Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Erythema Multiforme Major 547

➣Patient does not appear ill (no systemic involvement); targe-

toid lesions present, but are classic targets and typically on

extremities; only one mucosal surface sometimes affected (oral)

■Staphylococcal scalded skin syndrome

➣Occurs primarily in children

➣Rash associated with nasopharyngeal infection, generalized

large, flaccid superficial bullae, sparing of mucous membranes

■Viral exanthem

➣Morbilliform eruption; no target lesions

■Vasculitis

■Acute generalized exanthematous pustulosis

management

What to Do First

■Discontinue any possible causative agents.

■Assess severity of skin involvement – surface area involved, degree

of rash/erosions/necrosis.

■Assess severity of mucosal involvement – oral intake possible, degree

of pain.

■Assess systemic involvement.

■Evaluate for secondary infection.

General Measures

■Supportive therapy as indicated by severity of involvement

■Fluid, electrolyte management

■Precautions to decrease risk of sepsis

■Aggressive treatment if any signs of secondary infection

■Early ophthalmologic evaluation

specific therapy

■Systemic corticosteroids or other immunosuppressives as treatment

for SJS remains controversial; no controlled trials available

■Intravenous immune globulin 0.75 g/kg/day for 4 days appears to

stop progression and improve prognosis.

follow-up

■Depending on severity, patients are generally hospitalized and cared

for in an experienced intensive care unit.

complications and prognosis

Complications

■Fluid and electrolyte abnormalities