Erythema Multiforme

What is erythema multiforme?

Erythema multiforme is a condition that causes red spots on the skin. The spots often have a dark center surrounded by pale red rings, like a target or bull’s-eye. Sometimes, the spots have blisters.

The spots can appear in different places on the body, including the:

●Arms and legs

●Chest and back

●Face and neck

●Palms of the hands

●Soles of the feet

●Lips, tongue, and gums

●Genital area

Sometimes, erythema multiforme affects the eyes. When this happens, the whites of the eyes can look red.

The spots might itch or burn. Some people have a fever and feel tired and achy before the spots appear. The spots usually show up over 3 to 5 days. They disappear in about 2 weeks.

What causes erythema multiforme?

Most of the time, erythema multiforme is caused by an infection. But medicines can cause erythema multiforme, too.

Are there tests I should have?

Your nurse or doctor should be able to tell if you have erythema multiforme by looking at your skin and doing an exam. They might also take a small skin sample and a blood sample. These samples will help your doctor make sure your symptoms aren’t being caused by another medical condition.

Is there anything I can do on my own to feel better?

Yes. You can try putting a cool, damp cloth on the area with the spots. If you have a fever or feel achy, you can take over-the-counter medicines such as acetaminophen (sample brand name: Tylenol).

How is erythema multiforme treated?Treatments include medicines to ease itching and pain. Some medicines are creams that you rub on your skin. Others are pills.

If you have spots in your mouth, your doctor might give you a special mouthwash to help relieve the pain.

If your eyes are red or uncomfortable, you might need to see an eye doctor.

Can erythema multiforme be prevented?

If your condition was caused by a medicine, do not take that medicine again. Talk to your doctor or nurse about switching to a different medicine.

Some people who are infected with a certain virus keep getting erythema multiforme over and over again. If you get erythema multiforme more than several times a year, talk with your doctor or nurse. They might give you a medicine to take every day that will help keep you from getting it so often.

Fibroids

Uterine fibroids are growths found inside your uterus (womb). Uterine fibroids also may be called tumors (lumps) or leiomyomas. Uterine fibroids often appear in groups, or you may have only one. They can be small or large, and they can grow in size. They are almost always benign (not cancer) and likely will not spread to other parts of your body.

Medicines:

  • Pain medicine: You may be given medicine to take away or decrease pain. Do not wait until the pain is severe before you take your medicine.
  • Hormone medicine: This medicine changes the level of certain hormones and may then help shrink your fibroids.
  • Contraceptives: These medicines help prevent pregnancy. They also may help shrink your fibroids.
  • Take your medicine as directed: Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are taking any vitamins, herbs, or other medicines. Keep a list of the medicines you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

Avoid heavy lifting:

You will need to avoid lifting heavy objects for a period of time after surgery. This helps prevent injury to your surgery wound. Ask your healthcare provider when you may return to your normal daily activities.

Avoid pregnancy:

You will need to avoid pregnancy until you have healed after treatment for your fibroids. Ask your healthcare provider when it is safe to become pregnant.

Contact your healthcare provider if:

  • You feel weak and are more tired than usual.
  • You do not feel like your bladder is empty after you urinate. You also may urinate small amounts more often.
  • You have new or worse hot flashes.
  • You have any questions about your condition or care.

Seek immediate care or call 911 if:

  • Your heart begins to race, and you feel faint.
  • You have increased vaginal bleeding, pelvic pain, or pelvic pressure.
  • You have a fever.
  • Your leg feels warm, tender, and painful. It may look swollen and red.
  • You cough up blood.
  • You feel lightheaded, short of breath, and have chest pain. You cough up blood.
  • You feel lightheaded, short of breath, and have chest pain.

Epidural Abscess

An epidural abscess is an infection that forms in the space between your skull bones and your brain lining (intracranial epidural abscess). Quite often, it forms in the space between the bones of your spine and the lining membrane of your spinal cord (spinal epidural abscess).

An epidural abscess results in a pocket of pus that builds up and causes swelling. It can press against your bones and the membranes that protect your spinal cord and your brain (meninges). This swelling and the underlying infection can affect sensations and physical movement and can cause other problems. An epidural abscess needs to be treated right away.

What causes an epidural abscess?

Typically, an epidural abscess is caused by a Staphylococcus aureus bacterial infection. It could also result from a fungus or another germ circulating in your body. Much of the time, healthcare providers can’t find a particular cause of the infection.

What are the risk factors for epidural abscess?

If you suffer from persistent sinus or ear infections, or have had an injury to your head, you may be more likely to develop an epidural abscess inside your skull. You’re more likely to develop an epidural abscess on your spine if you have an infection in the bones of your spine or in your blood, or have had a surgical procedure on your back.

What are the symptoms of an epidural abscess?

The symptoms of an epidural abscess depend on the location of the abscess. An epidural abscess may cause these symptoms:

  • Headache
  • Disturbed consciousness
  • Fever
  • Unusual sensation throughout your body
  • Problems with coordination and movement
  • Trouble walking
  • General weakness of the muscles in both the arms and legs that worsens
  • Paralysis — being unable to move your legs or arms
  • Pain in your back
  • Inability to control your bowels or bladder
  • Feeling nauseated or vomiting
  • Feeling very tired and sluggish

How is an epidural abscess diagnosed?

A healthcare provider will ask about your medical history and symptoms. Diagnostic tests and exams may include:

  • Neurological exam to look for changes in motor and sensory function, vision, coordination and balance, mental status, and in mood or behavior
  • Magnetic resonance imaging (MRI) scan
  • Computed tomography (CT) scan
  • Tests of a fluid sample from the abscessed area to determine the cause of the infection
  • Blood tests to look for germs and other signs of infection

How is an epidural abscess treated?

Typically, your healthcare provider will give you antibiotics to fight the infection that caused the abscess. A surgeon may need to drain the fluid from the abscess with a needle, to help relieve the pressure. Sometimes, your surgeon may remove it entirely. You will most likely require surgery to drain or remove the abscess if you have difficulty moving or are unable to move at all, or if you have sensation problems, such as numbness, somewhere in the body.

What are the complications of an epidural abscess?

Without treatment, serious complications can occur, such as:

  • Meningitis, an infection of your meninges
  • Abscess of your spinal cord itself
  • Infection inside your spine or skull bones
  • Long-term back pain
  • Irreversible damage to your brain or nervous system, including paralysis

Once damage to your nervous system has occurred, it can be difficult to restore normal nervous system function. Untreated epidural abscess can be extremely dangerous and may result in death.

Key points

  • An epidural abscess is an infection inside your skull or near your spine. It requires immediate treatment.
  • Symptoms can include headache, fever, changes in consciousness, vomiting, changes in sensation, weakness, trouble moving or walking, and loss of bladder or bowel control.
  • Treatment is with strong antibiotics. Surgery might be needed to drain the fluid from your abscess or to remove it completely.

Epistaxis (nosebleed)

Epistaxis is a condition where there is bleeding from the nose. This
occurs when the blood vessels inside the nose are injured or damaged.
Medications
 Take your medications as prescribed by your doctor.
 If you are on blood thinners, make sure you check with your doctor
about re-starting them.
 Do not take NSAIDS (eg. advil®, Naproxen®).
Activity
▪ Do not lift objects over 10 lbs. (4 kg) for 2 to 3 weeks.
 Get enough rest. Try not to overtire yourself.
 Sleep with the head of your bed elevated approximately 30°.
Nutrition
 Follow the “Eating Well With Canada’s Food Guide”.
 Drink 6 to 8 glasses (1 glass = 8 oz or 250 mL) of fluids
throughout the day.
If Your Nose Bleeds
 Lean forward to keep the blood from going down the back of your
throat.
 Breathe through your mouth.
 Pinch the bridge of your nose for 5 to 20 minutes with your thumb
and index finger.
Prevent a Nosebleed
 Use a humidifier to keep the air moist.
 If your nose gets dry, apply a small dab of lubricating ointment, like
Rhinaris or Secaris® gels, inside your nose. Do this several times
a day.
 Do not pick your nose or put any foreign objects in it.
 Ask your doctor if the medicines that you are taking could cause
nosebleeds.
 Quit smoking or reduce the amount of cigarettes you smoke.

Prostatitis

The prostate gland is a small, walnut-shaped organ. It lies just below a man’s bladder. It surrounds the urethra, the tube that carries urine through the penis and out of the body.

Prostatitis is a painful condition caused by inflammation or infection of the prostate gland. Sometimes the condition is caused by bacteria, but often the cause is not known.

Prostatitis caused by bacteria usually is treated with self-care and antibiotics.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.
  • Take warm baths to help soothe pain.
  • Straining to pass stools can hurt when your prostate is inflamed. Avoid constipation.
    • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fibre.
    • Drink plenty of fluids, enough so that your urine is light yellow or clear like water. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
    • Get some exercise every day. Build up slowly to 30 to 60 minutes a day on 5 or more days of the week.
    • Take a fibre supplement, such as Benefibre or Metamucil, every day if needed. Read and follow the instructions on the label.
    • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.
  • Avoid alcohol, caffeine, and spicy foods, especially if they make your symptoms worse.

When should you call for help?

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have symptoms of a urinary tract infection. These may include:
    • Pain or burning when you urinate.
    • A frequent need to urinate without being able to pass much urine.
    • Pain in the flank, which is just below the rib cage and above the waist on either side of the back.
    • Blood in your urine.
    • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You cannot empty your bladder completely.
  • You do not get better as expected.

Phlegmasea Cerulea Dolens

Phlegmasia cerulea dolens (literally: painful blue inflammation) is an uncommon severe form of deep venous thrombosis which results from extensive thrombotic occlusion (blockage by a thrombus) of the major and the collateral veins of an extremity. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb. There is a high risk of massive pulmonary embolism, even under anticoagulation. Foot gangrene may also occur. An underlying malignancy is found in 50% of cases. Usually, it occurs in those afflicted by a life-threatening illness

Post Herpetic Neuralgia

Postherpetic neuralgia is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.

The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time.

Symptoms

The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred — most commonly in a band around your trunk, usually on one side of your body.

Signs and symptoms might include:

  • Pain that lasts three months or longer after the shingles rash has healed. The associated pain has been described as burning, sharp and jabbing, or deep and aching.
  • Sensitivity to light touch. People with the condition often can’t bear even the touch of clothing on the affected skin (allodynia).
  • Itching and numbness. Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.

When to see a doctor

See a doctor at the first sign of shingles. Often the pain starts before you notice a rash. Your risk of developing postherpetic neuralgia is lessened if you begin taking antiviral medications within 72 hours of developing the shingles rash.

Causes

Nerves on the backShingles affects the nervesOpen pop-up dialog box

Once you’ve had chickenpox, the virus remains in your body for the rest of your life. As you age or if your immune system is suppressed, such as from medications or chemotherapy, the virus can reactivate, causing shingles.

Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers can’t send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that can last months — or even years.

Risk factors

When you have shingles, you might be at greater risk of developing postherpetic neuralgia as a result of:

  • Age. You’re older than 50.
  • Severity of shingles. You had a severe rash and severe pain.
  • Other illness. You have a chronic disease, such as diabetes.
  • Shingles location. You had shingles on your face or torso.
  • Your shingles antiviral treatment was delayed for more than 72 hours after your rash appeared.

Complications

Depending on how long postherpetic neuralgia lasts and how painful it is, people with the condition can develop other symptoms that are common with chronic pain such as:

  • Depression
  • Fatigue
  • Difficulty sleeping
  • Lack of appetite
  • Difficulty concentrating

Prevention

The Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get a Shingrix vaccine to prevent shingles, even if they’ve had shingles or the older vaccine Zostavax. Shingrix is given in two doses, two to six months apart.

The CDC says two doses of Shingrix is more than 90 percent effective in preventing shingles and postherpetic neuralgia. Shingrix is preferred over Zostavax. The effectiveness may be sustained for a longer period of time than Zostavax. Zostavax may still be used sometimes for healthy adults age 60 and older who aren’t allergic to Zostavax and who don’t take immune-suppressing medications.

Herpetic Withlow

Herpetic whitlow is a finger infection. It’s usually caused by the herpes virus that causes cold sores. It can spread to a finger from a cold sore in or around your mouth. Whitlow also can be caused by the virus that causes genital herpes.

An area of your finger may be red. It may have a small group of blisters. Your finger also may hurt, itch, or tingle.

Your finger should get better on its own. This may take a few weeks. But whitlow may come back to the same area of your finger.

Your doctor may prescribe medicines to help fight the herpes virus. You may be asked to cover your finger with a bandage. This can avoid spreading the infection.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine.
  • Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
  • Follow your doctor’s advice to care for your finger. If you did not get instructions:
    • Wash the area with clean water 2 times a day. Don’t use hydrogen peroxide or alcohol, which can slow healing.
    • You may cover the area with a thin layer of petroleum jelly, such as Vaseline, and a non-stick bandage.

When should you call for help?

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have symptoms that the infection is getting worse, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the area.
    • Pus draining from the area.
    • Fever.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not get better as expected.