erythema multiforme/Stevens-Johnson syndrome

I took Madison to the Doctor today. She has erythema multiforme/Stevens-Johnson syndrome. They said they would have wanted to see her yesterday if they new it was as bad as it is, but it was worse this morning so I guess it was best I took her today. She looks really bad I am really scared for her. She was seen by three different Doctors and all were very concerned. The horrible thing for her is that there is no treatment unless it stages get worst she is at about a 6 right now, 10 being death! So I am a little freaked out.

Here is a little about erythema multiforme/Stevens-Johnson

Erythema multiforme is a type of allergic reaction that occurs in response to medications, infections, or illness. Medications include:

• Barbiturates
• Penicillins
• Phenytoin
• Sulfonamides

Erythema multiforme (also known as Stevens-Johnson syndrome [SJS]) and toxic epidermal necrolysis (TEN) are often confused in the medical literature.

In 1860, Ferdinand von Hebra initially described erythema multiforme as an acute, self-limited condition with characteristic red papular skin lesions.¹ The papules evolve into pathognomonic target lesions or iris lesions that appear within a 72-hour period and begin on the extremities. Lesions remain in a fixed location for at least 7 days and then begin to heal. Precipitating factors include herpes simplex virus (HSV), Epstein-Barr virus, and histoplasmosis. Because this condition may be related to a persistent antigenic stimulus, recurrence is the rule rather than the exception, with most affected individuals experiencing 1-2 recurrences per year. Erythema multiforme is typically a benign, self-limited disorder.

SJS is a mucocutaneous disorder. It was first described by Stevens and Johnson in 1922 as febrile erosive stomatitis, severe conjunctivitis, and disseminated cutaneous eruption.² Lesions typically begin on the face and trunk. They are flat, atypical lesions, described as irregular purpuric macules with occasional blistering. Most patients also have extensive mucosal involvement. More than 50% of all cases are attributed to medications. This is a more serious illness and is potentially life threatening.

The confusion between these two separate clinical entities began in 1950, when Thomas coined the terms erythema multiforme minor and erythema multiforme major to describe conditions he encountered.

• Erythema multiforme minor was applied to patients with the illness originally described by von Hebra as erythema multiforme.
• Erythema multiforme major was applied to patients who also displayed oral mucosal involvement, similar to that described by Stevens and Johnson.

Up to 50% of patients with HSV-associated erythema multiforme have been found to have oral ulcers. However, this is now recognized as a variant of erythema multiforme, rather than SJS. Because SJS and erythema multiforme have different precipitating factors and different clinical patterns, the terms erythema multiforme major and erythema multiforme minor should no longer be used.

• Erythema multiforme with mucosal involvement is now termed bullous erythema multiforme.
• SJS is recognized as a separate clinical entity.

Lyell first described TEN in 1956.³ His original description made no reference to the work of Stevens and Johnson. The distinction between SJS and TEN is not clear. In fact, these conditions probably represent differing severities of the same disease process.

SJS and TEN have similar precipitating factors, identical histopathologic lesions, and similar clinical patterns. By current convention, the following terminology is used:

• The term SJS is used when the disease involves less than 10% of the total body surface area.
• TEN is used when the disease involves more than 30% of the body surface area.
• Patients whose disease involves 10-30% of their body surface area are said to have SJS/TEN overlap. Mortality increases as the percentage of involved body surface increases, making TEN the more severe of the skin reactions.

I just ask that all of you pray for her. Please ask the Lord to watch over her and help her heal fast. I trust in the Lord with all my heart and know that in times like these I am so greatful he is in my life. I truly don't know what I would do with out the Faith I have in him.

I opened up my bible and just read and these stood out to me I thought they just fit.

"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." Mt 6:34

"Come to me all who are weary and burdened and I will give you rest." Mt. 11:28

Thank you all for thinking about Madison and Praying for her. I will keep you updated on her condition as it gets better or worse.

~Cyn~