ERYTHEMA MULTIFORME EXSUDATIVUM (HEBRA); A CLINICAL ENTITY ASSOCIATED WITH SYSTEMIC FEATURES

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Abstract
The attributes of the cutaneous lesions in this disease are described as well as a number of features of special interest,, such as the Isomorphe Reizeffekt. The appearances in the mucous membranes are discussed, especially the reasons for the difficulties involved in recognizing the enanthem. The Stevens-Johnson syndrome and the Eetodermosis Erosive Pluriorificiale of French authors are considered as variants of this disease showing preponderant involvement of the mucous membranes, especially the oral and ocular. The systemic features are described and utilized as the basis for a differential diagnosis from a number of diseases that sometimes simulate erythema multiforme exsudativum. The prognosis is generally benign but fatalities occasionally occur owing to: (1) bronchopneumonia secondary to aspiration of decomposed and infected material in the oropharynx. notably in elderly persons; (2) simultaneous involvement of the tracheobronohial tract with superimposed bronchopneumonia; (3) an intercurrent complication which may be related only in the sense that there is lowering of the patient''s local or general resistance; (4) perforation of the eyeball, when the conjunctiva and cornea are intensely affected, leading to panophthalmitis and perhaps (?) secondary invasion of the blood stream, especially in children. Blindness in one or both eyes, partial or total, represents the most common complication in these cases. The etiology of the disease is unknown. 0f the several possibilities, the most recent investigations seem to point in the direction of a virus factor. The treatment is essentially symptomatic and empirical. Criteria for the use of more potent drugs are mentioned (germanm and sulphanil-amide) and a more critical attitude toward the evaluation of therapeutic results in this disease is urged.