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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