ERYTHEMA MULTIFORME

NCLEX QUESTIONS
1. The most common risk factor associated with Erythema Multiforme is: a. NSAIDs b. Herpes Simplex Virus c. Genetics

SIGNIFICANCE TO NURSING
Although Erythema Multiforme appears like it may be a contagious infection, it is not contagious at all. Nurses treating someone with EM do not have to worry about contracting the illness. Lesions throughout the body can be very painful, so the main focus of nursing for a patient with EM is to treat their wounds and make sure they are comfortable. Other health care providers involved in the care and treatment of an individual with EM include dermatologists and pharmacists.

d. Exposure to radiation

2. What is a cardinal sign of Erythema Multiforme? a. Itchy rash on the abdomen b. Elevated temperature c. Targetoid lesions d. Diaphoresis

References:

JORDAN MULLAUER NURS 300 FERRIS STATE UNIVERSITY

Sanchis, J., Bagn, J., Gavald, C., Murillo, J., & Diaz, J. (2010). Erythema multiforme: diagnosis, clinical manifestations and treatment in a retrospective study of 22 patients. Journal Of Oral Pathology & Medicine, 39(10), 747-752. doi:10.1111/j.1600-0714.2010.00912.x Sokumbi, O. and Wetter, D. A. (2012), Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. International Journal of Dermatology, 51: 889902. doi: 10.1111/j.13654632.2011.05348.x Images retrieved from images.google.com

ERYTHEMA MULTIFORME
ETIOLOGY There is no clear cause for EM, but it has been suggested to be an immunologic response to infection, illness, or drug use. One of the most common causes of EM is related to the Herpes Simplex Virus (HSV). The bodys immune system reacts to a flare up of the virus and causes an outbreak of EM. A wide variety of drugs have also been known to have EM as a side effect. (Sanchis, 2010)
MINOR CHILD MAJOR MUCOSA

Jordan Mullauer NURS 300

CLINICAL MANIFESTATIONS The first sign of EM is usually a small, erythematous, edamatous papule that can resemble an insect bite. The lesions grow and develop into the characteristic targetoid lesions. Lesions are typically symmetrical in nature and develop primarily on extremities and the oral mucosa. (Sokumbi, 2012) POTENTIAL COMPLICATIONS The most severe form of EM is Stevens-Johnson Syndrome (SJS) which is potentially life threatening. Lesions of SJS can cover the entire body and several mucosal areas. Systemic effects such as flu-like symptoms can also occur. (Sanchis, 2010) LIFESPAN AND CULTURAL CONSIDERATIONS Not a whole lot of studies have been done specifically on cultural considerations for EM, but so far, no race is more at risk than another. The disease occurs primarily in young adults, with a preference for young females. (Sokumbi, 2012) NURSING DIAGNOSES 1. Risk for infection r/t open lesions throughout body. 2. Impaired skin integrity r/t open lesions throughout body. 3. Disturbed body image r/t multiple lesions and scars. OUTCOME CRITERIA 1. Remain free from symptoms of infection. 2. Describe measures to protect and heal the skin and to care for any skin lesions. 3. Demonstrate adaptation to changes in physical appearance.

INCIDENCE Erythema Multiforme is relatively rare as it accounts for only about 0.8-6 million cases per million individuals per year. In terms of autoimmune disorders of the mucosa, it comprises 6.2% of all diseases. (Sanchis, 2010) infection related EM accounts for 90% of cases, while drug related EM accounts for 10%. (Sokumbi, 2012) RISK FACTORS As mentioned above, having HSV is one of the most prominent risk factors associated with EM. Others include a list of medications including NSAIDs, Mycoplasma pneumonia infection, and hepatitis C. (Sokumbi, 2012) PATHOPHYSIOLOGY An immune reaction is known to be linked to EM, and this occurs through T lymphocytes that react to antigens in the drugs, infections, or illnesses. Immune complexes are then formed that consequently destroy epithelial tissue. (Sanchis, 2010)

EXPLANATION OF DISEASE
Erythema Multiforme is a disorder of the skin and mucosal areas of the body presenting with several different types of lesions. Lesions of the oral mucosa are polymorphic erosive, ampullar and erythematous lesions, and bloodstained crusts. Lesions on the rest of the body are usually target like and present in a symmetrical nature throughout. The target lesions present as a small blister and erode into large open wounds. The disorder can be episodic or recurrent. There are varying degrees of the disorder, beginning with Erythema Multiforme Minor (EMm) followed by EM Major (EMM), Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN). (Sanchis, 2010)