It is sometimes called Erythema Multiforme Major and is a severe skin involvement with bullous skin lesions, more than 2 mucous membrane involvement as well as multisystem involvement.
(Picture from Wikipedia)
The aetiology is as for erythema multiforme. Clinically the patient may have fevers, arthralgias, headache and diarrhoea. The lesions may begin as macules and progress to bullae, which may then rupture. Lesions can occur anywhere. The palms and soles may be affected. Lips are affected in a large percentage of cases.
Investigations
FBC- looking for increased WCC
EUC – to guide treatment
Blood cultures
Management
Management is as for any other critical patient – A B C.
The skin lesions must be treated as if they are burns. With this in mind, there needs to be appropriate fluid and electrolyte replacement and patients may even need to be considered for a burns unit.
