Erythema multiforme major

Stevens-Johnson syndrome—a severe expression of erythema multiforme (also known as erythema multiforme major). It typically involves the skin and the mucous membranes with the potential for severe morbidity and even death. 

Stevens-Johnson Syndrome, Erythema Multiforme Major, and Toxic Epidermal Necrolysis... 

SJS was for many years considered a severe variant of erythema multiforme major (EMM) however, over the past decade some experts have reclassified SJS as a less severe variant of toxic epidermal necrolysis (TEN) rather than a form of EMM. However, this perspective is not universally accepted. SJS occurs acutely in all ages, with 20% in children and a peak incidence in adults between the second and fourth decades of life. SJS is a potentially fatal disorder with a mortality of approximately 5%.TEN has a mortality rate of approximately 30%. About 50% of cases of these disorders are idiopathic. Identifiable causal factors include microbial infection, particularly with Mycoplasma pneumoniae and HS Vj and medications, including sulfonamides, tetracycline, penicillin, nonsteroidal anti-inflammatory drugs (NSAIDs), psychotropic agents, antiepileptics, and immunizing vaccines. Recent research suggests that HSV infection is a principal fector in the genesis of EMM, whereas medications are a more likely precipitant of SJS and TEN. 

Micali G, Linthicum K, Han N, West DP. Increased risk of erythema multiforme major with combination anticonvnlsant and radiation therapies. Pharmacotherapy 1999 19(2) 223-7. 

Skin Erythema multiforme major in a 74-year-old woman was attributed to dihydrocodeine in an over-the-counter cold medicine Pabron S containing dihydrocodeine 8 mg [78" ]. Patch testing was positive. 

Matsuzawa Y, Fujishima S, Nakada T, lijima M. Erythema multiforme major putatively induced by dihydrocodeine phosphate. Clin Exp Dermatol 2010 35 673-4. 

Unithiol has been reported to have a low overall incidence of adverse effects (< 4%). Self-limited dermatologic reactions (drug exanthems or urticaria) are the most commonly reported adverse effects, although isolated cases of major allergic reactions, including erythema multiforme and Stevens-Johnson syndrome, have been reported. Because rapid intravenous infusion may cause vasodilation and hypotension, unithiol should be infused slowly over an interval of 15-20 minutes. 

All major anticonvulsants have adverse effects on the skin, ranging from a mild maculopapular rash to life-threatening Stevens-Johnson syndrome or Lyell s syndrome (toxic epidermal necrolysis), severe forms of erythema multiforme. 

Rzany B, Hering O, Mockenhaupt M, Schroder W, Goerttler E, Ring J, Schopf E. Histopathological and epidemiological characteristics of patients with erythema exudativum multiforme major, Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol 1996 135(1) 6-11. 

---