ISSN 2398-2977      

Erythema multiforme

pequis

Introduction

  • A rare, immune-mediated, reaction pattern in the skin, mucous membranes or both.
  • Cause: hypersensitivity reaction against antigens such as drugs, infections and neoplasms.
  • Signs: persistent urticaria, maculopapular eruptions, vesicobullous or necroulcerative dermatitis.
  • Diagnosis: history, physical examination, histopathology.
  • Treatment: no specific therapy, withdrawal of offending antigen if possible.
  • Prognosis: guarded to good.

Pathogenesis

Etiology

  • Hypersensitivity reaction against drugs, infectious agents or other antigens.
  • The following drugs have been implicated in cases of erythema multiforme in the horse:
  • Other underlying causes include viral, especially herpes   Equine herpesvirus  , fungal and bacterial infections, neoplasia, especially lymphoreticular neoplasms, and routine vaccination.
  • The majority of cases are idiopathic.

Predisposing factors

General
  • Drugs.
  • Vaccines.
  • Infections.
  • Systemic disease.
  • Neoplasia.

Specific

  • The pathogenesis is not completely understood, but studies in dogs have shown that an upregulation of adhesion molecules on keratinocytes may represent an early phase in the development of the condition.
  • This allows the tethering and keeping of lymphocytes in the epithelium, followed by keratinocyte apoptosis that is probably produced by signals from intra-epithelial T-lymphocytes.
  • Alterations in the keratinocyte by drugs, infectious agents, etc may be an important step in the disease process.

Pathophysiology

  • Hypothesized to be a host-specific cell-mediated hypersensitivity reaction directed toward various antigens.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Lloyd D et al (2000) Stannards illustrated equine dermatology notes: Immunologic diseases. Vet Derm 11, 163-178 VetMedResource.
  • Scott D W et al (1998) Erythema multiforme in the horse: Literature review and report of 9 cases(1988-1996). Equine Pract 20 (6), 6-9 VetMedResource.
  • Scott D W et al (1997) Idiosyncratic cutaneous adverse drug reactions in the horse: Literature review and report of 19 cases(1990-1996). Equine Pract 19 (10), 12-16 VetMedResource.

Other sources of information

  • Scott D W et al (2001) Small Animal Dermatology. Eds: Muller & Kirk. 6th edn. W B Saunders, USA.
  • Scott D W (1988) Large Animal Dermatology. W B Saunders, USA.

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