There was a disorder Birnie had heard of but never seen called Urticaria multiforme (U.M.). It’s a type of allergic reaction, she remembered, seen in kids usually after a viral infection, but Birnie couldn’t recall more than that.
In the ED setting, EM in children is frequently misdiagnosed. Greater awareness of diagnostic factors for EM may improve diagnostic accuracy. Teledermatology and incentives to include clinical pictures in the (electronic) medical record may be useful adjuncts for patients with suspected EM and other dermatological conditions.
Acute annular urticaria (ring-shaped hives) is a benign cutaneous hypersensitivity reaction that occurs frequently in childhood. The condition is sometimes mistaken for other ring-shaped disorders — most often, erythema multiforme and less commonly, serum-sickness–like reactions. The value of renaming acute annular urticaria “urticaria multiforme,” as the authors propose, is debatable.
The majority of pediatric rashes that present to the ED are often met with a combination of disdain and fear: “This looks like nothing, but is it something?” or “This looks awful, but is it a big deal?” One of the concerning characteristics is the target lesion, but not all target lesions are created equal. Let us take a minute to digest a morsel on Erythema Multiforme...
A skin disease characterized by papular or vesicular lesions and reddening or discoloration of the skin often in concentric zones about the lesions
Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus (HSV). It presents with a skin eruption characterised by a typical target lesion. There may be mucous membrane involvement. It is acute and self-limiting, usually resolving without complications.
Erythema multiforme is divided into major and minor forms and is now regarded as distinct from Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
Onset of erythema multiforme is usually sudden in an otherwise healthy individual. Red spots (macules or papules), or ridges (wheals), and sometimes blisters appear on the tops of the hands and forearms. Other areas of involvement may include the face, neck, palms, soles of feet, legs, and trunk.
Erythema multiforme (EM) is a skin condition considered to be a hypersensitivity reaction to infections or drugs.It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur - hence the name. It is usually an acute, self-limiting disease that affects the skin. Mucous membranes, however, are affected little, if at all. (EM was previously described as having minor and major forms. The major form - more serious and with more extensive involvement of both skin and mucosa - is now known as Stevens-Johnson syndrome (SJS).)