have what are called "co-infections," which are other diseases the tick gave you at the same time it gave your Lyme. It's important that you be evaluated by someone who really understands how Lyme and other diseases manifest and interact. Typically, this will be a doc who's associated with the International Lyme and Associated Diseases Society. (ILADS). A good way to find one of these docs near you is to go to http://www.lymenet.com, click on "flash discussion," then on "seeking a doctor."
Other good sources of info about Lyme disease:
http://www.canlyme.com
http://www.lymeinfo.net
http://www.lymediseaseassociation.org
http://www.ilads.org
http://www.betterhealthguy.com
http://www.publichealthalert.com
http://www.freewebs.com/teenswithlyme
http://www.lymetimes.org
Reply:I dont know but it is progressive and lethal so go to the docter
Reply:I finally got properly diagnosed after sympomts for 6 years. I went to dozens of doctors. Most had no conclusion and the most recent insisted I had MS. I got worse and worse to the point that I haven't been able to work for nearly 3 years. Not all doctors are sufficiently familiar with lyme. I was persistent which finally paid off. Don't let the attitude and ignorance of others get in your way.
Can Lyme Disease stay dorment for 7 years, or are there other disease's that have similer symptoms???
Many people report experiences similar to yours. It appears that your body was capable of holding the Lyme disease at bay for a period of years--and then something happened which upset the balance and allow the illness to assert itself. It's also possible that in addition to Lyme you could have what are called "co-infections," which are other diseases the tick gave you at the same time it gave your Lyme. It's important that you be evaluated by someone who really understands how Lyme and other diseases manifest and interact. Typically, this will be a doc who's associated with the International Lyme and Associated Diseases Society. (ILADS). A good way to find one of these docs near you is to go to http://www.lymenet.com, click on "flash discussion," then on "seeking a doctor."
Other good sources of info about Lyme disease:
http://www.canlyme.com
http://www.lymeinfo.net
http://www.lymediseaseassociation.org
http://www.ilads.org
http://www.betterhealthguy.com
http://www.publichealthalert.com
http://www.freewebs.com/teenswithlyme
http://www.lymetimes.org
Reply:I dont know but it is progressive and lethal so go to the docter
Reply:I finally got properly diagnosed after sympomts for 6 years. I went to dozens of doctors. Most had no conclusion and the most recent insisted I had MS. I got worse and worse to the point that I haven't been able to work for nearly 3 years. Not all doctors are sufficiently familiar with lyme. I was persistent which finally paid off. Don't let the attitude and ignorance of others get in your way.
Does the chest tightness in Sarcoidosis ease??
I had Sarcoidosis in Feb 2006, although I did have terrible Erythema Nodosum in my legs I didn't have medication, and the symptoms seemed to going in Autumn last year. My eyes and lung capacity was tested and they were fine.
But now the chest tightness seems to be getting worse which can be painful when coughing or sneezing. I would love to hear what you think and if you've had experiences of your own in how to ease it.
Thanks
Does the chest tightness in Sarcoidosis ease??
It sounds as if you experienced remission with no pulmonary invovement if your pft was not diminished. Perhaps you should check with your MD anyway and get an xray to rule out fibrotic changes and consider asthma as a cause for chest tightness.
Reply:It can, but the disease can have residual affects such as mild asthma. You may need to use some bronchodilators during high allergy seasons to help or some advair to prevent any bronchospasms.
The disease can completely resolve, but the fibrotic changes can be permanent and you may have some slight residual affects.
I would talk to your doctor abou starting on advair or asmanex to control the cough and chest tightness. You probably have some asthma as a result. PFT's may or may not show it completely.
periwinkle
But now the chest tightness seems to be getting worse which can be painful when coughing or sneezing. I would love to hear what you think and if you've had experiences of your own in how to ease it.
Thanks
Does the chest tightness in Sarcoidosis ease??
It sounds as if you experienced remission with no pulmonary invovement if your pft was not diminished. Perhaps you should check with your MD anyway and get an xray to rule out fibrotic changes and consider asthma as a cause for chest tightness.
Reply:It can, but the disease can have residual affects such as mild asthma. You may need to use some bronchodilators during high allergy seasons to help or some advair to prevent any bronchospasms.
The disease can completely resolve, but the fibrotic changes can be permanent and you may have some slight residual affects.
I would talk to your doctor abou starting on advair or asmanex to control the cough and chest tightness. You probably have some asthma as a result. PFT's may or may not show it completely.
periwinkle
Why/how did I get a delayed pain reaction to a tooth extraction?
I had a 2nd wisdom tooth extracted 38 hours ago. The gum didn't begin to really swell and hurt until a few hours ago. I was able to sleep the first night without taking Vicodin, but I just took 10 mg. It feels as if the site the tooth was pulled from is acting like a heart, pumping pain throughout my lower left jaw, face, and even ear. The gum is irritated and inflamed as well. *erythema/edema/pain* three classic signs of infection...should I take ciprofloxacin in addition to pain meds.?
Why/how did I get a delayed pain reaction to a tooth extraction?
The local anesthetic has worn off but, the pain your describing could either be a " dry socket", which is quite painful. If the dentist prescribed an antibiotic ( Cipro) by all means take them. Be sure to complete the full course even if the symptoms go away before you complete the Cipro. You should not wait until your pain level is too high because then you have to wait up to 45 mins.for the Vicodin to kick in. During that wait, your pain level is still increasing. So, it is best to take the pain medicine once you start to feel discomfort. If your symptoms persist or worsen, contact your Dentist. I hope that this helps and that you feel better soon.
Reply:If your Dr. prescribed it for you, for that reason, yes.
Reply:You need to contact your Doctor and explain what your symptoms are,sounds like your have a dry socket from the extraction.I have heard,and don't quote me on this, but a friend of mine once told me to put vasoline into the area where the tooth was and the pain should quit.I don't know if you want to try it but it may be worth a try.
Reply:Better consult your doctor to make sure the wound is not infected. And do not procrastinate.
Reply:Infection.
Take antibiotics and NSAID
Why/how did I get a delayed pain reaction to a tooth extraction?
The local anesthetic has worn off but, the pain your describing could either be a " dry socket", which is quite painful. If the dentist prescribed an antibiotic ( Cipro) by all means take them. Be sure to complete the full course even if the symptoms go away before you complete the Cipro. You should not wait until your pain level is too high because then you have to wait up to 45 mins.for the Vicodin to kick in. During that wait, your pain level is still increasing. So, it is best to take the pain medicine once you start to feel discomfort. If your symptoms persist or worsen, contact your Dentist. I hope that this helps and that you feel better soon.
Reply:If your Dr. prescribed it for you, for that reason, yes.
Reply:You need to contact your Doctor and explain what your symptoms are,sounds like your have a dry socket from the extraction.I have heard,and don't quote me on this, but a friend of mine once told me to put vasoline into the area where the tooth was and the pain should quit.I don't know if you want to try it but it may be worth a try.
Reply:Better consult your doctor to make sure the wound is not infected. And do not procrastinate.
Reply:Infection.
Take antibiotics and NSAID
Allergic to the pills, how about the Depo shot?
Okay. Here's the history. I'm allergic to ALL forms of oral birth control. The nuva-ring and I didn't get along well, and I've been bleeding from it for the past 3 months. I would have stopped using it, but I liked the protection it gives me against pregnancy, even though my partner and I are avid condom users. Anyway, I'm down to almost nothing in the way of contraceptives.
I don't have a positive view on the depo shot, but it seems that's where I'm headed. I'm willing to try it for one month, and if it's terrible, than I just won't use it again.
But I'm worried about having an allergy to it, like it do to the pills. If I take the pills I develop Erythema Nodosum immediately and it takes forever to ago, let alone having a shot that doesn't expire for months, that would be BAD.
Anyway, any advice is nice to have. =)
ps. I'd talk to my doctor, but they're usually willing to only say good thing about medications, and never the bad. I'd rather get advice from PEOPLE. =)
Allergic to the pills, how about the Depo shot?
The shot is horrible. Most people (over 70%) experience significant weight gain. I gained over 40 lbs on it, no matter what I did. Depression, irregular menstrual cycle, hair loss, skin problems, and loss of sex drive are all common side effects. I had constant migranes while on this, too.
The most troubling of all is the effect on bone calcium levels: Depo depletes bone calcium, which can lead to osteoporosis. It is non-reversible, too. Once the damage is done, it can't be undone.
It is effective for 3 months, but it can take between 6-8 months to clear your system. If you have a bad reaction, you are stuck with it that whole time. Just so you know, allergic reactions are fairly common to this, too.
Reply:I wouldn't suggest this for you at all. These shots have similar hormones as oral contraceptives. If you have problems with them, imagine having a shot that will be in your system for months! With a pill, you can just stop taking it. Once you get this shot, thats its, and its in your body until it wears off. I wouldn't risk it especially since you don't get along well with hormanal birth control.
Reply:don't get the shot. if you have bad reactions to all other birth control, the shot will most likely be the same, plus it lasts for 3 months i believe. 3 months with an allergic reaction would suck. ummm, i think you're stuck being ever so careful with condoms.
Reply:I'm allergic to all oral forms of birth control too. I was on the shot for awhile and I didn't have an allergic reaction. However, I did gain some weight and have episodes of depression. While I was on it, I had to be on an anti-depressant. The weight gain wasn't super horrible for me. The weight went straight to my boobs and brought me up from an A-cup to a C-cup.
However, I probably wouldn't recommend the shot. I would recommend the patch. I didn't have any negatives from using the patch. No reactions whatsoever. The only down side of the patch is that basically it looks like a band-aid. You have to put it on your rear end or your stomach so you have to watch what you wear to the beach or where it's positioned on your body. Generally, you don't want it to look like there's a band-aid on your butt.
Another good thing about the patch is that you put it on once a week for a month. Less often than the pill, but more often then the shot. You'd figure out in the first week, if you were allergic.
Reply:what about an IUD? (intra uterine device) Can be placed durring a doctor visit, and good for 7 years. Can be removed if you want to try for a baby. No medicine involved. Has your docor ever mentioned this option to you? Also, about the patch, that someone mentioned earlier. If you are allergic to pills, you probably will have the same reaction to the patch. There are hormones in the patch just like the pill. I know this through personal experience, as I have horrible reactions to the pill, and the patch. Found out the hard way, and it sucked.
Reply:seeing as you and your partner are avid condom users, is ther any real need for you to be putting synthetic and potentially harmful hormones into your body? i know there is the protection aspect but there is always the morning after pill if the condom breaks. other than that only 0.5% of children are born when condoms are used correctly so give your body a break and let it get back to normal before you tr anything else.
it could be that the other pills are suitable but that you havent recovered from the reaction from the previous and your body is trying to get used to a different one, yet again, so it causes yet another ad reaction. try the mini pill (POP) as it is normally oestrogen that causes the problems and this contains none of that horrible substance!
good luck!
Reply:Have you tried ALL the brands of pills that are out?
I would realllllllllllllly not go with depo. Google "depo provera lawsuit" and check the reviews on http://www.rateitall.com and you'll see why. There are so many negative side affects that many many women have suffered while on this shot.
Frankly I'd rather just stick with condoms instead of going with depo provera.
I don't have a positive view on the depo shot, but it seems that's where I'm headed. I'm willing to try it for one month, and if it's terrible, than I just won't use it again.
But I'm worried about having an allergy to it, like it do to the pills. If I take the pills I develop Erythema Nodosum immediately and it takes forever to ago, let alone having a shot that doesn't expire for months, that would be BAD.
Anyway, any advice is nice to have. =)
ps. I'd talk to my doctor, but they're usually willing to only say good thing about medications, and never the bad. I'd rather get advice from PEOPLE. =)
Allergic to the pills, how about the Depo shot?
The shot is horrible. Most people (over 70%) experience significant weight gain. I gained over 40 lbs on it, no matter what I did. Depression, irregular menstrual cycle, hair loss, skin problems, and loss of sex drive are all common side effects. I had constant migranes while on this, too.
The most troubling of all is the effect on bone calcium levels: Depo depletes bone calcium, which can lead to osteoporosis. It is non-reversible, too. Once the damage is done, it can't be undone.
It is effective for 3 months, but it can take between 6-8 months to clear your system. If you have a bad reaction, you are stuck with it that whole time. Just so you know, allergic reactions are fairly common to this, too.
Reply:I wouldn't suggest this for you at all. These shots have similar hormones as oral contraceptives. If you have problems with them, imagine having a shot that will be in your system for months! With a pill, you can just stop taking it. Once you get this shot, thats its, and its in your body until it wears off. I wouldn't risk it especially since you don't get along well with hormanal birth control.
Reply:don't get the shot. if you have bad reactions to all other birth control, the shot will most likely be the same, plus it lasts for 3 months i believe. 3 months with an allergic reaction would suck. ummm, i think you're stuck being ever so careful with condoms.
Reply:I'm allergic to all oral forms of birth control too. I was on the shot for awhile and I didn't have an allergic reaction. However, I did gain some weight and have episodes of depression. While I was on it, I had to be on an anti-depressant. The weight gain wasn't super horrible for me. The weight went straight to my boobs and brought me up from an A-cup to a C-cup.
However, I probably wouldn't recommend the shot. I would recommend the patch. I didn't have any negatives from using the patch. No reactions whatsoever. The only down side of the patch is that basically it looks like a band-aid. You have to put it on your rear end or your stomach so you have to watch what you wear to the beach or where it's positioned on your body. Generally, you don't want it to look like there's a band-aid on your butt.
Another good thing about the patch is that you put it on once a week for a month. Less often than the pill, but more often then the shot. You'd figure out in the first week, if you were allergic.
Reply:what about an IUD? (intra uterine device) Can be placed durring a doctor visit, and good for 7 years. Can be removed if you want to try for a baby. No medicine involved. Has your docor ever mentioned this option to you? Also, about the patch, that someone mentioned earlier. If you are allergic to pills, you probably will have the same reaction to the patch. There are hormones in the patch just like the pill. I know this through personal experience, as I have horrible reactions to the pill, and the patch. Found out the hard way, and it sucked.
Reply:seeing as you and your partner are avid condom users, is ther any real need for you to be putting synthetic and potentially harmful hormones into your body? i know there is the protection aspect but there is always the morning after pill if the condom breaks. other than that only 0.5% of children are born when condoms are used correctly so give your body a break and let it get back to normal before you tr anything else.
it could be that the other pills are suitable but that you havent recovered from the reaction from the previous and your body is trying to get used to a different one, yet again, so it causes yet another ad reaction. try the mini pill (POP) as it is normally oestrogen that causes the problems and this contains none of that horrible substance!
good luck!
Reply:Have you tried ALL the brands of pills that are out?
I would realllllllllllllly not go with depo. Google "depo provera lawsuit" and check the reviews on http://www.rateitall.com and you'll see why. There are so many negative side affects that many many women have suffered while on this shot.
Frankly I'd rather just stick with condoms instead of going with depo provera.
Ahhhhh im going to pull all my hair out! cant anyone help?
ok i have tried many diff forms of birth control... i am allergic to all of them.. they give me erythema multiforme and i hate using condoms or film with my long term boyfriend. why hasnt anyone found a reason for the allergy.. like what ingredient causes it any why.. so i can take something. my period is always late i get really bad cyst and i get really bad pms. its ruining my life.. help me anyone!
Ahhhhh im going to pull all my hair out! cant anyone help?
i always have problems with things like that but i am taking the shot. depo-provera and it has worked fine for me
Reply:I had pretty much the same problems...come to find out I only had one ovary %26amp; tube...the left one was destroyed when I was a small child %26amp; had spinal meningitis. Try looking into some herbal remedies for your PMS. They worked for me. As for the birth control, I think they have an IUD you can have put in. But I've heard from other women that that can hurt too. My solution came when I got a hysterectomy at the age of 29. I never had any children but never really wanted any anyway. Hope this helps some.
Reply:have you tried the mirena
Reply:Well, you have the best reason in the world then to wait til you are married to continue having sex. Then you don't have to worry about any artificial birth control, and it affecting your health.
Time probably for a good checkup and testing with your gynecologist.
Ahhhhh im going to pull all my hair out! cant anyone help?
i always have problems with things like that but i am taking the shot. depo-provera and it has worked fine for me
Reply:I had pretty much the same problems...come to find out I only had one ovary %26amp; tube...the left one was destroyed when I was a small child %26amp; had spinal meningitis. Try looking into some herbal remedies for your PMS. They worked for me. As for the birth control, I think they have an IUD you can have put in. But I've heard from other women that that can hurt too. My solution came when I got a hysterectomy at the age of 29. I never had any children but never really wanted any anyway. Hope this helps some.
Reply:have you tried the mirena
Reply:Well, you have the best reason in the world then to wait til you are married to continue having sex. Then you don't have to worry about any artificial birth control, and it affecting your health.
Time probably for a good checkup and testing with your gynecologist.
What is the diagonosis of this kind of disease?
Parents bring their 28-day-old female neonate to the emergency department with a 1-week history of progressive erythema and swelling of her left nipple and breast. The mother reports the child has had no trauma to the breast, nipple discharge, or fevers; however, the patient has had decreased oral intake and tenderness of the affected breast.
The area is not responding to a regimen of cephalexin that the patient's paediatrician prescribed 3 days ago. The patient was born by means of caesarean delivery; the rest of her perinatal history is unremarkable.
Physical examination reveals an afebrile and well-appearing infant in no obvious distress. The left breast (see Image 1) is warm and tender, with an underlying area of fluctuance. Other findings are normal. Laboratory tests reveal a slightly elevated WBC count.
Hint
Other family members have recurrent skin infections. The patient's mother has a wound infection at the incision site of the caesarean deliver
What is the diagonosis of this kind of disease?
Given the poor feeding, inflamed left nipple and breast and fluctuant abscess present this is obviously a case of mastitis neonatorum, usually caused by staphylococcus aureus - in this case one resistant to cephalexin.
This one is partially treated and hence the child is not systemically unwell.
The abscess should be incised and drained and the neonate should be placed on an intravenous antibiotic - flucloxacillin would be sufficient for most cases of Staphylococcus aureus but I happen to know the case you are copying from had MRSA, and appears to have surrounding cellulitis.
I would thus use clindamycin +/- rifampicin.
The patient should be admitted to a paediatric surgical ward to observe for the resolution of the illness.
Parents also should be advised to seek treatment with their usual family doctor and to wash frequently and effectively.
The mother, particularly, should be checked for mastitis.
Reply:If you are looking for solutions then you should go to www.zeoliteinfo.com and you can get the product at www.mywaiora.com/698685. In the zeoliteinfo.com go the the Targetnews.
All the Best
night blooming cereus
The area is not responding to a regimen of cephalexin that the patient's paediatrician prescribed 3 days ago. The patient was born by means of caesarean delivery; the rest of her perinatal history is unremarkable.
Physical examination reveals an afebrile and well-appearing infant in no obvious distress. The left breast (see Image 1) is warm and tender, with an underlying area of fluctuance. Other findings are normal. Laboratory tests reveal a slightly elevated WBC count.
Hint
Other family members have recurrent skin infections. The patient's mother has a wound infection at the incision site of the caesarean deliver
What is the diagonosis of this kind of disease?
Given the poor feeding, inflamed left nipple and breast and fluctuant abscess present this is obviously a case of mastitis neonatorum, usually caused by staphylococcus aureus - in this case one resistant to cephalexin.
This one is partially treated and hence the child is not systemically unwell.
The abscess should be incised and drained and the neonate should be placed on an intravenous antibiotic - flucloxacillin would be sufficient for most cases of Staphylococcus aureus but I happen to know the case you are copying from had MRSA, and appears to have surrounding cellulitis.
I would thus use clindamycin +/- rifampicin.
The patient should be admitted to a paediatric surgical ward to observe for the resolution of the illness.
Parents also should be advised to seek treatment with their usual family doctor and to wash frequently and effectively.
The mother, particularly, should be checked for mastitis.
Reply:If you are looking for solutions then you should go to www.zeoliteinfo.com and you can get the product at www.mywaiora.com/698685. In the zeoliteinfo.com go the the Targetnews.
All the Best
night blooming cereus
What does it mean to underline the accented syllable in the following terms:?
impetigo, erythema, eczema, pilonidal cyst, dermatomycosis, streatoma,
What does it mean to underline the accented syllable in the following terms:?
The accented syllable is the syllable that gets the "oomph." So, for an example, in the word favor, I would underline the "fa," since you say the "fa" harder than you say the "vor." Your first word would have the "ti" underlined, since that is where you say the word the hardest. em-pi-TI-go. I hope that made sense.
What does it mean to underline the accented syllable in the following terms:?
The accented syllable is the syllable that gets the "oomph." So, for an example, in the word favor, I would underline the "fa," since you say the "fa" harder than you say the "vor." Your first word would have the "ti" underlined, since that is where you say the word the hardest. em-pi-TI-go. I hope that made sense.
Do Vitamin B12 supplements have side effects?
My face felt very dry and red the same day I started taking these supplements. The bottle said that slight irritation could occur by won't last.. Then after having problems breathing today I decided to lookin into it more. And this is what I found.....
Dermatologic: Itching, rash, transitory exanthema, and urticaria have been reported. Vitamin B12 (20 micrograms/day) and pyridoxine (80mg/day) has been associated with cases of rosacea fulminans, characterized by intense erythema with nodules, papules, and pustules. Symptoms may persist for up to 4 months after the supplement is stopped, and may require treatment with systemic corticosteroids and topical therapy.
Do Vitamin B12 supplements have side effects?
Vitamin B12 is also essential for health, try getting B12 through the diet, maybe it won't be as harsh. My family uses B12 %26amp; hasn't yet seen those side effects, maybe try changing brands?
Reply:take 2000 mg a day with zero problems..............................
so maybe you read into things or should ask physician.
I am better with it than without it.
Reply:Vitamin B supplements in general, especially those that contains Niacin can cause flushing of the skin. I would say that you might try a B complex without Niacin (B3) or a "No Flush" Niacin.
If you have breathing problems, I would quit taking immediately.
Reply:i used to take vitamin B complex .. so i gain 7 kg in two months .. but without any shown side effect :)
Dermatologic: Itching, rash, transitory exanthema, and urticaria have been reported. Vitamin B12 (20 micrograms/day) and pyridoxine (80mg/day) has been associated with cases of rosacea fulminans, characterized by intense erythema with nodules, papules, and pustules. Symptoms may persist for up to 4 months after the supplement is stopped, and may require treatment with systemic corticosteroids and topical therapy.
Do Vitamin B12 supplements have side effects?
Vitamin B12 is also essential for health, try getting B12 through the diet, maybe it won't be as harsh. My family uses B12 %26amp; hasn't yet seen those side effects, maybe try changing brands?
Reply:take 2000 mg a day with zero problems..............................
so maybe you read into things or should ask physician.
I am better with it than without it.
Reply:Vitamin B supplements in general, especially those that contains Niacin can cause flushing of the skin. I would say that you might try a B complex without Niacin (B3) or a "No Flush" Niacin.
If you have breathing problems, I would quit taking immediately.
Reply:i used to take vitamin B complex .. so i gain 7 kg in two months .. but without any shown side effect :)
Medical transcriptionists- "kaylor"?
In an operative report:
"SURGICAL FINDINGS: There is a 1 cm diameter ulcer sinus track in the central part of the right forefoot. There is an ulceration of approximately 6 cm in diameter beneath the medial cuneiform. The forefoot is indurated and erythematous. There is kaylor."
And in a request for consultation, same patient, diabetic:
"There is erythema, induration, and kaylor to the right forefoot."
I can't figure what (sounds like) "kalor" is supposed to be. Please help! This is one of my final transcriptions for MT school. Thanks.
Medical transcriptionists- "kaylor"?
Try and listen to it again, if possible, and see if what the doctor is saying may be "eschar". It is dried scabbed skin.
Also, the correct spelling after sinus would be tract (not track).
Good Luck!
Reply:Great advice crazzkc24
I agree......
"SURGICAL FINDINGS: There is a 1 cm diameter ulcer sinus track in the central part of the right forefoot. There is an ulceration of approximately 6 cm in diameter beneath the medial cuneiform. The forefoot is indurated and erythematous. There is kaylor."
And in a request for consultation, same patient, diabetic:
"There is erythema, induration, and kaylor to the right forefoot."
I can't figure what (sounds like) "kalor" is supposed to be. Please help! This is one of my final transcriptions for MT school. Thanks.
Medical transcriptionists- "kaylor"?
Try and listen to it again, if possible, and see if what the doctor is saying may be "eschar". It is dried scabbed skin.
Also, the correct spelling after sinus would be tract (not track).
Good Luck!
Reply:Great advice crazzkc24
I agree......
I have swollen brown lines all over my face? 10 POINTS?
my doctor prescribed me Erythromycin Benzoyl Peroxide Topical Gel for my acne...after using it only 2 times i stopped because all these bumpy thin brown lines appeared on my face and my skin peeled and itched like crazy...
i think this is Erythema...i'm not sure what it is...
but i don't want this anymore!!!=(
i'm so scared!!!
why did she do this to me and how can i fix this!?
thnx
:(
I have swollen brown lines all over my face? 10 POINTS?
You are allergic to something. see the doc again to find out what.
Reply:Go for a second opinion then go back to her and tell her what she has done!!!!!!!!!!!
Reply:go see ur doctor and tell him or she whats going on.
Reply:Go tell your doctor!
This is unacceptable!
Reply:i think u shd lay off the medicine for a while n for a couple of days just sake ur face, meaning a get a cloth soak it in hot hot water n den squeeze most of the exess water out then press it against ur face. it should help and soothe ur skin.
Reply:Go back to this doctor %26amp; show her what happened to your face. If you get nowhere with her, see a dermatologist.
Reply:From Webmd info for this drug:
seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching, swelling, severe dizziness, trouble breathing.
GO TO THE HOSPITAL!!!
Reply:Your skin is too sensitive for Benzyl Peroxide . More than 40 percent of people develop allergic contact dermatitis from using Benzyl Peroxide because it irritates the sensitive skin and makes it inflammed .
Recommendation stop all topical treatments and apply 1percent hydrocortisone cream on bumpy thin brown lines till the inflammation resolves . Cold water compressed would also help .
See your dermatologis for alternate treatment options .
Reply:ask a doctor
orchid cactus
i think this is Erythema...i'm not sure what it is...
but i don't want this anymore!!!=(
i'm so scared!!!
why did she do this to me and how can i fix this!?
thnx
:(
I have swollen brown lines all over my face? 10 POINTS?
You are allergic to something. see the doc again to find out what.
Reply:Go for a second opinion then go back to her and tell her what she has done!!!!!!!!!!!
Reply:go see ur doctor and tell him or she whats going on.
Reply:Go tell your doctor!
This is unacceptable!
Reply:i think u shd lay off the medicine for a while n for a couple of days just sake ur face, meaning a get a cloth soak it in hot hot water n den squeeze most of the exess water out then press it against ur face. it should help and soothe ur skin.
Reply:Go back to this doctor %26amp; show her what happened to your face. If you get nowhere with her, see a dermatologist.
Reply:From Webmd info for this drug:
seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching, swelling, severe dizziness, trouble breathing.
GO TO THE HOSPITAL!!!
Reply:Your skin is too sensitive for Benzyl Peroxide . More than 40 percent of people develop allergic contact dermatitis from using Benzyl Peroxide because it irritates the sensitive skin and makes it inflammed .
Recommendation stop all topical treatments and apply 1percent hydrocortisone cream on bumpy thin brown lines till the inflammation resolves . Cold water compressed would also help .
See your dermatologis for alternate treatment options .
Reply:ask a doctor
orchid cactus
Medical question?
i just got back from a procedure at the hospital it says that i have patchy erythema of the mucosa and antrum and stomach body and a hiatal hernia what the heck is this and what do i do to make it better i live in a small town and the dr wont talk to me about it so i know what to do ...frustration!!!
thanks
Medical question?
A hiatal hernia is a hernia (protruding intestine) that has pushed through to another space. In your case it sounds to be someplace in either your upper stomach or esophagus. The erythema of the mucosa and antrum shows slight gastritis, which can easily be associated with the hernia and/or a desease called G.E.R.D..
Diet can help, but it is not cure.
Reply:well.....first thing is find another doc.........seems like you have
stomach reflux from the hernia...the esophagus can become erosive by the acid backup.......try over-counter prevasid or tagamet......also,you might need a blood test called H.pylori to check for a bacteria that can cause GERD..........good luck.......
thanks
Medical question?
A hiatal hernia is a hernia (protruding intestine) that has pushed through to another space. In your case it sounds to be someplace in either your upper stomach or esophagus. The erythema of the mucosa and antrum shows slight gastritis, which can easily be associated with the hernia and/or a desease called G.E.R.D..
Diet can help, but it is not cure.
Reply:well.....first thing is find another doc.........seems like you have
stomach reflux from the hernia...the esophagus can become erosive by the acid backup.......try over-counter prevasid or tagamet......also,you might need a blood test called H.pylori to check for a bacteria that can cause GERD..........good luck.......
What causes a burning pain in the left lower back which would radiate to the flank and sometimes all the way a
Was given a NSAID a over the counter drug for the pain and had a allergic reation to it. It gave me a rash that had patches of erythema with clusters of vesicles extending in a dermatomal distribution from my left lower back to the midline of my abdomen.
What causes a burning pain in the left lower back which would radiate to the flank and sometimes all the way a
Can be anything from sciatica (the inflammation of a sciatic nerve, coming out of your spine going down your leg) to a kidney stone, a cyst, a pulled muscle, a vertebrae out of alignment.
Go to your doctor and get examined. DO not self-medicate. You can do more damage than help your condition.
Reply:Sounds like shingles to me, and not from any NSAID.
Reply:Burning pain that radiate to flank seems to be something wrong with kidney and bladder.
Reply:i think u should try a specialist because this is a special case
What causes a burning pain in the left lower back which would radiate to the flank and sometimes all the way a
Can be anything from sciatica (the inflammation of a sciatic nerve, coming out of your spine going down your leg) to a kidney stone, a cyst, a pulled muscle, a vertebrae out of alignment.
Go to your doctor and get examined. DO not self-medicate. You can do more damage than help your condition.
Reply:Sounds like shingles to me, and not from any NSAID.
Reply:Burning pain that radiate to flank seems to be something wrong with kidney and bladder.
Reply:i think u should try a specialist because this is a special case
Could anyone give me more info about Crohn's?
First off, I was diagnosed with Crohn's in Nov. 2005. It all started in June 2003 when I was diagnosed with Erythema Nodosum, (a painful inflammatory disease that usually affects your legs). Since that time I have had numerous problems that were undiagnosable by my stupid doctor, (I have since found a new one). Since Nov 05' I have had four allergic reactions to medications (the last one landed my in the hospital with acute pancreatitus) and surgery to remove my appenidix after 5 wks on antibiotics due to the inflammation of my intestines. But now I am getting Remicaide infusions and having to give myself a shot once a wk of Methotrexate. Which I was told will require that I have a liver biopsy in about a year.
I have done alot of research online about the disease, so I know pretty much all the technical stuff. But my question is, if the Remicaide puts me into "remission", are there ways of knowing when the Crohn's is returning before the excruciating pains start again?
Could anyone give me more info about Crohn's?
Hi! I have had crohns since the begining of 1991 %26amp; wasn't diagnosed until Jan 98. You are the only one who will know if your crohn's is active. They can do blood tests for immflammation in the body, but it would have to be weekly. I have been on Remicade since May 05, %26amp; have had one mild flare since being on it, I was put on pred for 8 weeks %26amp; it subsided. If you don't feel right I would do a liquid diet for a couple days %26amp; definately call your dr. if you do not feel better in a week. Only YOU know your body.
Reply:Check out Crohn's and Me
http://clk.atdmt.com/4D4/go/lv...
It is community for Crohn's sufferers.. It is pretty cool.. pretty impressed Report It
Reply:This site has great info for you. Take care!!
Reply:I cousin of mine has it. He got really bloated then had part of his intestince remove. He is in remission for now.
Check out the wikipedia entry.
Reply:hey there. I have crohn's. i have had it sense I was 16. I;m 22 now, and there is a lot of technical stuff to know. honestly none of this matters. What matters is that you know your body. I would love to talk with you about everything. I am also on remicade. I don't knwo if you have AIM but why don't you e-mail me Chell2414@aim.com
Reply:Get a copy of Elizabeth Lipski's Digestive Wellness. It is a goldmine of info on this and other GI tract problems.
Alibris.com
Reply:unfortunately, there's no way to know for sure. i hope you have long remmisions, just live your life and try not to think about it that much. in the worst case, it will come back, and you'll take some medicine, and feel good again.
i have crohn too, and it sucks, but life must go on ah?
Reply:I have helpful information on Crohn's. Read the testmonials on my blog roll and the other info on my page.
Reply:Hello, my mom is 55 yrs old has had Crohn's for 25 years she has a pouch on her belly and has had too many surgeries to count. There is more hope now than when she found out she had it. Hers is irreversible. She has 6inches of her small intestines left and that is it, she has no rectum either. My prayers are with anyone who has this disease,
I have done alot of research online about the disease, so I know pretty much all the technical stuff. But my question is, if the Remicaide puts me into "remission", are there ways of knowing when the Crohn's is returning before the excruciating pains start again?
Could anyone give me more info about Crohn's?
Hi! I have had crohns since the begining of 1991 %26amp; wasn't diagnosed until Jan 98. You are the only one who will know if your crohn's is active. They can do blood tests for immflammation in the body, but it would have to be weekly. I have been on Remicade since May 05, %26amp; have had one mild flare since being on it, I was put on pred for 8 weeks %26amp; it subsided. If you don't feel right I would do a liquid diet for a couple days %26amp; definately call your dr. if you do not feel better in a week. Only YOU know your body.
Reply:Check out Crohn's and Me
http://clk.atdmt.com/4D4/go/lv...
It is community for Crohn's sufferers.. It is pretty cool.. pretty impressed Report It
Reply:This site has great info for you. Take care!!
Reply:I cousin of mine has it. He got really bloated then had part of his intestince remove. He is in remission for now.
Check out the wikipedia entry.
Reply:hey there. I have crohn's. i have had it sense I was 16. I;m 22 now, and there is a lot of technical stuff to know. honestly none of this matters. What matters is that you know your body. I would love to talk with you about everything. I am also on remicade. I don't knwo if you have AIM but why don't you e-mail me Chell2414@aim.com
Reply:Get a copy of Elizabeth Lipski's Digestive Wellness. It is a goldmine of info on this and other GI tract problems.
Alibris.com
Reply:unfortunately, there's no way to know for sure. i hope you have long remmisions, just live your life and try not to think about it that much. in the worst case, it will come back, and you'll take some medicine, and feel good again.
i have crohn too, and it sucks, but life must go on ah?
Reply:I have helpful information on Crohn's. Read the testmonials on my blog roll and the other info on my page.
Reply:Hello, my mom is 55 yrs old has had Crohn's for 25 years she has a pouch on her belly and has had too many surgeries to count. There is more hope now than when she found out she had it. Hers is irreversible. She has 6inches of her small intestines left and that is it, she has no rectum either. My prayers are with anyone who has this disease,
I just had a biopsy done on breast now it has ulcerated doctor said "this is unusual case for him "what
i had breast biopsy done now it has ulcerated doctor said erythema and sore was just unusual what could this be ?why results are still NOT in it has been over a week
I just had a biopsy done on breast now it has ulcerated doctor said "this is unusual case for him "what
Has your dr. prescribed an antibiotic ointment or pills to deal with the ulceration? A week is way to long for any lab, doctor or pathologist to keep someone in suspense. Get on the phone and hound your primary doctor. If he/she hasn't received the lab results, it's ok to be persistent, call the clinic or office where your biopsy was done and demand to speak to the dr. in charge there. It's your life and you have a right to know.
I had to wait over Memorial Day weekend plus 2 extra days because my doctor isn't in the office on Tuesdays and Wednesday. It was hell, I couldn't sleep, or eat and couldn't function at work. I called and left her a voice message telling her it was ok to call me at work, on my cell phone or whereever and give me the news over the phone. I didn't want to wait for the staff to fit me in for an appointment and then have to wait an hour in the waiting room......
My dr. was fantastic and put me in touch immediately with a surgeon. A month after I was diagnosed I had surgery and started chemo a month later. October 28th will be my 2 year anniversary of my last chemo treatment.
I wish you luck!
Reply:Find a Dr. thet you can talk to and you will get answers from, an onocoligest. This isn't something to fool around with . Your result's should be in, press the Dr. to get you result's ASAP and do look for another Dr. Good luck.
Reply:I got my results the next day....call them over and over until you get an answer. Be proactive, it is so important.
Reply:Call the doctor or go there and tell them you want answers. I had a biopsy done on Monday and was told it takes 2-3 days. I had my result on Thursday. A week seems too much. It is nervewrecking as it is, don't let them make you wait.
My tumor was cancer and after the surgery they did more tests on the tumor . The very last test there took over 3 weeks to come back.
palm
I just had a biopsy done on breast now it has ulcerated doctor said "this is unusual case for him "what
Has your dr. prescribed an antibiotic ointment or pills to deal with the ulceration? A week is way to long for any lab, doctor or pathologist to keep someone in suspense. Get on the phone and hound your primary doctor. If he/she hasn't received the lab results, it's ok to be persistent, call the clinic or office where your biopsy was done and demand to speak to the dr. in charge there. It's your life and you have a right to know.
I had to wait over Memorial Day weekend plus 2 extra days because my doctor isn't in the office on Tuesdays and Wednesday. It was hell, I couldn't sleep, or eat and couldn't function at work. I called and left her a voice message telling her it was ok to call me at work, on my cell phone or whereever and give me the news over the phone. I didn't want to wait for the staff to fit me in for an appointment and then have to wait an hour in the waiting room......
My dr. was fantastic and put me in touch immediately with a surgeon. A month after I was diagnosed I had surgery and started chemo a month later. October 28th will be my 2 year anniversary of my last chemo treatment.
I wish you luck!
Reply:Find a Dr. thet you can talk to and you will get answers from, an onocoligest. This isn't something to fool around with . Your result's should be in, press the Dr. to get you result's ASAP and do look for another Dr. Good luck.
Reply:I got my results the next day....call them over and over until you get an answer. Be proactive, it is so important.
Reply:Call the doctor or go there and tell them you want answers. I had a biopsy done on Monday and was told it takes 2-3 days. I had my result on Thursday. A week seems too much. It is nervewrecking as it is, don't let them make you wait.
My tumor was cancer and after the surgery they did more tests on the tumor . The very last test there took over 3 weeks to come back.
palm
Medical transcriptionists. "kaylor" again?
This doc has no accent, but I can't figure this one out.
"There is erythema, induration, and [sounds like "kay-lor"] to the right forefoot. There is no odor. There is sanguinopurulent..."
Please let me know if you have any ideas.
Medical transcriptionists. "kaylor" again?
Could be "Pallor".
Reply:Keloid?
Reply:I'd guess choler, if I had to guess.
Reply:i honestly have no clue and apparently have never had that problem before.
Reply:calor, is bodily heat that is a sign of inflammation.
palor is a paleness.
Because he says there is erythema (redness) I'd go with Calor
Reply:Yes, the answer would be calor. Discussed several times in the below link with regard to the foot/feet.
I answered your other one about this but said eschar because I had not heard calor used in a foot exam before but have seen heard it and thought of your last question. :)
"There is erythema, induration, and [sounds like "kay-lor"] to the right forefoot. There is no odor. There is sanguinopurulent..."
Please let me know if you have any ideas.
Medical transcriptionists. "kaylor" again?
Could be "Pallor".
Reply:Keloid?
Reply:I'd guess choler, if I had to guess.
Reply:i honestly have no clue and apparently have never had that problem before.
Reply:calor, is bodily heat that is a sign of inflammation.
palor is a paleness.
Because he says there is erythema (redness) I'd go with Calor
Reply:Yes, the answer would be calor. Discussed several times in the below link with regard to the foot/feet.
I answered your other one about this but said eschar because I had not heard calor used in a foot exam before but have seen heard it and thought of your last question. :)
Blood disorder????
my 4 yo has been getting spontaneous bruising to his legs mainly but is also happening on his arms and back, they look like he is being poked but he isnt, they come and go, he also has a history of erythema nodosum and has been recently been diagnosed with a lipoma.. i have an appointment friday with my local gp and am hoping to get a blood test done has anyone been in a similar situation or can shed any light on my situation.... also no these are not every day kid bruises he also has those all over his legs too.....
Blood disorder????
With erythema nodosum, a collagen vascular problem may exist and he may have a mild thrombocytopenia (low platelets).The lipoma is probably a red herring .
Blood disorder????
With erythema nodosum, a collagen vascular problem may exist and he may have a mild thrombocytopenia (low platelets).The lipoma is probably a red herring .
I took my 3 year old son to the ER . He has a rash all over and a fever they said its Erythema Multiforme?
he was taking an antibiotic this is why he got this has anyone ever had this ? or know someone who has ? I'm taking him to the doc in the AM just wonder what i should ask
Thanks for any and all help
I took my 3 year old son to the ER . He has a rash all over and a fever they said its Erythema Multiforme?
Erythema multiforme is a common rash, the name just means it is redness (the erythema part), multiforme (because it takes on varied appearance). It's usually viral in origin, but it is also associated with medications. In his case, it may be due to the antibiotic, or another virus has simply taken advantage of the situation where his immune system is already busy elsewhere. It's unusual in a child of his age, but not entirely unheard of. I'd wait to see what the pediatrician has to say about it. You may be in for a change of antibiotic at the very least. If it is a true EM rash, it will last about 2 weeks, no matter what you do, as that's the usual time frame to battle off a virus. In the meantime he'll be more comfy after a cool bath with a handful of oatmeal thrown in, or a handful of baking soda. Also strip him to the shorts, and keep him fairly cool and out of sunlight. If he gets in the least bit sweaty or hot he'll itch and be in misery. He needs lots to drink, and whatever you can get him to eat is fine. It's not usually contagious, so if there are other children you probably have no worries there. Keep the fever in control with children's Tylenol or Ibuprofen. When the fever comes down, he'll probably feel like being up and messing about- it's amazing how resilient they are. Otherwise, just wait to see what the pediatrician has to say about it all. He should do fine, just itchy and red until it finally goes it's way. I've had 6, with plenty of mystery rashes along the way, and seen plenty more through work. Most go as quietly as they came on, with no problems aside from living with the itchy, grumpy child in the meantime.
Reply:all you need to know
http://www.nlm.nih.gov/medlineplus/ency/...
Reply:its basically an allergic reaction to the medication he was taking. Years ago i was talking sulfur for something and broke out in a horrible rash, found out I was allergic. They made me take anti-histomines to kill the itch from the rash, and i have to avoid that type of medication from now on. Make sure when he gets sick again and they are perscribing antibotics you tell them he is allergic to that particular kind.
Reply: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.
i hope he is ok and everything goes alright keep me psoted
Reply:My 2 year old son also developed this same thing. His was caused by an allergic reaction to a viral infection. We took him to his pediatrician and they ordered blood tests. That's how we discovered the cause. He was covered from head to toe with what appeared to be giant hives which later looked like bruises. It took about 2-3 weeks for them all to go away. I was frightened at first because I thought it was something worse. We just had to let his body heal itself.
We gave him baths with Aveeno and they gave him antihistamines to take for it. I had never heard of anyone else having it until I read this.
Reply:My nephew has had it a couple times. I found you a web site about it! To help him with the itching we gave him baths with Aveeno or oatmeal bath and the DR gave him antihistamines to help too! They may do some blood work at your appointment they will try to find out what is irritating him ! It is probably the antibiotics! Best Wishes! I know he must feel miserable! I hope he gets to feeling better soon!
Thanks for any and all help
I took my 3 year old son to the ER . He has a rash all over and a fever they said its Erythema Multiforme?
Erythema multiforme is a common rash, the name just means it is redness (the erythema part), multiforme (because it takes on varied appearance). It's usually viral in origin, but it is also associated with medications. In his case, it may be due to the antibiotic, or another virus has simply taken advantage of the situation where his immune system is already busy elsewhere. It's unusual in a child of his age, but not entirely unheard of. I'd wait to see what the pediatrician has to say about it. You may be in for a change of antibiotic at the very least. If it is a true EM rash, it will last about 2 weeks, no matter what you do, as that's the usual time frame to battle off a virus. In the meantime he'll be more comfy after a cool bath with a handful of oatmeal thrown in, or a handful of baking soda. Also strip him to the shorts, and keep him fairly cool and out of sunlight. If he gets in the least bit sweaty or hot he'll itch and be in misery. He needs lots to drink, and whatever you can get him to eat is fine. It's not usually contagious, so if there are other children you probably have no worries there. Keep the fever in control with children's Tylenol or Ibuprofen. When the fever comes down, he'll probably feel like being up and messing about- it's amazing how resilient they are. Otherwise, just wait to see what the pediatrician has to say about it all. He should do fine, just itchy and red until it finally goes it's way. I've had 6, with plenty of mystery rashes along the way, and seen plenty more through work. Most go as quietly as they came on, with no problems aside from living with the itchy, grumpy child in the meantime.
Reply:all you need to know
http://www.nlm.nih.gov/medlineplus/ency/...
Reply:its basically an allergic reaction to the medication he was taking. Years ago i was talking sulfur for something and broke out in a horrible rash, found out I was allergic. They made me take anti-histomines to kill the itch from the rash, and i have to avoid that type of medication from now on. Make sure when he gets sick again and they are perscribing antibotics you tell them he is allergic to that particular kind.
Reply: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.
i hope he is ok and everything goes alright keep me psoted
Reply:My 2 year old son also developed this same thing. His was caused by an allergic reaction to a viral infection. We took him to his pediatrician and they ordered blood tests. That's how we discovered the cause. He was covered from head to toe with what appeared to be giant hives which later looked like bruises. It took about 2-3 weeks for them all to go away. I was frightened at first because I thought it was something worse. We just had to let his body heal itself.
We gave him baths with Aveeno and they gave him antihistamines to take for it. I had never heard of anyone else having it until I read this.
Reply:My nephew has had it a couple times. I found you a web site about it! To help him with the itching we gave him baths with Aveeno or oatmeal bath and the DR gave him antihistamines to help too! They may do some blood work at your appointment they will try to find out what is irritating him ! It is probably the antibiotics! Best Wishes! I know he must feel miserable! I hope he gets to feeling better soon!
My friend underwent colonoscopy test and diagnosed that she is having red erythema in intestine. what is it?
Erythema is an abnormal redness of the skin caused by capillary congestion. It is one of the cardinal signs of inflammation.
Erythema details
It can be caused by infection, massage, electrical treatments, acne medication, allergies, exercise or solar radiation (sunburn), any of which can cause the capillaries to dilate, resulting in redness. Erythema is a common side effect of radiotherapy treatment due to patient exposure to electromagnetic radiation.
petunia
Erythema details
It can be caused by infection, massage, electrical treatments, acne medication, allergies, exercise or solar radiation (sunburn), any of which can cause the capillaries to dilate, resulting in redness. Erythema is a common side effect of radiotherapy treatment due to patient exposure to electromagnetic radiation.
petunia
Does anyone know what causes Palmar Erythema with a diagnosis of liver cirrhosis?
I found millions of websites that state it is a symptom of portal hypertension in association with Cirrhosis, but I need to know the mechanism behind it. What causes it? Any smarties out there?
Does anyone know what causes Palmar Erythema with a diagnosis of liver cirrhosis?
I really don't believe that any one knows what causes it.
Does anyone know what causes Palmar Erythema with a diagnosis of liver cirrhosis?
I really don't believe that any one knows what causes it.
What would a therapists response be if a client had "Erythema" reaction after therapy?
If you don't mind can you also add in a response for:
Hyperamia
Headaches
Vertigo on rising
Discomfort
Excessive urination
Thank you in advance
What would a therapists response be if a client had "Erythema" reaction after therapy?
Get them a drink of water or juice to be sipped, they should sit up slowly and dangle their feet over the edge of the bed/table for a few mins before attempting to stand. Ther erythema could be a local reaction to friction or an allergy to something used on the skin.
Reply:Erythema n. Redness of the skin caused by dilatation and congestion of the capillaries, often a sign of inflammation (such as from a burn) or infection but can also be due to massage, electrical treatments, acne medication, allergies, exercise or solar radiation (sunburn). Erythema is a common side effect of radiotherapy treatment due to patient exposure to electromagnetic radiation. What does this have to do with the list of symptoms above? Are you experiencing all of these symptoms at any given time or just some on occasion? What kind of therapy are you referring to?
Reply:What kind of therapy?
Reply:Zukky, I'm not a therapist, but I do work in conjunction with several therapists - I'm very concerned by your questions tonight. I really think you need to look at either a different therapist, or go see your GP and get referred to a registered orthodox therapist. Take care of yourself
Hyperamia
Headaches
Vertigo on rising
Discomfort
Excessive urination
Thank you in advance
What would a therapists response be if a client had "Erythema" reaction after therapy?
Get them a drink of water or juice to be sipped, they should sit up slowly and dangle their feet over the edge of the bed/table for a few mins before attempting to stand. Ther erythema could be a local reaction to friction or an allergy to something used on the skin.
Reply:Erythema n. Redness of the skin caused by dilatation and congestion of the capillaries, often a sign of inflammation (such as from a burn) or infection but can also be due to massage, electrical treatments, acne medication, allergies, exercise or solar radiation (sunburn). Erythema is a common side effect of radiotherapy treatment due to patient exposure to electromagnetic radiation. What does this have to do with the list of symptoms above? Are you experiencing all of these symptoms at any given time or just some on occasion? What kind of therapy are you referring to?
Reply:What kind of therapy?
Reply:Zukky, I'm not a therapist, but I do work in conjunction with several therapists - I'm very concerned by your questions tonight. I really think you need to look at either a different therapist, or go see your GP and get referred to a registered orthodox therapist. Take care of yourself
Is anyone familar with Erythema Nodosum?
Yeah, you might as well use plain old water.
Is anyone familar with Erythema Nodosum?
yes i do my son was diagnosed with erythema nodosum last year, he is 4. After many hosp visits and being told many different things, we were told that it was likely my son is allergic to a virus so now every time he gets a cold he gets the nodules so, best to find out the undrlying cause first... Report It
Is anyone familar with Erythema Nodosum?
yes i do my son was diagnosed with erythema nodosum last year, he is 4. After many hosp visits and being told many different things, we were told that it was likely my son is allergic to a virus so now every time he gets a cold he gets the nodules so, best to find out the undrlying cause first... Report It
MMANTOUX TEST RESULT IS "Erythema & induration present Diameter 10 mm. Interpretation: Positve?
ESR is 67 ,Weakness prevailing, Dr prescribed 100 mg doxycyline tab. 2 times daily for 14 days after that CBC and ESR test to be done. What is the discease? Is the course of treatment is correct?
MMANTOUX TEST RESULT IS "Erythema %26amp; induration present Diameter 10 mm. Interpretation: Positve?
10 mm induration may occur if you have previously had BCG vaccination, or if you live in an endemic area and have been exposed to the disease without getting it. It can also occur if you are suffering from TB now. The doctor is treating you with an antibiotic and wants to reassess you later. That means he is not sure of the diagnosis. You may be having some other infection. You have not mentioned your symptoms and signs. ESR can be raised in any bacterial infection. Perhaps you have enlarged lymph glands in your neck. In any case, what your doctor is doing seems to be the correct thing. Go along with it. I hope it does not turn out to be TB, after all.
Reply:TB presents with low grade fever, weakness, weight loss, loss of appetite,night sweats. Other symptoms depend upon the organ involved, such as lungs, intestines, lymph glands, joints, spine, kidneys, brain. Report It
Reply:The test is positive if there is induration of 10mm. Sounds like TB, but not sure about the rest of the info. Sorry if its not much help
mint
MMANTOUX TEST RESULT IS "Erythema %26amp; induration present Diameter 10 mm. Interpretation: Positve?
10 mm induration may occur if you have previously had BCG vaccination, or if you live in an endemic area and have been exposed to the disease without getting it. It can also occur if you are suffering from TB now. The doctor is treating you with an antibiotic and wants to reassess you later. That means he is not sure of the diagnosis. You may be having some other infection. You have not mentioned your symptoms and signs. ESR can be raised in any bacterial infection. Perhaps you have enlarged lymph glands in your neck. In any case, what your doctor is doing seems to be the correct thing. Go along with it. I hope it does not turn out to be TB, after all.
Reply:TB presents with low grade fever, weakness, weight loss, loss of appetite,night sweats. Other symptoms depend upon the organ involved, such as lungs, intestines, lymph glands, joints, spine, kidneys, brain. Report It
Reply:The test is positive if there is induration of 10mm. Sounds like TB, but not sure about the rest of the info. Sorry if its not much help
mint
State two possible causes of the appearance of erythema following a hand and arm massage?
Very likely, the substance used to facilitate the massaging - eg. oil or powder etc - is the prime suspect it this case. The exact cause of Erythema multiforme 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.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.Pathophysiology of EM is not completely understood but appears to involve a hypersensitivity reaction that can be triggered by a variety of stimuli, particularly bacterial, viral, or chemical products. EM affects males more often than females, with a male-to-female ratio ranging from 3:2 to 2:1.
Hope this is of some help
matador 89
State two possible causes of the appearance of erythema following a hand and arm massage?
Possibly allergic reaction to massage oil. Possibly not true erythema, but redness caused by friction on the skin.
Reply:Maybe allergic reaction to cream
Hope this is of some help
matador 89
State two possible causes of the appearance of erythema following a hand and arm massage?
Possibly allergic reaction to massage oil. Possibly not true erythema, but redness caused by friction on the skin.
Reply:Maybe allergic reaction to cream
What is erythema?
Erythema is redness or inflammation of the skin or mucous membranes, like a mild sunburn, but there is also more detailed diagnosis such as erythema infectiosum (fifth disease), erythema migrans(found in Lyme disease, also known as bulls eye rash), along with many others.
What is erythema?
Here's the definition.
http://www.medterms.com/script/main/art....
Reply:Redness of the skin, indicative of inflammation, infection or allergies.
http://www.doctorupdate.net/du_toolkit/s...
Reply:Hi, Hope this helps a little.
Erythema nodosum is a skin inflammation that results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees..It is a viral infection that predominantly affects children between the ages of 5 and 15.
Reply:Redness.
What is erythema?
Here's the definition.
http://www.medterms.com/script/main/art....
Reply:Redness of the skin, indicative of inflammation, infection or allergies.
http://www.doctorupdate.net/du_toolkit/s...
Reply:Hi, Hope this helps a little.
Erythema nodosum is a skin inflammation that results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees..It is a viral infection that predominantly affects children between the ages of 5 and 15.
Reply:Redness.
What is erythema chronicum migraine?
http://www.neurologyreviews.com/feb04/nr...
What is erythema chronicum migraine?
your head hurts like hell
Reply:Erythema chronicum migrans is the initial lesion of Lyme disease, and often appears at the site of the infecting tick bite. It is a red, enlarging rash, flat or slightly raised, and may reach from 4 to 20 inches across (the average rash is 6 inches).
Reply:Erythema chronicum migrans is the initial lesion of Lyme disease, and often appears at the site of the infecting tick bite. It is a red, enlarging rash, flat or slightly raised, and may reach from 4 to 20 inches across (the average rash is 6 inches).
What is erythema chronicum migraine?
your head hurts like hell
Reply:Erythema chronicum migrans is the initial lesion of Lyme disease, and often appears at the site of the infecting tick bite. It is a red, enlarging rash, flat or slightly raised, and may reach from 4 to 20 inches across (the average rash is 6 inches).
Reply:Erythema chronicum migrans is the initial lesion of Lyme disease, and often appears at the site of the infecting tick bite. It is a red, enlarging rash, flat or slightly raised, and may reach from 4 to 20 inches across (the average rash is 6 inches).
If my 6 mth old baby has erythema multiforme, does that mean he is going to be more prone to it in the future?
It's very rare to see erythema multiforme in children that young (under 3 years on average is rare). However, it is caused by the herpes virus, the same virus that causes cold sores, so unfortunately it can sit dormant for a while and cause a recurrance....There are antiviral meds (though not sure how safe they are at this age) called zovirax and acyclovir and occasionally they'll use oral steroids to treat flares....
Hopefully he has few outbreaks....herpes virus can become painful.
I hope this helps a bit.
sage
Hopefully he has few outbreaks....herpes virus can become painful.
I hope this helps a bit.
sage
Can anyone tell me anything about erythema multiforme?
My brother-in-law has it and is at a loss as to what has caused it. So far the doctor has given him steroids and antihistamines for the itch. That works as long as he takes the steroids but when the regimen is over, it comes back. Any suggestions?
Can anyone tell me anything about erythema multiforme?
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.
hope he feels better
Reply:----------------------------------------...
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Background
Erythema multiforme is part of a spectrum of diseases beginning with a self-limited rash of the skin and mucous membranes which may progress to a disseminated blistering and sometimes fatal disorder known as Stevens-Johnson syndrome (SJS). Older classification systems divided the disease into erythema multiforme minor and major. The major variant is associated with fever, systemic symptoms, and severe oral lesions. These severe cases were sometimes termed SJS and were usually associated with drugs while the minor form was associated with herpes and other infections. At the extreme end is toxic epidermal necrolysis (TEN) which is the most advanced form of Stevens-Johnson syndrome and erythema multiforme. One clinical distinction uses the diagnosis of TEN if greater than 30% of the total body surface area is involved by blisters and peeling and SJS when mucosal lesions are present and the blisters involve less than 30% of the total body surface area.
Working Classification System
Bullous erythema multiforme
Recurrent erythema multiforme
Persistent erythema multiforme
Stevens-Johnson syndrome
Overlap Stevens-Johnson syndrome/toxic epidermal necrolysis (epidermal detachment between 10-30%)
Toxic epidermal necrolysis with spots (widespread purpuric macules or target lesions)
Toxic epidermal necrolysis without spots
The recurrent form has been associated herpes simplex virus infection. The persistent form has been associated with underlying malignancies and Epstein-Barr virus.
The disease is a lichenoid interface dermatitis. See the outline below for detailed information.
TEN may present with generalized erythema rapidly progressing to blisters and shedding of skin. Mortality may be up to 35%. Unlike erythema multiforme, drugs are implicated in the majority of cases. The list is extensive and includes sulfonamides, anticonvulsants, NSAIDs, allopurinol, clindamycin, chloroquine, and ranitidine. The reactive metabolites of the drugs adhere to the keratinocytes leading to an immune reponse.
OUTLINE
Disease Associations
Pathogenesis
Laboratory/Radiologic/Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/
Immunohistochemistry/
Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links
DISEASE ASSOCIATIONS CHARACTERIZATION
DRUG ASSOCIATED
Stevens-Johnson syndrome caused by the antiretroviral drug nevirapine J Am Acad Dermatol 2001;44:354-7
Nevirapine is a non-nucleoside reverse transcriptase inhibitor widely used in combination with other antiretroviral agents for the treatment of HIV infection
This describes 2 cases of SJS related to nevirapine use
LUPUS
Lupus-associated toxic epidermal necrolysis: A novel manifestation of lupus?
Mandelcorn R, Shear NH.
Division of Dermatology, Department of Medicine, University of Toronto.
J Am Acad Dermatol 2003 Apr;48(4):525-9 Abstract quote
BACKGROUND: Toxic epidermal necrolysis is an acute mucocutaneous reaction characterized by extensive cutaneous and mucosal sloughing and systemic involvement. It is generally associated with drug ingestion.
Objective and Methods: We describe 2 patients who developed typical clinical and histopathologic features of toxic epidermal necrolysis with unusual subacute progression, absence of systemic involvement or high-risk drug ingestion, and features of lupus erythematosus.
CONCLUSION: We propose that this constellation of features represents a new entity not previously described. This entity may represent a more severe variant of Rowell's syndrome or, alternatively, a novel manifestation of lupus erythematosus
PATHOGENESIS CHARACTERIZATION
CHEMOKINES
CC and CXC Chemokines Are Differentially Expressed in Erythema Multiforme In Vivo.
Spandau U, Brocker EB, Kampgen E, Gillitzer R.
Department of Ophthalmology, University of Heidelberg Medical School, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Arch Dermatol 2002 Aug;138(8):1027-33 Abstract quote
BACKGROUND: A characteristic feature of erythema multiforme is an acute inflammatory reaction of the skin with an infiltrate largely composed of mononuclear cells around the upper dermal vessels and in the dermal-epidermal interface.
OBJECTIVE: To determine the composition and localization of leukocyte subsets and corresponding expression of chemokines with chemoattractant properties for lymphocytes and macrophages.
MATERIALS AND METHODS: Immunohistochemical analysis was performed to localize leukocyte subsets (CD1(+), CD3(+), CD4(+), CD8(+), and CD68(+)). Expression of transcripts and proteins of chemokines (macrophage chemoattractant protein [MCP] 1); macrophage inflammatory protein [MIP] 1alpha and MIP-1beta; regulated on activation, normal T-cell expressed and secreted [RANTES]; growth-related oncogene alpha; epithelial-derived neutrophil attractant 78; interleukin 8; macrophage interferon-gamma inducible gene [Mig]; and interferon-gamma inducible protein 10) was determined by in situ hybridization and immunohistochemical analysis.
SETTING: Department of Dermatology, University of Wurzburg Medical School.
RESULTS: High levels of messenger RNA expression of MCP-1, RANTES, Mig, and interferon-gamma inducible protein 10 were detected and localized in the interface zone and subepidermal infiltrate. In contrast, other investigated chemokines (growth-related oncogene alpha, interleukin 8, epithelial-derived neutrophil attractant 78, I-309, MIP-1alpha, and MIP-1beta) were minimally expressed or absent. Protein expression of MCP-1, RANTES, Mig, and interferon-gamma inducible protein 10 was high in the interface zone and low in the subepidermal infiltrate. The messenger RNA expression and protein immunoreactivity patterns overlapped. According to the expression profiles, Mig, interferon-gamma inducible protein 10, MCP-1, and RANTES were expressed by basal keratinocytes above and mononuclear cells within the inflammatory foci.
CONCLUSION: These cytokines are important agents in the cytokine network and contribute to the cell-specific and spatially restricted recruitment of mononuclear cells in the acute inflammation of erythema multiforme lesions.
T LYMPHOCYTES Arch Dermatol 1992;128:50-53
Dermal infiltrate is predominately CD4 helper cells while the epidermal cells are CD8 positive
TEN
Immunoregulatory Effector Cells in Drug-Induced TEN Am J Dermatopathol 2000;22:413-417
High density of Factor XIIIa and Mac387 positive cells in lesional skin suggests an important pathogenic role
TNFalpha may be a major cytokine and a lesser role for IL-6 but IL-6 induces increased expressionn of TNFalpha
Soluble Interleukin 2 Receptor and Interleukin 1 in Toxic Epidermal Necrolysis A Comparative Analysis of Serum and Blister Fluid Samples
Osvaldo Correia, MD; Luis Delgado, MD, PhD; Jean-Claude Roujeau, MD, PhD; Laurence Le Cleach, MD; José A. Fleming-Torrinha, MD, PhD
Arch Dermatol. 2002;138:29-32 Abstract quote
Background
Toxic epidermal necrolysis (TEN) is a rare but severe adverse drug disease, characterized by extensive skin and mucosal detachment with participation of different immunoinflammatory pathways, in particular with early participation of activated CD8+ T lymphocytes.
Objective
To further study the potential role of T lymphocytes in the early phase of keratinocyte necrosis.
Design
Prospective study.
Setting
University hospitals.
Patients
Thirteen patients with clinical and histopathologic criteria of TEN and 6 patients with second-degree burns.
Main Outcome Measures
Measurement of soluble interleukin (IL) 2 receptor (sIL-2R) and IL-1 in serum samples and fluid of recent blisters.
Results
In the blister fluid of patients with TEN, we found significantly higher levels of sIL-2R than in patients with burns, whereas IL-1 levels were higher in the blister fluid of burned patients. No significant differences were found in serum samples of patients with TEN and burns, in either sIL-2R or IL-1. In TEN we also found significantly higher levels of sIL-2R in the blister fluid compared with serum samples, pointing to a predominantly local production contrasting with the low concentration of sIL-2R in the blister fluid of burned patients.
Conclusions
Our findings of elevated sIL-2R levels in blister fluid of patients with TEN are probably related to a local down-regulation of an immunologically mediated cytotoxic reaction and further support the involvement of activated T lymphocytes in the early blisters of TEN.
Increased interleukin 10, tumor necrosis factor alpha, and interleukin 6 levels in blister fluid of toxic epidermal necrolysis.
Correia O, Delgado L, Barbosa IL, Campilho F, Fleming-Torrinha J.
Department of Dermatology, Instituto Portugues Oncologia, 4200 Porto, Portugal.
J Am Acad Dermatol 2002 Jul;47(1):58-62 Abstract quote
BACKGROUND: Toxic epidermal necrolysis is a severe, usually drug-induced disease that shares clinical, histologic, and immunologic similarities with the severe forms of cutaneous acute graft-versus-host disease.
OBJECTIVE: Our purpose was to further characterize common immune-inflammatory pathways in these skin disorders by measurement of different cytokines.
METHODS: Evaluation of serum levels of interleukin 10 (IL-10), tumor necrosis factor alpha, IL-6, and soluble IL-6 receptor in the early phase of both diseases and in blister fluid of toxic epidermal necrolysis.
RESULTS: Serum levels of IL-10 and IL-6 were significantly higher in patients with toxic epidermal necrolysis (P =.0001) and acute graft-versus-host disease (P =.001) compared with those of blood donors. We found an increase in IL-6 levels in blister fluid and significantly higher levels of IL-10 (P =.018) and tumor necrosis factor alpha (P =.028) in blister fluid compared with serum in patients with toxic epidermal necrolysis.
CONCLUSION: A similar serum cytokine profile of toxic epidermal necrolysis and acute graft-versus-host disease further emphasizes common immunologic mechanisms. The presence of inflammatory cytokines, IL-6 and tumor necrosis factor alpha, in the blister fluid of patients with toxic epidermal necrolysis is associated with significantly higher levels of IL-10, which through its down-regulatory role, may be involved in limitation of the disease extension.
CLINICAL VARIANTS CHARACTERIZATION
Correlations between clinical patterns and causes of erythema multiforme majus, stevens-johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study.
Auquier-Dunant A, Mockenhaupt M, Naldi L, Correia O, Schroder W, Roujeau JC.
Service de Dermatologie, Hopital Henri Mondor, 94010 Creteil, France.
Arch Dermatol 2002 Aug;138(8):1019-24 Abstract quote
BACKGROUND: It was proposed that Stevens-Johnson syndrome and toxic epidermal necrolysis differed from erythema multiforme majus by the pattern and localization of skin lesions.
OBJECTIVE: To evaluate the validity of this clinical separation.
DESIGN: Case-control study.
SETTINGS: Active survey from 1989 to 1995 of 1800 hospital departments in Europe.
PATIENTS: A total of 552 patients and 1720 control subjects.
METHODS: Cases were sorted into 5 groups (erythema multiforme majus, Stevens-Johnson syndrome, Stevens-Johnson syndrome-toxic epidermal necrolysis overlap, toxic epidermal necrolysis, and unclassified erythema multiforme majus or Stevens-Johnson syndrome) by experts blinded as to exposure to drugs and other factors. Etiologic fractions for herpes and drugs obtained from case-control analyses were compared between these groups.
RESULTS: Erythema multiforme majus significantly differed from Stevens-Johnson syndrome, overlap, and toxic epidermal necrolysis by occurrence in younger males, frequent recurrences, less fever, milder mucosal lesions, and lack of association with collagen vascular diseases, human immunodeficiency virus infection, or cancer. Recent or recurrent herpes was the principal risk factor for erythema multiforme majus (etiologic fractions of 29% and 17%, respectively) and had a role in Stevens-Johnson syndrome (etiologic fractions of 6% and 10%) but not in overlap cases or toxic epidermal necrolysis. Drugs had higher etiologic fractions for Stevens-Johnson syndrome, overlap, or toxic epidermal necrolysis (64%-66%) than for erythema multiforme majus (18%). Unclassified cases mostly behaved clinically like erythema multiforme.
CONCLUSIONS: This large prospective study confirmed that erythema multiforme majus differs from Stevens-Johnson syndrome and toxic epidermal necrolysis not only in severity but also in several demographic characteristics and causes.
PEDIATRIC
Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a review of 10 years' experience.
Forman R, Koren G, Shear NH.
The Division of Clinical Pharmacology/Toxicology, Sunnybrook Medical Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
Drug Saf. 2002;25(13):965-72. Abstract quote
OBJECTIVE: To review 10 years' experience in a tertiary care paediatric hospital of erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). In addition, to apply a recently described classification system for EM, SJS and TEN in children.
DESIGN: Retrospective study of all children with a discharge diagnosis of EM, SJS or TEN over a 10-year period.
SETTING: A university tertiary care paediatric hospital.
PATIENTS: Sixty-one paediatric patients with a discharge diagnosis of EM, SJS or TEN.
MAIN OUTCOME MEASURES: Epidemiology, laboratory features, causative factors, treatment methods, complications and mortality of EM, SJS and TEN in this group of patients. Comparison of correlation with aetiology of old and new classification systems in a paediatric population.
RESULTS: Mucous membrane involvement was documented in 61% of patients. Ocular involvement was seen in 39%. Complications occurred in 21% cases, all of whom had SJS or TEN. Only one patient died as a result of their skin condition. Corticosteroids were used in 18% of cases; 95% of whom had a discharge diagnosis of SJS or TEN. The drugs most commonly identified as aetiological agents were sulphonamides and penicillins (26% each). The most frequently implicated infectious agent was herpes simplex virus (19.7%). Classification of study cases according to Bastuji-Garin et al. indicates a strong trend toward bullous EM cases being attributable to infection and SJS/TEN cases to drugs. There was no such clear trend with respect to aetiology when diagnosis was done without the classification system.
CONCLUSION: EM, SJS and TEN rarely cause mortality but significant morbidity is seen. Infectious agents, particularly herpes simplex virus, and drugs, especially the sulphonamides and penicillins, are the most common aetiological agents. The classification system proposed by Bastuji-Garin et al. correlates better with aetiology than the practice that preceded it.
HISTOLOGICAL TYPES CHARACTERIZATION
General Mild infiltrate of lymphocytes whicc may obscure the dermoepidermal junction Prominent cell death with basal vacuolar change and individual cell necrosis
Severe cases may have papillary dermal edema with secondary subepidermal vesicular change
VARIANTS
TOXIC EPIDERMAL NECROLYSIS
Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis.
Quinn AM, Brown K, Bonish BK, Curry J, Gordon KB, Sinacore J, Gamelli R, Nickoloff BJ.
Departments of Pathology, Surgery, Internal Medicine, and Preventive Medicine and Epidemiology, Loyola University, Maywood, IL 60153, USA. Arch Dermatol. 2005 Jun;141(6):683-7. Abstract quote
OBJECTIVE: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction.
DESIGN: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections.
SETTING: North American tertiary care, university-based burn unit.Patients Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30% or more of their total body surface area and who underwent skin punch biopsies immediately following admission.Main Outcome Measure The degree of dermal mononuclear (DM) inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN) were calculated, and clinical outcome was recorded as survived or died during hospitalization.
RESULTS: Extent of inflammation was assessed by categorizing the mean +/- SD DM cell counts as follows: sparse, 161 +/- 36 cells/HPF (n = 15); moderate, 273 +/- 76 cells/HPF (n = 15); and extensive, 392 +/- 124 cells/HPF (n = 7). There was good concordance between observer ratings (P%26lt;.001). While 73% of patients (n = 11) with sparse inflammation survived, only 47% (n = 7) with moderate and 29% (n = 2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65% using grade of inflammation, 68% with mean cell count, and 71% with SCORTEN.
CONCLUSIONS: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.
SPECIAL STAINS/
IMMUNOPEROXIDASE CHARACTERIZATION
Direct immunofluorescence (DIF) Intrapidermal degenerating keratinocytes surrounded with IgM and C3
G ranular staining for C3 along the dermoepidermal junction
Indirect immunofluorescence (IIF)
PROGNOSIS AND TREATMENT CHARACTERIZATION
TEN
Analysis of Intravenous Immunoglobulin for the Treatment of Toxic Epidermal Necrolysis Using SCORTEN: The University of Miami Experience.
Trent JT, Kirsner RS, Romanelli P, Kerdel FA.
University of Miami Department of Dermatology, PO Box 016250, Miami, FL 33136.
Arch Dermatol 2003 Jan;139(1):39-43 Abstract quote
BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition caused by certain medications. Keratinocytes affected by TEN have been found to undergo apoptosis mediated by Fas-FasL interactions. Treatment with intravenous immunoglobulin (IVIG) has been proposed to inhibit this interaction.
OBJECTIVE: To demonstrate the effectiveness of IVIG therapy in reducing mortality in patients with TEN.
DESIGN: A retrospective analysis of 16 consecutive patients with TEN who were treated with IVIG. The SCORTEN system, a validated predictor of TEN mortality, was used to analyze the data of these patients. Using SCORTEN, we compared the predicted mortality of our patient population with observed mortality.
SETTING: Dermatology inpatient unit at a university-affiliated hospital.
INTERVENTION: All 16 patients received IVIG treatment daily for 4 days. Fifteen patients received 1 g/kg per day and 1 patient received 0.4 g/kg per day.
MAIN OUTCOME MEASURES: For each patient, causes of TEN and other medical problems were documented prior to IVIG therapy, as were the 7 independent SCORTEN risk factors. RESULTS: One patient died. Based on the SCORTEN system, 5.81 patients were expected to die. These mortality rates were compared using the standardized mortality ratio (SMR) analysis ([Sigma observed deaths/Sigma expected deaths] x 100) to determine the efficacy of this treatment, which showed that patients with TEN treated with IVIG were 83% less likely to die than those not treated with IVIG (SMR = 0.17; 95% confidence interval, 0.0-0.96). CONCLUSION: Based on comparison of our observed mortality rate with the SCORTEN-predicted mortality rate, treatment with IVIG significantly decreased mortality in patients with TEN.
Intravenous immunoglobulin treatment for stevens-johnson syndrome and toxic epidermal necrolysis: a prospective noncomparative study showing no benefit on mortality or progression.
Bachot N, Revuz J, Roujeau JC.
Service de Dermatologie, Hopital Henri Mondor, 49010 Creteil CEDEX, France.
Arch Dermatol 2003 Jan;139(1):33-6 Abstract quote
BACKGROUND: It has been proposed that Fas-Fas ligand interaction was responsible for the apoptosis of epidermal cells in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) and that high doses of intravenous immunoglobulin (IVIG) could help patients by blocking the apoptosis.
OBJECTIVE: To study the effects of IVIG on SJS and TEN.
DESIGN: Prospective open trial.
SETTING: Referral center of a university hospital.
PATIENTS: Thirty-four consecutive patients admitted for SJS (n = 9), SJS-TEN (n = 5), or TEN (n = 20) a mean of 4.3 days after onset.
INTERVENTION: A dose of 2 g/kg of IVIG was administered within 2 days (half doses or full doses over a longer period for patients with low creatinine clearance).
MAIN OUTCOME MEASURES: Detached plus detachable proportions of the total body surface area measured before and after treatment and predicted death rate estimated on admission with a validated prognostic score.
RESULTS: Epidermal detachment involved a mean +/- SD 19% +/- 16% of the total body surface area on admission and 32% +/- 26% after IVIG treatment (progression in 22 of 34 cases, including most patients referred early). The prognostic score predicted 8.2 deaths (24%); 11 were observed (32%; 95% confidence interval, 17%-51%). Most deaths occurred in elderly patients who had initially impaired renal function.
CONCLUSIONS: The confidence interval of the observed death rate excludes a dramatic decrease in mortality. No measurable effect was observed on the progression of detachment or on the speed of reepidermalization. These results do not support the routine use of IVIG treatment for patients with SJS or TEN, especially in cases of impaired renal function.
Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins: multicenter retrospective analysis of 48 consecutive cases.
Prins C, Kerdel FA, Padilla RS, Hunziker T, Chimenti S, Viard I, Mauri DN, Flynn K, Trent J, Margolis DJ, Saurat JH, French LE.
Dermatology Department, Geneva University Hospital, 1211 Geneva 14, Switzerland.
Arch Dermatol 2003 Jan;139(1):26-32 Abstract quote
OBJECTIVE: To evaluate the effect of high-dose intravenous immunoglobulin (IVIG) in toxic epidermal necrolysis (TEN), parameters that may affect response to treatment, and the effect of different IVIG batches on Fas-mediated cell death.
DESIGN: Multicenter retrospective analysis of 48 consecutive TEN patients treated with IVIG.
SETTING: Fourteen university hospital dermatology centers in Europe and the United States.
PATIENTS: Forty-eight patients with TEN (skin detachment %26gt;10% of their body surface [mean, 44.8%; range, 10%-95%]).
INTERVENTIONS: Infusion of IVIG in all patients (range, 0.8-5.8 g/kg), and analysis of the ability of different IVIG batches to inhibit Fas-mediated cell death.
MAIN OUTCOME MEASURES: Objective response to IVIG treatment, final outcome at day 45, parameters that may affect response to IVIG treatment, and tolerance.
RESULTS: Infusion of IVIG (mean total dose, 2.7 g/kg [range, 0.65-5.8 g/kg]; mean consecutive days, 4 [range, 1-5 days]) was associated with a rapid cessation (mean, 2.3 days [range, 1-6 days]) of skin and mucosal detachment in 43 patients (90%) and survival in 42 (88%). Patients who responded to IVIG had received treatment earlier in the course of disease and, on average, higher doses of IVIG. Furthermore, analysis of 35 IVIG batches revealed significant batch-to-batch variations in the capacity of IVIG to inhibit Fas-mediated cell death in vitro.
CONCLUSIONS: Early infusion of high-dose IVIG is safe, well tolerated, and likely to be effective in improving the survival of patients with TEN. We recommend early treatment with IVIG at a total dose of 3 g/kg over 3 consecutive days (1 g/kg per day for 3 days).
Long-term consequences of toxic epidermal necrolysis in children.
Sheridan RL, Schulz JT, Ryan CM, Schnitzer JJ, Lawlor D, Driscoll DN, Donelan MB, Tompkins RG.
Shriners Burns Hospital, Boston, Massachusetts, USA.
Pediatrics 2002 Jan;109(1):74-8 Abstract quote
OBJECTIVE: Toxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury not just to the skin. Historically, it has been associated with a high mortality but few long-term consequences among survivors. With improved survival, long-term consequences may be becoming more apparent. The objective of this study was to define these long-term consequences and their frequency.
METHODS: From July 1, 1991, to June 30, 2000, 11 children with severe TEN were referred to a regional pediatric burn facility. Wounds were managed with a strategy involving prevention of wound desiccation and superinfection, including the frequent use of biological wound coverings. All children survived and have been followed in the burn clinic. The records of all children were reviewed in detail.
RESULTS: Two boys and 9 girls with an average age of 7.2 +/- 1.8 years (range: 6 months-15 years) and sloughed surface area of 76 +/- 6% of the body surface (range: 50%-95%) were admitted to the burn unit for care. Antibiotics (3 children), anticonvulsants (4 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were believed to have triggered the syndrome. Six (55%) children required intubation for an average of 9.7 +/- 1.8 days (range: 2-14 days). Mucosal involvement occurred in 10 (91%) and ocular involvement in 10 (91%). Lengths of stay averaged 19 +/- 3 days (range: 6-40 days). Overall follow-up averaged 14 +/- 13 months. Three children had no apparent long-term consequences of the disease and were referred to primary care follow-up after the 2-month burn clinic visit. The remaining children had follow-up averaging 23 +/- 13 months. The most common long-term morbidity involved eyes (3 children [27%]), nails (4 children [36%]), and variegated skin depigmentation (all children). One child developed vaginal stenosis from mucosal inflammation. No esophageal strictures or recurrent TEN has been diagnosed.
CONCLUSIONS: Survival has improved in children with TEN, but long-term sequelae are not infrequent. The most common long-term consequences involve the eyes, the skin, and the nails.
A multicenter review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twentieth century.
Palmieri TL, Greenhalgh DG, Saffle JR, Spence RJ, Peck MD, Jeng JC, Mozingo DW, Yowler CJ, Sheridan RL, Ahrenholz DH, Caruso DM, Foster KN, Kagan RJ, Voigt DW, Purdue GF, Hunt JL, Wolf S, Molitor F.
Burn Multicenter Study Group, Shriners Hospitals for Children Northern California and University of California Davis Regional Burn Center, Sacramento, CA 95817, USA.
J Burn Care Rehabil 2002 Mar-Apr;23(2):87-96 Abstract quote
Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care.
The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, non-burn hospital and burn center treatment, and outcome.
A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and non-burn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P %26lt; 0.05), prophylactic antibiotics (22 vs 37.9%, P %26lt; 0.05), corticosteroid use (22 vs 51%, P %26lt; 0.05), and wound management.
Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and non-burn centers. Early transport to a burn unit is warranted to improve patient outcome.
Treatment of toxic epidermal necrolysis with intravenous immunoglobulin in children.
Tristani-Firouzi P, Petersen MJ, Saffle JR, Morris SE, Zone JJ.
Department of Dermatology, University of Utah School of Medicine, Salt Lake City 84132, USA
J Am Acad Dermatol 2002 Oct;47(4):548-52 Abstract quote
BACKGROUND: Toxic epidermal necrolysis (TEN) is an acute illness characterized by rapid onset of skin necrosis and high mortality. Standard treatment is primarily aimed at supportive care in a burn unit setting.
OBJECTIVE: We evaluated the outcome of 8 pediatric patients treated for TEN with intravenous immunoglobulin (IVIg) over a 3-year period.
METHODS: We performed a retrospective analysis of pediatric patients with a diagnosis of TEN between 1999 and 2001, obtained from a computerized database.
RESULTS: Mean body surface involvement of 8 patients treated with IVIg was 67%. The average length of hospitalization was 13.6 days, with an average delay in treatment of 3.2 days. The average time to arrest in progression of lesions was 2.1 days and to complete re-epithelialization, 8.1 days. The mortality rate was 0%. The majority of complications were infectious.
CONCLUSION: IVIg is a safe and effective treatment for TEN in the pediatric population. Randomized trials are needed to further evaluate the efficacy of IVIg compared with other modalities.
J Am Acad Dermatol 1991;25:69-79.
Arch Dermatol 1993;129:92-96.
Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.
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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.
Erythema multiforme may become noticeable with a classic skin lesion, with or without systemic (whole body) symptoms. In Stevens-Johnson syndrome, the systemic symptoms are severe and the lesions are extensive, involving multiple body areas, especially the mucous membranes. Toxic epidermal necrolysis (TEN syndrome, or Lyell's syndrome) involves multiple large blisters (bullae) that coalesce, followed by sloughing of all or most of the skin and mucous membranes.
Symptoms Return to top
Multiple skin lesions:
With sudden onset, which may recur
That may spread
That may appear as nodule, papule, or macule
Central lesion surrounded by concentric rings of paleness and redness, also called "target", "iris", or "bull's eye"
May have vesicles and bullae (blisters of various sizes)
Located on the legs, arms, palms, hands, or feet
May involve the face or lips
Trunk is usually not involved
Usually symmetrical
Itching of the skin may be present
Fever
General ill feeling
Joint aches
Additional symptoms that may be associated with this disease:
Vision abnormalities
Dry eyes
Bloodshot eyes
Eye pain
Eye burning, itching and discharge
Mouth sores
Signs and tests Return to top
The diagnosis is primarily based on the appearance of the skin lesion and its typical symmetrical distribution, especially if there is a history of risk factors or associated diseases.
There may be a positive Nikolsky's sign.
A skin lesion biopsy and microscopic examination may be helpful to differentiate erythema multiforme from other disorders. Erythema multiforme may show tissue death and other changes. Microscopic examination of the tissue may also show antibody deposits.
Treatment Return to top
Treatment goals include control of the underlying causes or illnesses, treatment of the symptoms, and prevention of infection. Suspected medications should be discontinued.
Treatment of mild symptoms may include:
Moist compresses applied to skin lesions
Medications such as antihistamines to control itching
Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort
Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking
Treatment of severe symptoms may include:
Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
Systemic corticosteroids to control inflammation
Intravenous immunoglobulins (IVIG) to stop the process
Antibiotics to control secondary skin infections
Good hygiene and isolation from others may be required to prevent secondary infections.
Extensive skin involvement may cause the loss of large quantities of body fluids, causing shock in addition to the risk of infection. Intensive care with support of body systems may be required.
Skin grafting may be helpful in cases in which large areas of the body are affected.
In cases that are caused by the herpes virus, daily antiviral medications may be prescribed to prevent recurrences of erythema multiforme.
Expectations (prognosis) Return to top
Mild forms of erythema multiforme usually resolve without difficulty in 2 - 6 weeks, but they may recur. More severe forms may be difficult to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis are associated with high death rates.
Complications Return to top
Permanent skin damage and scarring
Occasionally, lesions on internal organs causing:
Pneumonitis (lung inflammation)
Myocarditis (heart inflammation)
Nephritis (kidney inflammation)
Hepatitis (liver inflammation)
Secondary skin infection (cellulitis)
Systemic infection, sepsis
Loss of body fluids, shock
Calling your health care provider Return to top
Go to the emergency room or call the local emergency number (such as 911) if symptoms indicate erythema multiforme. Involvement of a large area of the body is an emergency situation.
Update Date: 10/29/2004
Can anyone tell me anything about erythema multiforme?
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.
hope he feels better
Reply:----------------------------------------...
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Background
Erythema multiforme is part of a spectrum of diseases beginning with a self-limited rash of the skin and mucous membranes which may progress to a disseminated blistering and sometimes fatal disorder known as Stevens-Johnson syndrome (SJS). Older classification systems divided the disease into erythema multiforme minor and major. The major variant is associated with fever, systemic symptoms, and severe oral lesions. These severe cases were sometimes termed SJS and were usually associated with drugs while the minor form was associated with herpes and other infections. At the extreme end is toxic epidermal necrolysis (TEN) which is the most advanced form of Stevens-Johnson syndrome and erythema multiforme. One clinical distinction uses the diagnosis of TEN if greater than 30% of the total body surface area is involved by blisters and peeling and SJS when mucosal lesions are present and the blisters involve less than 30% of the total body surface area.
Working Classification System
Bullous erythema multiforme
Recurrent erythema multiforme
Persistent erythema multiforme
Stevens-Johnson syndrome
Overlap Stevens-Johnson syndrome/toxic epidermal necrolysis (epidermal detachment between 10-30%)
Toxic epidermal necrolysis with spots (widespread purpuric macules or target lesions)
Toxic epidermal necrolysis without spots
The recurrent form has been associated herpes simplex virus infection. The persistent form has been associated with underlying malignancies and Epstein-Barr virus.
The disease is a lichenoid interface dermatitis. See the outline below for detailed information.
TEN may present with generalized erythema rapidly progressing to blisters and shedding of skin. Mortality may be up to 35%. Unlike erythema multiforme, drugs are implicated in the majority of cases. The list is extensive and includes sulfonamides, anticonvulsants, NSAIDs, allopurinol, clindamycin, chloroquine, and ranitidine. The reactive metabolites of the drugs adhere to the keratinocytes leading to an immune reponse.
OUTLINE
Disease Associations
Pathogenesis
Laboratory/Radiologic/Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/
Immunohistochemistry/
Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links
DISEASE ASSOCIATIONS CHARACTERIZATION
DRUG ASSOCIATED
Stevens-Johnson syndrome caused by the antiretroviral drug nevirapine J Am Acad Dermatol 2001;44:354-7
Nevirapine is a non-nucleoside reverse transcriptase inhibitor widely used in combination with other antiretroviral agents for the treatment of HIV infection
This describes 2 cases of SJS related to nevirapine use
LUPUS
Lupus-associated toxic epidermal necrolysis: A novel manifestation of lupus?
Mandelcorn R, Shear NH.
Division of Dermatology, Department of Medicine, University of Toronto.
J Am Acad Dermatol 2003 Apr;48(4):525-9 Abstract quote
BACKGROUND: Toxic epidermal necrolysis is an acute mucocutaneous reaction characterized by extensive cutaneous and mucosal sloughing and systemic involvement. It is generally associated with drug ingestion.
Objective and Methods: We describe 2 patients who developed typical clinical and histopathologic features of toxic epidermal necrolysis with unusual subacute progression, absence of systemic involvement or high-risk drug ingestion, and features of lupus erythematosus.
CONCLUSION: We propose that this constellation of features represents a new entity not previously described. This entity may represent a more severe variant of Rowell's syndrome or, alternatively, a novel manifestation of lupus erythematosus
PATHOGENESIS CHARACTERIZATION
CHEMOKINES
CC and CXC Chemokines Are Differentially Expressed in Erythema Multiforme In Vivo.
Spandau U, Brocker EB, Kampgen E, Gillitzer R.
Department of Ophthalmology, University of Heidelberg Medical School, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Arch Dermatol 2002 Aug;138(8):1027-33 Abstract quote
BACKGROUND: A characteristic feature of erythema multiforme is an acute inflammatory reaction of the skin with an infiltrate largely composed of mononuclear cells around the upper dermal vessels and in the dermal-epidermal interface.
OBJECTIVE: To determine the composition and localization of leukocyte subsets and corresponding expression of chemokines with chemoattractant properties for lymphocytes and macrophages.
MATERIALS AND METHODS: Immunohistochemical analysis was performed to localize leukocyte subsets (CD1(+), CD3(+), CD4(+), CD8(+), and CD68(+)). Expression of transcripts and proteins of chemokines (macrophage chemoattractant protein [MCP] 1); macrophage inflammatory protein [MIP] 1alpha and MIP-1beta; regulated on activation, normal T-cell expressed and secreted [RANTES]; growth-related oncogene alpha; epithelial-derived neutrophil attractant 78; interleukin 8; macrophage interferon-gamma inducible gene [Mig]; and interferon-gamma inducible protein 10) was determined by in situ hybridization and immunohistochemical analysis.
SETTING: Department of Dermatology, University of Wurzburg Medical School.
RESULTS: High levels of messenger RNA expression of MCP-1, RANTES, Mig, and interferon-gamma inducible protein 10 were detected and localized in the interface zone and subepidermal infiltrate. In contrast, other investigated chemokines (growth-related oncogene alpha, interleukin 8, epithelial-derived neutrophil attractant 78, I-309, MIP-1alpha, and MIP-1beta) were minimally expressed or absent. Protein expression of MCP-1, RANTES, Mig, and interferon-gamma inducible protein 10 was high in the interface zone and low in the subepidermal infiltrate. The messenger RNA expression and protein immunoreactivity patterns overlapped. According to the expression profiles, Mig, interferon-gamma inducible protein 10, MCP-1, and RANTES were expressed by basal keratinocytes above and mononuclear cells within the inflammatory foci.
CONCLUSION: These cytokines are important agents in the cytokine network and contribute to the cell-specific and spatially restricted recruitment of mononuclear cells in the acute inflammation of erythema multiforme lesions.
T LYMPHOCYTES Arch Dermatol 1992;128:50-53
Dermal infiltrate is predominately CD4 helper cells while the epidermal cells are CD8 positive
TEN
Immunoregulatory Effector Cells in Drug-Induced TEN Am J Dermatopathol 2000;22:413-417
High density of Factor XIIIa and Mac387 positive cells in lesional skin suggests an important pathogenic role
TNFalpha may be a major cytokine and a lesser role for IL-6 but IL-6 induces increased expressionn of TNFalpha
Soluble Interleukin 2 Receptor and Interleukin 1 in Toxic Epidermal Necrolysis A Comparative Analysis of Serum and Blister Fluid Samples
Osvaldo Correia, MD; Luis Delgado, MD, PhD; Jean-Claude Roujeau, MD, PhD; Laurence Le Cleach, MD; José A. Fleming-Torrinha, MD, PhD
Arch Dermatol. 2002;138:29-32 Abstract quote
Background
Toxic epidermal necrolysis (TEN) is a rare but severe adverse drug disease, characterized by extensive skin and mucosal detachment with participation of different immunoinflammatory pathways, in particular with early participation of activated CD8+ T lymphocytes.
Objective
To further study the potential role of T lymphocytes in the early phase of keratinocyte necrosis.
Design
Prospective study.
Setting
University hospitals.
Patients
Thirteen patients with clinical and histopathologic criteria of TEN and 6 patients with second-degree burns.
Main Outcome Measures
Measurement of soluble interleukin (IL) 2 receptor (sIL-2R) and IL-1 in serum samples and fluid of recent blisters.
Results
In the blister fluid of patients with TEN, we found significantly higher levels of sIL-2R than in patients with burns, whereas IL-1 levels were higher in the blister fluid of burned patients. No significant differences were found in serum samples of patients with TEN and burns, in either sIL-2R or IL-1. In TEN we also found significantly higher levels of sIL-2R in the blister fluid compared with serum samples, pointing to a predominantly local production contrasting with the low concentration of sIL-2R in the blister fluid of burned patients.
Conclusions
Our findings of elevated sIL-2R levels in blister fluid of patients with TEN are probably related to a local down-regulation of an immunologically mediated cytotoxic reaction and further support the involvement of activated T lymphocytes in the early blisters of TEN.
Increased interleukin 10, tumor necrosis factor alpha, and interleukin 6 levels in blister fluid of toxic epidermal necrolysis.
Correia O, Delgado L, Barbosa IL, Campilho F, Fleming-Torrinha J.
Department of Dermatology, Instituto Portugues Oncologia, 4200 Porto, Portugal.
J Am Acad Dermatol 2002 Jul;47(1):58-62 Abstract quote
BACKGROUND: Toxic epidermal necrolysis is a severe, usually drug-induced disease that shares clinical, histologic, and immunologic similarities with the severe forms of cutaneous acute graft-versus-host disease.
OBJECTIVE: Our purpose was to further characterize common immune-inflammatory pathways in these skin disorders by measurement of different cytokines.
METHODS: Evaluation of serum levels of interleukin 10 (IL-10), tumor necrosis factor alpha, IL-6, and soluble IL-6 receptor in the early phase of both diseases and in blister fluid of toxic epidermal necrolysis.
RESULTS: Serum levels of IL-10 and IL-6 were significantly higher in patients with toxic epidermal necrolysis (P =.0001) and acute graft-versus-host disease (P =.001) compared with those of blood donors. We found an increase in IL-6 levels in blister fluid and significantly higher levels of IL-10 (P =.018) and tumor necrosis factor alpha (P =.028) in blister fluid compared with serum in patients with toxic epidermal necrolysis.
CONCLUSION: A similar serum cytokine profile of toxic epidermal necrolysis and acute graft-versus-host disease further emphasizes common immunologic mechanisms. The presence of inflammatory cytokines, IL-6 and tumor necrosis factor alpha, in the blister fluid of patients with toxic epidermal necrolysis is associated with significantly higher levels of IL-10, which through its down-regulatory role, may be involved in limitation of the disease extension.
CLINICAL VARIANTS CHARACTERIZATION
Correlations between clinical patterns and causes of erythema multiforme majus, stevens-johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study.
Auquier-Dunant A, Mockenhaupt M, Naldi L, Correia O, Schroder W, Roujeau JC.
Service de Dermatologie, Hopital Henri Mondor, 94010 Creteil, France.
Arch Dermatol 2002 Aug;138(8):1019-24 Abstract quote
BACKGROUND: It was proposed that Stevens-Johnson syndrome and toxic epidermal necrolysis differed from erythema multiforme majus by the pattern and localization of skin lesions.
OBJECTIVE: To evaluate the validity of this clinical separation.
DESIGN: Case-control study.
SETTINGS: Active survey from 1989 to 1995 of 1800 hospital departments in Europe.
PATIENTS: A total of 552 patients and 1720 control subjects.
METHODS: Cases were sorted into 5 groups (erythema multiforme majus, Stevens-Johnson syndrome, Stevens-Johnson syndrome-toxic epidermal necrolysis overlap, toxic epidermal necrolysis, and unclassified erythema multiforme majus or Stevens-Johnson syndrome) by experts blinded as to exposure to drugs and other factors. Etiologic fractions for herpes and drugs obtained from case-control analyses were compared between these groups.
RESULTS: Erythema multiforme majus significantly differed from Stevens-Johnson syndrome, overlap, and toxic epidermal necrolysis by occurrence in younger males, frequent recurrences, less fever, milder mucosal lesions, and lack of association with collagen vascular diseases, human immunodeficiency virus infection, or cancer. Recent or recurrent herpes was the principal risk factor for erythema multiforme majus (etiologic fractions of 29% and 17%, respectively) and had a role in Stevens-Johnson syndrome (etiologic fractions of 6% and 10%) but not in overlap cases or toxic epidermal necrolysis. Drugs had higher etiologic fractions for Stevens-Johnson syndrome, overlap, or toxic epidermal necrolysis (64%-66%) than for erythema multiforme majus (18%). Unclassified cases mostly behaved clinically like erythema multiforme.
CONCLUSIONS: This large prospective study confirmed that erythema multiforme majus differs from Stevens-Johnson syndrome and toxic epidermal necrolysis not only in severity but also in several demographic characteristics and causes.
PEDIATRIC
Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a review of 10 years' experience.
Forman R, Koren G, Shear NH.
The Division of Clinical Pharmacology/Toxicology, Sunnybrook Medical Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
Drug Saf. 2002;25(13):965-72. Abstract quote
OBJECTIVE: To review 10 years' experience in a tertiary care paediatric hospital of erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). In addition, to apply a recently described classification system for EM, SJS and TEN in children.
DESIGN: Retrospective study of all children with a discharge diagnosis of EM, SJS or TEN over a 10-year period.
SETTING: A university tertiary care paediatric hospital.
PATIENTS: Sixty-one paediatric patients with a discharge diagnosis of EM, SJS or TEN.
MAIN OUTCOME MEASURES: Epidemiology, laboratory features, causative factors, treatment methods, complications and mortality of EM, SJS and TEN in this group of patients. Comparison of correlation with aetiology of old and new classification systems in a paediatric population.
RESULTS: Mucous membrane involvement was documented in 61% of patients. Ocular involvement was seen in 39%. Complications occurred in 21% cases, all of whom had SJS or TEN. Only one patient died as a result of their skin condition. Corticosteroids were used in 18% of cases; 95% of whom had a discharge diagnosis of SJS or TEN. The drugs most commonly identified as aetiological agents were sulphonamides and penicillins (26% each). The most frequently implicated infectious agent was herpes simplex virus (19.7%). Classification of study cases according to Bastuji-Garin et al. indicates a strong trend toward bullous EM cases being attributable to infection and SJS/TEN cases to drugs. There was no such clear trend with respect to aetiology when diagnosis was done without the classification system.
CONCLUSION: EM, SJS and TEN rarely cause mortality but significant morbidity is seen. Infectious agents, particularly herpes simplex virus, and drugs, especially the sulphonamides and penicillins, are the most common aetiological agents. The classification system proposed by Bastuji-Garin et al. correlates better with aetiology than the practice that preceded it.
HISTOLOGICAL TYPES CHARACTERIZATION
General Mild infiltrate of lymphocytes whicc may obscure the dermoepidermal junction Prominent cell death with basal vacuolar change and individual cell necrosis
Severe cases may have papillary dermal edema with secondary subepidermal vesicular change
VARIANTS
TOXIC EPIDERMAL NECROLYSIS
Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis.
Quinn AM, Brown K, Bonish BK, Curry J, Gordon KB, Sinacore J, Gamelli R, Nickoloff BJ.
Departments of Pathology, Surgery, Internal Medicine, and Preventive Medicine and Epidemiology, Loyola University, Maywood, IL 60153, USA. Arch Dermatol. 2005 Jun;141(6):683-7. Abstract quote
OBJECTIVE: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction.
DESIGN: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections.
SETTING: North American tertiary care, university-based burn unit.Patients Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30% or more of their total body surface area and who underwent skin punch biopsies immediately following admission.Main Outcome Measure The degree of dermal mononuclear (DM) inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN) were calculated, and clinical outcome was recorded as survived or died during hospitalization.
RESULTS: Extent of inflammation was assessed by categorizing the mean +/- SD DM cell counts as follows: sparse, 161 +/- 36 cells/HPF (n = 15); moderate, 273 +/- 76 cells/HPF (n = 15); and extensive, 392 +/- 124 cells/HPF (n = 7). There was good concordance between observer ratings (P%26lt;.001). While 73% of patients (n = 11) with sparse inflammation survived, only 47% (n = 7) with moderate and 29% (n = 2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65% using grade of inflammation, 68% with mean cell count, and 71% with SCORTEN.
CONCLUSIONS: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.
SPECIAL STAINS/
IMMUNOPEROXIDASE CHARACTERIZATION
Direct immunofluorescence (DIF) Intrapidermal degenerating keratinocytes surrounded with IgM and C3
G ranular staining for C3 along the dermoepidermal junction
Indirect immunofluorescence (IIF)
PROGNOSIS AND TREATMENT CHARACTERIZATION
TEN
Analysis of Intravenous Immunoglobulin for the Treatment of Toxic Epidermal Necrolysis Using SCORTEN: The University of Miami Experience.
Trent JT, Kirsner RS, Romanelli P, Kerdel FA.
University of Miami Department of Dermatology, PO Box 016250, Miami, FL 33136.
Arch Dermatol 2003 Jan;139(1):39-43 Abstract quote
BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition caused by certain medications. Keratinocytes affected by TEN have been found to undergo apoptosis mediated by Fas-FasL interactions. Treatment with intravenous immunoglobulin (IVIG) has been proposed to inhibit this interaction.
OBJECTIVE: To demonstrate the effectiveness of IVIG therapy in reducing mortality in patients with TEN.
DESIGN: A retrospective analysis of 16 consecutive patients with TEN who were treated with IVIG. The SCORTEN system, a validated predictor of TEN mortality, was used to analyze the data of these patients. Using SCORTEN, we compared the predicted mortality of our patient population with observed mortality.
SETTING: Dermatology inpatient unit at a university-affiliated hospital.
INTERVENTION: All 16 patients received IVIG treatment daily for 4 days. Fifteen patients received 1 g/kg per day and 1 patient received 0.4 g/kg per day.
MAIN OUTCOME MEASURES: For each patient, causes of TEN and other medical problems were documented prior to IVIG therapy, as were the 7 independent SCORTEN risk factors. RESULTS: One patient died. Based on the SCORTEN system, 5.81 patients were expected to die. These mortality rates were compared using the standardized mortality ratio (SMR) analysis ([Sigma observed deaths/Sigma expected deaths] x 100) to determine the efficacy of this treatment, which showed that patients with TEN treated with IVIG were 83% less likely to die than those not treated with IVIG (SMR = 0.17; 95% confidence interval, 0.0-0.96). CONCLUSION: Based on comparison of our observed mortality rate with the SCORTEN-predicted mortality rate, treatment with IVIG significantly decreased mortality in patients with TEN.
Intravenous immunoglobulin treatment for stevens-johnson syndrome and toxic epidermal necrolysis: a prospective noncomparative study showing no benefit on mortality or progression.
Bachot N, Revuz J, Roujeau JC.
Service de Dermatologie, Hopital Henri Mondor, 49010 Creteil CEDEX, France.
Arch Dermatol 2003 Jan;139(1):33-6 Abstract quote
BACKGROUND: It has been proposed that Fas-Fas ligand interaction was responsible for the apoptosis of epidermal cells in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) and that high doses of intravenous immunoglobulin (IVIG) could help patients by blocking the apoptosis.
OBJECTIVE: To study the effects of IVIG on SJS and TEN.
DESIGN: Prospective open trial.
SETTING: Referral center of a university hospital.
PATIENTS: Thirty-four consecutive patients admitted for SJS (n = 9), SJS-TEN (n = 5), or TEN (n = 20) a mean of 4.3 days after onset.
INTERVENTION: A dose of 2 g/kg of IVIG was administered within 2 days (half doses or full doses over a longer period for patients with low creatinine clearance).
MAIN OUTCOME MEASURES: Detached plus detachable proportions of the total body surface area measured before and after treatment and predicted death rate estimated on admission with a validated prognostic score.
RESULTS: Epidermal detachment involved a mean +/- SD 19% +/- 16% of the total body surface area on admission and 32% +/- 26% after IVIG treatment (progression in 22 of 34 cases, including most patients referred early). The prognostic score predicted 8.2 deaths (24%); 11 were observed (32%; 95% confidence interval, 17%-51%). Most deaths occurred in elderly patients who had initially impaired renal function.
CONCLUSIONS: The confidence interval of the observed death rate excludes a dramatic decrease in mortality. No measurable effect was observed on the progression of detachment or on the speed of reepidermalization. These results do not support the routine use of IVIG treatment for patients with SJS or TEN, especially in cases of impaired renal function.
Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins: multicenter retrospective analysis of 48 consecutive cases.
Prins C, Kerdel FA, Padilla RS, Hunziker T, Chimenti S, Viard I, Mauri DN, Flynn K, Trent J, Margolis DJ, Saurat JH, French LE.
Dermatology Department, Geneva University Hospital, 1211 Geneva 14, Switzerland.
Arch Dermatol 2003 Jan;139(1):26-32 Abstract quote
OBJECTIVE: To evaluate the effect of high-dose intravenous immunoglobulin (IVIG) in toxic epidermal necrolysis (TEN), parameters that may affect response to treatment, and the effect of different IVIG batches on Fas-mediated cell death.
DESIGN: Multicenter retrospective analysis of 48 consecutive TEN patients treated with IVIG.
SETTING: Fourteen university hospital dermatology centers in Europe and the United States.
PATIENTS: Forty-eight patients with TEN (skin detachment %26gt;10% of their body surface [mean, 44.8%; range, 10%-95%]).
INTERVENTIONS: Infusion of IVIG in all patients (range, 0.8-5.8 g/kg), and analysis of the ability of different IVIG batches to inhibit Fas-mediated cell death.
MAIN OUTCOME MEASURES: Objective response to IVIG treatment, final outcome at day 45, parameters that may affect response to IVIG treatment, and tolerance.
RESULTS: Infusion of IVIG (mean total dose, 2.7 g/kg [range, 0.65-5.8 g/kg]; mean consecutive days, 4 [range, 1-5 days]) was associated with a rapid cessation (mean, 2.3 days [range, 1-6 days]) of skin and mucosal detachment in 43 patients (90%) and survival in 42 (88%). Patients who responded to IVIG had received treatment earlier in the course of disease and, on average, higher doses of IVIG. Furthermore, analysis of 35 IVIG batches revealed significant batch-to-batch variations in the capacity of IVIG to inhibit Fas-mediated cell death in vitro.
CONCLUSIONS: Early infusion of high-dose IVIG is safe, well tolerated, and likely to be effective in improving the survival of patients with TEN. We recommend early treatment with IVIG at a total dose of 3 g/kg over 3 consecutive days (1 g/kg per day for 3 days).
Long-term consequences of toxic epidermal necrolysis in children.
Sheridan RL, Schulz JT, Ryan CM, Schnitzer JJ, Lawlor D, Driscoll DN, Donelan MB, Tompkins RG.
Shriners Burns Hospital, Boston, Massachusetts, USA.
Pediatrics 2002 Jan;109(1):74-8 Abstract quote
OBJECTIVE: Toxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury not just to the skin. Historically, it has been associated with a high mortality but few long-term consequences among survivors. With improved survival, long-term consequences may be becoming more apparent. The objective of this study was to define these long-term consequences and their frequency.
METHODS: From July 1, 1991, to June 30, 2000, 11 children with severe TEN were referred to a regional pediatric burn facility. Wounds were managed with a strategy involving prevention of wound desiccation and superinfection, including the frequent use of biological wound coverings. All children survived and have been followed in the burn clinic. The records of all children were reviewed in detail.
RESULTS: Two boys and 9 girls with an average age of 7.2 +/- 1.8 years (range: 6 months-15 years) and sloughed surface area of 76 +/- 6% of the body surface (range: 50%-95%) were admitted to the burn unit for care. Antibiotics (3 children), anticonvulsants (4 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were believed to have triggered the syndrome. Six (55%) children required intubation for an average of 9.7 +/- 1.8 days (range: 2-14 days). Mucosal involvement occurred in 10 (91%) and ocular involvement in 10 (91%). Lengths of stay averaged 19 +/- 3 days (range: 6-40 days). Overall follow-up averaged 14 +/- 13 months. Three children had no apparent long-term consequences of the disease and were referred to primary care follow-up after the 2-month burn clinic visit. The remaining children had follow-up averaging 23 +/- 13 months. The most common long-term morbidity involved eyes (3 children [27%]), nails (4 children [36%]), and variegated skin depigmentation (all children). One child developed vaginal stenosis from mucosal inflammation. No esophageal strictures or recurrent TEN has been diagnosed.
CONCLUSIONS: Survival has improved in children with TEN, but long-term sequelae are not infrequent. The most common long-term consequences involve the eyes, the skin, and the nails.
A multicenter review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twentieth century.
Palmieri TL, Greenhalgh DG, Saffle JR, Spence RJ, Peck MD, Jeng JC, Mozingo DW, Yowler CJ, Sheridan RL, Ahrenholz DH, Caruso DM, Foster KN, Kagan RJ, Voigt DW, Purdue GF, Hunt JL, Wolf S, Molitor F.
Burn Multicenter Study Group, Shriners Hospitals for Children Northern California and University of California Davis Regional Burn Center, Sacramento, CA 95817, USA.
J Burn Care Rehabil 2002 Mar-Apr;23(2):87-96 Abstract quote
Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care.
The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, non-burn hospital and burn center treatment, and outcome.
A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and non-burn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P %26lt; 0.05), prophylactic antibiotics (22 vs 37.9%, P %26lt; 0.05), corticosteroid use (22 vs 51%, P %26lt; 0.05), and wound management.
Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and non-burn centers. Early transport to a burn unit is warranted to improve patient outcome.
Treatment of toxic epidermal necrolysis with intravenous immunoglobulin in children.
Tristani-Firouzi P, Petersen MJ, Saffle JR, Morris SE, Zone JJ.
Department of Dermatology, University of Utah School of Medicine, Salt Lake City 84132, USA
J Am Acad Dermatol 2002 Oct;47(4):548-52 Abstract quote
BACKGROUND: Toxic epidermal necrolysis (TEN) is an acute illness characterized by rapid onset of skin necrosis and high mortality. Standard treatment is primarily aimed at supportive care in a burn unit setting.
OBJECTIVE: We evaluated the outcome of 8 pediatric patients treated for TEN with intravenous immunoglobulin (IVIg) over a 3-year period.
METHODS: We performed a retrospective analysis of pediatric patients with a diagnosis of TEN between 1999 and 2001, obtained from a computerized database.
RESULTS: Mean body surface involvement of 8 patients treated with IVIg was 67%. The average length of hospitalization was 13.6 days, with an average delay in treatment of 3.2 days. The average time to arrest in progression of lesions was 2.1 days and to complete re-epithelialization, 8.1 days. The mortality rate was 0%. The majority of complications were infectious.
CONCLUSION: IVIg is a safe and effective treatment for TEN in the pediatric population. Randomized trials are needed to further evaluate the efficacy of IVIg compared with other modalities.
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Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
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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.
Erythema multiforme may become noticeable with a classic skin lesion, with or without systemic (whole body) symptoms. In Stevens-Johnson syndrome, the systemic symptoms are severe and the lesions are extensive, involving multiple body areas, especially the mucous membranes. Toxic epidermal necrolysis (TEN syndrome, or Lyell's syndrome) involves multiple large blisters (bullae) that coalesce, followed by sloughing of all or most of the skin and mucous membranes.
Symptoms Return to top
Multiple skin lesions:
With sudden onset, which may recur
That may spread
That may appear as nodule, papule, or macule
Central lesion surrounded by concentric rings of paleness and redness, also called "target", "iris", or "bull's eye"
May have vesicles and bullae (blisters of various sizes)
Located on the legs, arms, palms, hands, or feet
May involve the face or lips
Trunk is usually not involved
Usually symmetrical
Itching of the skin may be present
Fever
General ill feeling
Joint aches
Additional symptoms that may be associated with this disease:
Vision abnormalities
Dry eyes
Bloodshot eyes
Eye pain
Eye burning, itching and discharge
Mouth sores
Signs and tests Return to top
The diagnosis is primarily based on the appearance of the skin lesion and its typical symmetrical distribution, especially if there is a history of risk factors or associated diseases.
There may be a positive Nikolsky's sign.
A skin lesion biopsy and microscopic examination may be helpful to differentiate erythema multiforme from other disorders. Erythema multiforme may show tissue death and other changes. Microscopic examination of the tissue may also show antibody deposits.
Treatment Return to top
Treatment goals include control of the underlying causes or illnesses, treatment of the symptoms, and prevention of infection. Suspected medications should be discontinued.
Treatment of mild symptoms may include:
Moist compresses applied to skin lesions
Medications such as antihistamines to control itching
Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort
Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking
Treatment of severe symptoms may include:
Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
Systemic corticosteroids to control inflammation
Intravenous immunoglobulins (IVIG) to stop the process
Antibiotics to control secondary skin infections
Good hygiene and isolation from others may be required to prevent secondary infections.
Extensive skin involvement may cause the loss of large quantities of body fluids, causing shock in addition to the risk of infection. Intensive care with support of body systems may be required.
Skin grafting may be helpful in cases in which large areas of the body are affected.
In cases that are caused by the herpes virus, daily antiviral medications may be prescribed to prevent recurrences of erythema multiforme.
Expectations (prognosis) Return to top
Mild forms of erythema multiforme usually resolve without difficulty in 2 - 6 weeks, but they may recur. More severe forms may be difficult to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis are associated with high death rates.
Complications Return to top
Permanent skin damage and scarring
Occasionally, lesions on internal organs causing:
Pneumonitis (lung inflammation)
Myocarditis (heart inflammation)
Nephritis (kidney inflammation)
Hepatitis (liver inflammation)
Secondary skin infection (cellulitis)
Systemic infection, sepsis
Loss of body fluids, shock
Calling your health care provider Return to top
Go to the emergency room or call the local emergency number (such as 911) if symptoms indicate erythema multiforme. Involvement of a large area of the body is an emergency situation.
Update Date: 10/29/2004
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