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多形红斑:识别与管理。

Erythema Multiforme: Recognition and Management.

机构信息

Thomas Jefferson University Hospital, Philadelphia, PA, USA.

出版信息

Am Fam Physician. 2019 Jul 15;100(2):82-88.

Abstract

Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Classically described as target-like, the erythema multiforme lesions can be isolated, recurrent, or persistent. Most commonly, the lesions of erythema multiforme present symmetrically on the extremities (especially on extensor surfaces) and spread centripetally. Infections, especially herpes simplex virus and Mycoplasma pneumoniae, and medications constitute most of the causes of erythema multiforme; immunizations and autoimmune diseases have also been linked to erythema multiforme. Erythema multiforme can be differentiated from urticaria by the duration of individual lesions. Erythema multiforme lesions are typically fixed for a minimum of seven days, whereas individual urticarial lesions often resolve within one day. Erythema multiforme can be confused with the more serious condition, Stevens-Johnson syndrome; however, Stevens-Johnson syndrome usually contains widespread erythematous or purpuric macules with blisters. The management of erythema multiforme involves symptomatic treatment with topical steroids or antihistamines and treating the underlying etiology, if known. Recurrent erythema multiforme associated with the herpes simplex virus should be treated with prophylactic antiviral therapy. Severe mucosal erythema multiforme can require hospitalization for intravenous fluids and repletion of electrolytes.

摘要

多形红斑是一种免疫介导的反应,涉及皮肤,有时还涉及黏膜。多形红斑的典型特征为靶形,皮损可以是孤立的、复发性的或持续性的。最常见的是,多形红斑的皮损对称分布于四肢(尤其是伸展表面),并向心性扩散。感染(尤其是单纯疱疹病毒和肺炎支原体)和药物是导致多形红斑的主要原因;疫苗接种和自身免疫性疾病也与多形红斑有关。多形红斑可通过皮损的持续时间与荨麻疹相鉴别。多形红斑皮损通常持续至少 7 天,而单个荨麻疹皮损通常在一天内消退。多形红斑可能与更严重的史蒂文斯-约翰逊综合征相混淆;然而,史蒂文斯-约翰逊综合征通常包含广泛的红斑或瘀点性斑疹,伴有水疱。多形红斑的治疗包括对症治疗,如局部使用类固醇或抗组胺药,并治疗已知的潜在病因。与单纯疱疹病毒相关的复发性多形红斑应进行预防性抗病毒治疗。严重的黏膜多形红斑可能需要住院治疗,以静脉补液和补充电解质。

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