Rash that usually occurs in adults
appears within 72 hours of the offending agent or pathogen.
hypersensitivity that occurs as a result of exposure to several things including medications and infections most commonly but also malignancy and vascular disorders.
Hands and forearms are most commonly affected but it can involve all areas.
usually characterized by variously sized target lesions. Plus or minus enanthem (mucosal rash).
The most common causes are HSV, then mycoplasma infections.
Other common offenders are sulfonamides, penicillins, phenytoin, lupus, barbiturates, hepatitis, and lupus.
The pneumonic SOAPS may be used
- Sulfonadmines,
- Oral hypoglycemics,
- Anticonvulsants/antibiotics,
- Penicillin/phenytoin,
- nSAIDS.
EM is on the spectrum with Stevens-Johnson and TEN, and has the least amount of epidermal detachment – none, versus SJS which has less than 10% and TEN having greater than 30% epidermal detacthment.
Patients may complain of burning or itching, fever, myalgias, arthralgias or malaise.
Treatment of localized disease involves short steroid burst and analgesics and antihistamines, while more advanced disease may benefit from inpatient admission to a burn unit.
Submitted by J. Stone.
References: (Tintinalli’s Emergency Medicine, Ch 245 Serious Generalized Skin Disorders.); picture