May Be The First Visible Drug Reaction Sign
According to the American Osteopathic College of Dermatology, erythema multiforme (EM) is a disease that involves red welts on the body’s surface. There is currently a medical movement to disambiguate EM from Stevens Johnson Syndrome (SJS), which has a similar appearance. The latter is considered much more serious because it involves the cell death of a greater percentage of the body’s surface area and can precipitate sepsis and death.
Clinical definitions today sometimes conflate the two diseases. Part of the reason is that EM itself, in terms of the words, simply refers to a reddening of the body’s protective layer. The papules, or rising bumps, in EM were originally diagnosed in 1860, from target-shaped redness on skin. Irregular-shaped lesions were distinguished by Stevens and Johnson in 1922, and the disorder was named after them. Then, in 1950, medical literature began describing them both as “minor” and “major” forms of EM.
Later research has shown the two to have different clinical aspects. While the erythema multiforme minor was relatively benign, with each skin eruption causing some discomfort but disappearing over time, doctors referred to SJS as erythema multiforme major when they described itchy burning edematous tissue—tissue which had edema or swelling from the abnormal collection of fluid, causing discomfort to the level of burning sensation.
The precipitating factors for EM and SJS are usually different. EM is more often linked with a virus, or the exanthema (exit symptom of a virus), like Epstein-Barr or HSV (Herpes Simplex Virus).
SJS is now known as the dangerous, sometimes fatal, condition that occurs in response to a drug-allergy reaction to medication. EM is the benign appearance of welts and blistering.
While part of the clinical presentation of SJS does involve the appearance of red welts, they do not merely signal the inflammation and irritation of the local area. What happens next involves the necrolysis, or death, of cells between the epidermis and the dermis. The welts become vesiculobullous, which means they blister—forming vesicles where they are filled with a clear serum or plasma, blood, or (in cases of infection) pus. The tissue where these welts appear becomes swollen and painful, a symptom known as burning edematous tissue. Patients are often admitted to a hospital’s burn unit for treatment because the health risks are similar.
When the body’s protective outer layer, its largest organ, is no longer effective in sealing out the infectious threats, the entire system becomes sensitive and vulnerable. The real cause of death when SJS is extreme is sepsis, or an overwhelming toxicity in the body. For that reason, infection is carefully guarded against with a careful environment and prophylactic antibiotics.
Drug reactions are the main cause of this condition, which used to be known as EM, and are therefore avoidable when medication is not absolutely necessary. However, if you have taken one of the frequently associated drugs, such as Bextra, Stevens Johnson Syndromeis an important health condition to learn about.
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