Skin and soft tissue infections

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Erythema multiforme

Case report:

A 28-year-old patient reported fever that has existed for a week, and also of headaches, malaise, and frailty and symptoms of an infection of the upper respiratory tract. For two days an erythematous, macular first round infiltration on the back of the right hand has arisen which went on within a very short time in a papular skin eruption. This Papel had increased and was accompanied by a central crust formation. In the Papel has occurred concentric color changes and other skin changes had occurred in the forearm. In the area of the mouth redness of the palate and swallowing also be pain, been noted.

Comment:

The fairly typical manifestation of this skin disease with the stages of macular erythematous lesions with subsequent Papelbildungen in symmetrical distribution distally on both extremities (especially the upper) together with the concentric color changes in these lesions ("iris lesions") and with the rather young age of Patients are relatively typical of the rare manifestation of erythema multiforme. An erythema multiforme, in the so-called minor form occur as in this case; in the other, so-called Major-form, there may be bullous lesions with epidermal nekrolytischen peeling skin and also broad Mukosaerosionen around the eyes, of the genital organs, the pharynx and the upper respiratory tract.

Etiology:

Etiologically numerous infectious and non-infectious causes can be suspected in the erythema multiforme. Three well-described etiologies relatively be made primarily responsible today: Herpes simplex, mycoplasma pneumoniae, and medicines. In about 60% of a erythema multiforme is preceded by a herpes simplex infection in an approximately one to three week intervals. Rare is a mycoplasma-associated erythema multiforme, which occurs especially in children and young adults. Among the drug-induced erythema association with sulfonamides, phenylbutazone (Butazolidin et al), diphenylhydantoin must be (Zentropil et al) and penicillins take particular account. Typically occurs the erythema multiforme one to three weeks after initiation of treatment with the substances mentioned. Pathogenetically an immunological response in the skin and on the mucous membranes is conditionally assumed by circulating immune complexes. Histologically, an accumulation of mononuclear cells to the superficial skin vessels together with a damage to the epidermis. The differential diagnosis must be considered in the skin symptoms of a bacterial endocarditis, chronic meningococcal bacteremia, secondary syphilis, and also on vascular connective tissue diseases manifesting.

Therapy:

An effective treatment for erythema multiforme does not exist. Infectious cause the herpes simplex infection should be treated with aciclovir (Zovirax). In case of repeated occurrence of erythema prophylactic therapy is recommended with oral acyclovir for prevention of recurrent herpetic erythema multiforme. A mycoplasma infection is with macrolides, for example, Azithromycin (ZITHROMAX), or tetracyclines, for example, Doxycycline (VIBRAMYCIN among others) treated. Possible causative drugs should be discontinued immediately. The importance of systemic steroid therapy is controversial and apparently not helpful.

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