Emergency Medical Minute7 Apr 2021

Podcast 656: Rashes

Contributor: Peter Bakes, MD

Educational Pearls:

Lyme disease gives a single expanding target lesion with central clearing called erythema chronicum migrans
Erythema multiforme is another targetoid rash that presents with multiple target lesions
Characterized into erythema minor and major based on severity but typically resolves
More severe hypersensitivity reactions include Stevens-Johnson Syndrome (<10% skin involvement), or Toxic Epidermal Necrolysis (>30% skin involvement)
SJS and TEN is associated with NSAIDS including aspirin, antiemetics like phenergan, anticonvulsants like dilantin or phenobarbital, and antibiotics like penicillin or sulfa drugs
Other causes include viral illnesses like Herpes simplex virus or mycoplasma pneumoniae
Treat by removing offending agent and treat supportively with monitoring for rash progression to SJS or TEN

References

Trayes KP, Love G, Studdiford JS. Erythema Multiforme: Recognition and Management. Am Fam Physician. 2019 Jul 15;100(2):82-88. PMID: 31305041.

Read J, Keijzers GB. Pediatric Erythema Multiforme in the Emergency Department: More Than "Just a Rash". Pediatr Emerg Care. 2017 May;33(5):320-324. doi: 10.1097/PEC.0000000000000618. PMID: 26555305.

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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