Turf Toe

What is Turf Toe Injury?

Turf Toe is medically termed as metatarsalphalangeal joint sprain. It is an injury, which is painful, located at the big toe base and that occurs most often in athletic persons who either play soccer, baseball or football and the like. It is soft tissue injury in the big toe joint. Other experts would define it as a sprain to the large toe joint’s ligament.

turf toe injury

Turf Toe Causes

Turf toe, anatomically speaking, works as a hinge that permits the up and down motion. It is often used whenever one walks or run. The turf toe will help in propelling yourself forward by means of pushing off the big toe and making your weight be shifted to the other foot.

An injury in the turf toe is primarily due to hyperextension, when one extremely bends the big toe joint in an upward motion, or hyperflexion, when one extremely bends the big toe joint in a downward motion. This will lead to pain upon weight bearing and sprain of the ligaments that surround the big toe joint.

Other etiology or factors that contribute to turf toe injury includes:

  1. Direct Injuries
  2. Prior Injuries
  3. Weight
  4. ROM or Range of Motion in your ankle
  5. Feet Position during playing any sports

Turf Toe Symptoms

When one is diagnosed with turf toe injury, one will manifest the following symptoms:

  1. Pain located at the big toe base area
  2. Tenderness upon touching the area
  3. Swelling of the ball and toe of the foot
  4. Inable to bear weight
  5. Inable to push off on the big toe
  6. Popping sound which is heard during the injury
  7. Functio Laesa or Reduce Function and mobility of the injured area
  8. Bruising at the ball of the foot and at the top of the big toe.

You must take note that not everyone will be able to experience the symptoms mentioned. The most common amongst the symptoms mentioned is pain. At first the pain is mild and tolerable until it becomes worse.


In diagnosing turf toe injury your doctor will ask you thorough questions regarding the injury and you will undergo physical assessments. Aside from that you will undergo some test for confirmation, such as:

  1. X-ray
  2. Bone Scan
  3. Ultrasound
  4. Electrotherapy treatment
  5. Ct- Scan
  6. MRI

These tests are necessary to detect the type and kind of injury or damage to the bone or ligaments. It will provide a clear picture and will tell the doctor the necessary medical steps to be done.

Turf Toe Treatment

In the treatment with turf toe injury, the following can be done:


Persons diagnosed with turf toe injury are through the synonym PRICE treatment meaning Protect, Rice, Ice, Compression, and Elevation. This is often done for immediate treatment. It is effective to reduce the pain and swelling episodes.


You can also be prescribed with medication such as anti-inflammatory and analgesics. Anti inflammatory works to reduce the inflammatory symptoms while analgesic medications work to reduce the pain. Examples of medications include Ibuprofen, Aspirin, Acetaminophen or Naproxen.

Turf Toe Surgery

Surgery, as protocol, is the last option to be considered, it is only needed when there is a need for repair especially when the ligament is completely torn or there is a bone fracture due to the injury of the ligament. The area will be then casted or splinted until it recovers.

Turf Toe Rehab

After treatment, the next step is rehabilitation. It is the process of restoring the person’s maximum strength after the injury to gain self-sufficiency and function as normally as possible.

With this Rehabilitation process, it is expected to perform the following:

Turf Toe Exercises

You can do exercises when you are in recuperation period such of these exercises include:

Towel Scrunches

This kind of exercise will help with the dexterity, strength and flexibility. You just need to sit on a chair then place a piece of towel on the floor and insert the towel between the floor and your feet. Then you grip the towel with the use of your toes. You then raise your feet slowly from the floor and hold the towel with both hands. You do this for ten seconds and then release the towel. Repeat the same procedure for about five to seven times.

Short Foot

This kind of exercise will help you go back to pre-injure state. What you do is you sit on a comfortable chair with your feet, in front of you, flat on the floor. With your toes kept flat, lift the arch of your foot up. You must do this without rolling your foot towards the outside portion. Hold the position for about five second and release and do it again.

Toe-Pick Up Exercises

This kind of exercise will also help you build dexterity, flexibility, and strength. You need to place marbles and bowel on the floor by the use of your bare foot. You just need to use your toes to pick each marbles and drop it to the bowl. Do this until all the marbles are inside the bowl and repeat the procedure.

Tuef Toe Braces

Braces can also be used. It protects the big toe from injury and restricts its movement. It can be also termed as toe splints. With the use of the braces, it is effective in lessening the pain. With the use of toe splint, the second toe will help protect the big toe from injury and lessen the pressure that it gives out on the neighboring toe. When one uses braces, one is expected to use lotion which is specially applied in irritating areas to reduce irritation.

Turf Toe Taping

Before returning to the normal physical activity, most often it is required to tape the toe. By taping the turf toe, you will prevent recurrence of the said condition. It is through the use of a tape, where loops of 1 to 2 centimeters wide piece of athletic kind of tape is looped around the dorsal surface to the plantar surface of the patient’s affected foot.

Turf Toe Insert

The turf toe inserts are put in the front portion of the foot. In this case, the normal foot can move without making the toe move around and bear much weight. It usually fit inside a shoe and it keeps the toe straight. There are also turf toe inserts that are padded for extra comfort of the user.

Turf Toe Pictures

Turf Toe pictures

Turf Toe pictures

Black Hairy Tongue

What is Black Hairy Tongue?

Black hairy tongue is a condition wherein the papillae on the tongue surface lengthen. The papillae may grow longer up to 15 mm in length and rub away with food, causing it to become disfigured and look furry. Black hairy tongue disease is also called lingua villosa nigra. The black color is associated with staining of the papillae with food, tobacco or tar. Black hairy tongue syndrome is usually yellowish-black in color. In the appearance of hairy papillae, it is due to the defective desquamation of the projections.

The appearance of black hairy tongue syndrome is usually mild and harmless. However, people become alarmed because of a peculiar color and appearance of the tongue. This condition is associated with the development of thrush or fungus in the oral cavity; however, some conditions are also not linked to fungal and bacterial infection.

Collectively, hairy tongue may be white, yellow, brown, or black in color depending on the cause that resulted in discoloration. Black hairy tongue is more common in men than in women because of more chronic vices such as smoking and the like. It may affect all age groups, but it is more predominant in adults because of more chronic exposure to causative factors.


blavk hairy tongue picture

Hair-like projections on the surface or dorsal part of the tongue

Image 1 Source: webmd.com

Black Hairy Tongue Symptoms

Symptoms of Black Hairy Tongue often include:

  • Hair-like projections on the surface or dorsal part of the tongue
  • Black discoloration on the tongue, but sometimes may be white, yellow or brown depending on the food that causes discoloration.
  • Slight alterations on the taste as a result of food debris that piles up and presence of long papillae
  • Halitosis because of accumulation of food particles on the elongated papillae
  • Burning sensation on the tongue or glossopyrosis
  • Tickling sensation on the oral cavity especially on the soft palate
  • Gagging sensation

Black Hairy Tongue Causes

The appearance of hairy tongue is not a disease, nor frequently caused by a disease. It is usually caused by external factors, which include:

  • Poor oral hygiene – Failure to brush the teeth and the tongue leads to accumulation of food debris and microorganism that thrive in the mouth. Fungal infection may occur and may leave swollen papillae that cause food particles to get in the tongue.
  • Frequent use of mouthwashes – Mouthwashes that contain hydrogen peroxide, menthol and witch hazel decrease the normal flora in the mouth, which results in opportunistic infections and reduction in the integrity of the tongue.
  • Antibiotic Treatment – The use of penicillin such as amoxicillin and other broad spectrum antibiotics causes the affectation of the oral cavity, which also destroys the normal bacterial flora in the mouth. As a result, opportunistic infections such as thrush or oral candidiasis may occur.
  • Pepto-Bismol – Taking chewable tablets of Pepto-Bismol may result in black hairy tongue after 24 hours.
  • Head and Neck Radiation – Exposure of the tongue to radiation causes the changes in the papillae resulting in hypertrophy and abnormal desquamation.
  • Mouth breathing – Frequent mouth breathing as a result of impaired respirations may also lead to black hairy tongue because of lack of moisture in the oral cavity. The tongue and lips often become dry and cause damages on the lining.
  • Tobacco use – The presence of tar in tobacco or cigarettes causes chronic irritation of the papillae, causing it to undergo hypertrophy. In addition, the tar can also discolor the tongue to a yellowish-black hue.
  • Chronic Coffee and Tea drinking – Coffee and tea may discolor the tongue over time. This is seen in elderly clients who have regularly consumed coffee or tea over their lifetime.
  • Soft Diet – The intake of soft diet lacks roughage and other food textures. These are essential in naturally debriding the tongue during chewing. In this regard, food debris and microorganisms may pile up on the surface of the tongue causing a thick surface with discoloration.
  • Drug abuse – Using prohibited drugs also affect the integrity of the tongue leading to hypertrophy and discoloration.
  • HIV infection – HIV may also lead to black hairy tongue because of increased risk for opportunistic infections such as candidiasis.

Black Hairy Tongue Diagnosis

Diagnostic tests employed for the condition include those that check for the presence of fungal infection. Diagnostic tests for black hairy tongue include:

  • Culture – Culture is done on the samples on the surface of the tongue to determine presence of fungal infection such as candidiasis or presence of other infections in the mouth.
  • Smears – Smears of the cells on the tongue may indicate presence of Candida albicans, the causative microorganism for candidiasis.
  • Histologic examinations –Histologic tests may indicate the presence of elongated filiform papillae. Occasional inflammatory cells and mild hyperkeratosis may also be observed.

In patients with HIV, black hairy tongue should be differentiated from the presence of a more serious condition called hairy leukoplakia. Leukoplakia is a complication of HIV as a result of Epstein-Barr virus. Mucosal punch biopsy may be significant in determining hairy leukoplakia in HIV patients.

Black Hairy Tongue Treatment

Treatment for black hairy tongue syndrome is focused on the eradication of the causative factor and enhancing the appearance of the tongue. This condition is mild and may resolve on its own. Management can be instituted to hasten the resolution of the condition. Treatments include:


Brushing the tongue twice a day or using tongue scraper helps in removing debris on the tongue and thereby reducing the discoloration. This measure also prevents the growth of fungus and bacteria that may cause infection. Mild cases of hairy tongue may be resolved using this management.

Diet modification

Patients who constantly consume soft diet may add additional roughage on the diet to mechanically debride the food particles that accumulated on the elongated papillae.

Antifungal medications

For patients with fungal infections along with the hairy tongue, antifungal medications are usually given. It may be given through mouth or by the use of topical anti-fungal agents.


Removal of the hairy projections may be done using laser, electrodessication or surgical knife and scissors. This treatment is employed when other measures deemed ineffective.

Black Hairy Tongue Side-effects or Complications

Black hairy tongue may result in mild complications such as permanent altering of taste sensations or the presence of metallic taste. Black hairy tongue also reduces the aesthetic appearance of the tongue.

Black Hairy Tongue Pictures

hairy tongue picture

Image 2 – Yellow or brown discoloration

Image Source: aocd-grandrounds.org

hairy tongue photo

hairy tongue image

Fever Blister

What is fever blister?

Fever Blister, better known as cold sore or oral herpes is a skin condition that is typical herpes simplex virus infection. The virus lies quiescent inside the body and is reactivated if the immune system falls from its normal rhythm. It may start as a blister and snaps out clear fluid. It will cause pain, burning sensation on the affected part then forms a scab. The usual parts that are mainly involved are the lips, nose and tongue. This happens because the virus goes to areas that the immune system may not detect their presence, making them latent in the mean time.

fever blister on lips

Fever Blister Stages

Cold sores undergo five stages:


This stage is also called as prodrome. There will be swelling, redness and inflammation on the site the blister will form. This stage is characterized by the tingling sensation on the future site. The usual duration of this stage can vary from 1-2 days.


At this stage, a blister is formed filled with clear fluid or these blisters may appear in cluster and they can vary in size. This stage lasts up to 2 days.


This is considered as the stage where the infection is most contagious. The blister ruptures and leaves a reddish sore that eventually turns gray. The clear fluid that broke out contains millions of viral cells that can be transmitted directly but this stage only lasts for a day. This is also known as the ulcer stage.


During this stage, the affected area scabs one after the other. Initially, it will scab first time and may bleed. This may also cause itching or burning sensation. Another scab is formed but smaller than the first, it will again peel off and another scab is produced. Until the scab disappears; it will not leave a scar. This stage lasts 2-3 days.



Fever blisters or cold sores are mainly caused by herpes simplex type 1. Although this virus came from the same family of virus that causes genital herpes; herpes simplex type 2, fever blisters are not considered as a notorious ailment.

The virus hides in the nerve cell, thus makes immune system unaware of its existence. Opportunistic virus stays dormant and will be activated when the virus sense that the immune system is down or the body is busy fighting off other illness and will not be able to release antibodies for it to be killed.

This condition is directly transmitted from person to person by:

  1. Direct contact on the fluid-filled area
  2. Sharing of things
  3. Kissing
  4. Touching the infected person’s saliva

The effect of the infection varies from person to person, an individual can have reinfection and the others may not.

Studies have shown that a major contributing factor of acquiring this disease is stress; which also has a lot of factors that could cause it. An individual is well aware of the situations they are stressed so it is advisable for them to be conscious with their body, and notice any tingling or burning sensation anywhere so as to get immediate care.


Mentioned earlier, symptoms of this condition vary in case to case basis. An individual may carry the virus but will not manifest symptoms. On the other hand, individuals who possess symptoms present these:

  1. pain around lips
  2. sore throat
  3. fever
  4. swollen glands in the neck area and other parts of the body
  5. drooling (in some children)
  6. blisters
  7. itching


Fever blisters resolve by themselves in a week or so, but if the condition affects your life greatly there is a way to relieve it in a shorter span of time.

The best time to treat fever blisters is during the prodromal stage when the affected site has the tingling or burning sensation. This will not cure for there is still no known cure for this, but early treatment can shorten the course of the disease.

There are many known medications that will manage this condition, some are given topically and others taken orally. Several antiviral medications are recommended for specific a specific type of infection.


This is recommended for recurrent infections. Immediate intake of this medication an hour after the outbreak will help reduce the time of healing into 2 days, it will also reduce the likelihood o symptoms to appear. The effectiveness of this drug depends on the onset of administration, the sooner Denavir is taken, the better.


This is also used for the same reason as Denavir. Studies have shown that applying this frequently reduces time of healing up to half a day. Giving low dose of Zovirax will help reduce the symptoms, but if pain is present it is advisable to give higher dose to manage pain.

Famciclovir and Valacyclovir

Both are recommended for recurrent cold sores. IT is said that these drugs will decrease the healing process up to 2 days.

Suppression therapy

Although taking medication is an effective way of treating fever blisters, studies have shown that for individuals who had recurrent type of infection, a daily dose of Zovirax, Famciclovir and Valacyclovir should be given to reduce symptoms as well as lessen the duration of the disease.

In addition to these medications, pain alleviation is also taken care of so as to improve the individual’s condition. These are used for temporary relief and not included in the ‘mainstays’ of treatment. There are certain drugs that are used to reduce pain:


This is used to relieve pain and help reduce symptoms by softening the blisters and allay dryness.


This medication is applied topically and is indicated for pain. It also contains moisturizing skin shield and an herbal complex. It is linked that moisturizer aid in a speedy healing of the blisters and will assist in relieving pain and burning sensation.

Home Remedies

There is no definite way to avoid fever blisters, chances cannot be calculated to predict when this will occur but there are certain measures that will help prevent not just cold sores but other diseases as well.

  1. Avoid the things that can cause stress; it is up to the individual to determine what these stressors are and be able to avoid them.
  2. Use sun screen all the time to lessen the uvrays that might harm the skin
  3. Use lip balm
  4. Avoid sharing personal things such as toothbrush and razor with a suspected and infected person
  5. Wash hands frequently


Although herpes simplex virus type affects the mouth, nose and tongue it can also reach other parts of the body. If the fingers are infected; this is called as herpetic whitlow. In worst cases, the infection can reach up to the brain and may lead to brain damage, dementia and cognitive abnormalities.


What is Progeria?

Progeria is a genetic abnormality where a baby grows or age rapidly. It comes from a Greek word which means prematurely old. It affects mostly children and this kind of disease condition gives the children and old appearance. It is usually a rarer kind of disease condition.

progeria syndrome picture

History of Progeria

The disease is sometimes called as Hutchinson- Gliford Progeria syndrome or Hutchinson-Gliford Syndrome. Its name was based from the one who first describe the condition and his name was Jonathan Hutchinson. He describes this disease condition in the year 1886. Upon his discovery, it was estimated around 100 cases have been reported. In 1897, Hastings Gliford was able to record the syndrome. Hence, the combination of the two discoverers Hutchinson-Gliford Progeria syndrome or the HGPS was coined.

As mentioned, Progeria came from a Greek word “pro” meaning before and “geras” meaning old age. This is a rare genetic disorder where children are the most often reported to have. According to studies, most of these children will live only up to the maximum age of 10-15 years old, if lucky.

Progeria Facts

One fact, Children manifest physical appearances that are like an old woman or man. Yet, despite these changes, one thing will remain constant. A child with Progeria will still have average to above average mental intellect. Meaning, their intellectual capabilities are not affected whatsoever. So they appear old, but think like a child.

Aside from that, the appearance of a child diagnosed with Progeria is that of small version of a child. That even when they reach teenage years, they will weigh around thirty pounds, which can be compared to a two year old child with a three and a half feet tall. They have bowl legged shape and they have brittle bone structure.

Progeria Symptoms

Actually after birth, the child will basically appear normal and its symptoms will only be visible at about six months to one year.

Progeria Symptoms

The symptoms of children with Progeria include:

  1. Alopecia or epilation
  2. Pinched Nose
  3. Small Jaw
  4. Small Face
  5. Big Head
  6. Scleroderma
  7. Prominent eyes
  8. Micrognathia or small lower jaw
  9. High Pitched voice
  10. Delayed tooth formation
  11. Stiff joints
  12. Limited Growth or sometimes described as dwarf in height
  13. Wrinkled Skin
  14. Loss of Body fat
  15. Hip dislocation
  16. Tumors
  17. Cataracts
  18. Insulin Resistance
  19. Generalized atherosclerosis
  20. CVA or Stroke

Its head and face manifest baldness, scalp veins, narrowed face. There is delayed tooth formation since their jaws are smaller than normal. Aside from that the eyelashes and their eyebrows are not quite visible. With regards to their bones, they have a fragile bone structure and have short stature and positive hip dislocations. Their skin also undergoes changes such as their connective tissues have been hardened and tough. They have a skin disease called scleroderma.

Progeria Causes

This rare genetic disease is an autosomal recessive kind of disease condition. About 90 percent of children who are diagnosed with Progeria have mutation in one gene. The gene is known to encode Lamin A, which is a protein gene that holds together the nucleus’ cell. According to theory, the person having Progeria has a defective (LMNA) Lamin A Protein making the nucleus more unstable, hence, leading to the symptoms of premature aging. The real reasons or etiology why this disease condition happens have not yet been pinpointed out. In addition to that this disease condition occurs intermittently. Even if this is a genetic kind of disease, not everyone in the family will be able to be diagnosed with Progeria.

Progeria Treatment

There is no specific cure of this kind of disease condition. Yet there could be therapies that could delay or ease the symptoms associated with this kind of disease. Such of these therapies include:


Medication such as Low dose aspirin can prevent occurrence of stroke and heart attack. Other medications can be prescribes such as “statin” drugs that will aid in the lowering of cholesterol level or anticoagulants which prevent blood clots. The hormonal medication can also help in increasing the weight and height of these inflicted children.

Physical and Occupational Therapy

This is necessary to help with the stiffness of the joint and hip problems and will help in blood circulation purposes. Also, it helps to make the child remain active.

Investigational Treatment

FTI or Farnesyltransferase inhibitor medications, which are known to treat cancer, have promising results in treating the Progeria disease. It corrects the cell defects that Progeria has. Yet this kind of medication is still being studied upon.

Extraction of Primary Teeth

Extracting the child’s tooth may help in the prevention of problems that are associated with delaying teeth loss.

Other treatments are aimed at symptomatic and supportive kind of treatment. Aside from these treatments, you can also do these home remedies such as:

Provide Regular Physical Activity

This is important to promote blood circulation.

Provide Small, Frequent Meals

Smaller and frequent meals can help increase the caloric intake of a child with Progeria.

Hydrating Child

Dehydration is a serious problem that is associated with this kind of disease condition. Hence, you need to let your child be well hydrated.

Providing Learning Opportunities

As mentioned, the brain or the intellectual learning capabilities of a patient diagnosed with Progeria is not really affected. She or He can still go to school.

Immunizing the Child

Immunizing a child with Progeria should also be done since studies show that all children are at risk when exposed to infectious disease condition.

Progeria Life Expectancy

When a child is diagnosed with Progeria, studies showed that children with this condition have a shorter lifespan. They are often diagnosed at an early age of 7 years old and their maximum age of life expectancy will be fifteen to twenty years of age. However, some of the patients diagnosed with disease condition can live until age thirty. Most of the causes of death of these patients or children are usually related to heart disease, atherosclerosis disease or stroke.

Erythema Multiforme

What is Erythema Multiforme?

A skin condition proposed to be a result of hypersensitivity reaction from drugs or infectious agents. erythema multiforme is characterized by red to pinkish papules, macules and the hallmark “target lesions” that are distributed throughout the limbs and sometimes the mucus membranes.

erythema multiforme picture

Image 1 –  Erythema multoforme on body

When Does Erythema Multiforme Happen?

The red (erythema) rashes usually emerge after exposure to a drug or an infectious agent, for this erythema multiforme is considered as an allergic reaction to a particular agent.

Erythema Multiforme Presentation

The emergence of the rash would vary from a self-limited rash to a life-threatening, severe one. Rash can present itself as small pink macules or papules, and as the condition progresses, the rash becomes large and widely distributed. Erythema multiforme rashes are usually located on the extremities, and rarely may involve the mucous membranes.

The hallmark sign of multiform erythema rash is its target like appearance. Here the lesions appear pale on the center, and pink-red around the circumference. It can also be itchy (as in mild cases) and can cause abrasions and scratches in severe cases when the itching escalates.

Erythema Multiforme Symptoms and Signs

  1. Itching or burning sensation on the site of the rash
  2. Numerous red-pink maculo-papular rash that begins on the extremities then may proceed to the torso
  3. Sharply demarcated pink to red rash
  4. Presence of a target like lesion (also called “iris” lesion)
  5. Presence of plaques
  6. Plaques or papules that have a darker, brown, purpuric, center (happens at the late stages of the condition)
  7. Presence of blisters and crusting on the center of the lesion may also be noted.
  8. Presence of mucosal lesions especially in the mouth

Other Signs and Symptoms may include:

  1. Fever
  2. Muscle pain
  3. Body malaise or weakness
  4. Cough or sore throat
  5. Joint pain

Erythema Multiforme Causes

Since this condition is a hypersensitivity reaction, the following agents are seen to cause erythema multiforme:

  • Herpes Simplex Virus (HSV) – This is the most common agent seen to cause erythema multiforme, almost 50% of the cases are attributed to infection of the herpes simplex virus. HSV has the capability to express its DNA on skin cells, particularly keratinocytes. When their genes are expressed in these cells, our body’s defense system forms killer cells to destroy the viral genes within the skin cells since it is a foreign body. The destruction of the HSV gene also causes the keratinocytes to be destroyed, and this process sparks the inflammatory reaction we seen in erythema multiforme.
  • Mycoplasma pneumoniae – Another infectious agent seen to cause erythema multiforme is Mycoplasma pneumoniae. This is an agent that causes fungal infections especially in children. The toxins released by this fungal agent may be the cause of rash and lesion formation seen in erythema multiforme.
  • Medications such as:
  1. Barbiturates
  2. Penicillins
  3. Sulfa drugs or sulfonamides
  4. NSAIDs or non-steroidal anti-inflammatories
  5. Hydantoins
  6. Phenothiazines
  • Vaccines for:
  1. Hep B
  2. Small Pox
  3. Hepatitis C
  4. Varicella Zoster
  5. Cytomegalovirus
  6. Human immunodeficiency virus
  7. Dipthteria-tetanus
  • New medications are also related to erythema multiforme formation:
  1. Rofecoxib (Vioxx)
  2. Candesartan cilextil (Atacand)
  3. Ciprofloxacin (Cipro)
  4. Metformin (Glucophage)
  5. Bupropion (Wellbutrin)
  6. Adalimurab (Humira)

Erythema Multiforme Diagnosis

Clinical Assessment

Simple assessment of the patient for the presence of target lesions is enough to diagnose erythema multiforme. Further strengthening the diagnosis is the presence of an HSV infection

Skin Biopsy

This is done when the clinical manifestations are not clear. For patients with recurring erythema multiforme or for those with no history of HSV infection, skin biopsy may be done.

Laboratory Tests

Laboratory tests such as Immunoglobulin M and G, HSV-1 and 2 may also be done if the clinical presentation is unclear.

Erythema Multiforme Differential Diagnosis

Many conditions also resemble the clinical presentation of erythema multiforme. Differential diagnosis is important to rule out other forms of condition from erythema multiforme. Differential diagnoses for this condition include the following:

  • Urticarial and urticarial vacuities
  • Vasculitis
  • Viral exanthems such as measles
  • Polymorphic light eruption
  • Lupus erythematosus
  • Pityriasis rosea
  • Steven-Johnson’s syndrome
  • Drug eruption
  • Toxic Epidermal necrolysis

It is important for the physician to take note of the distinguishing characteristics of erythema multiforme. This condition is usually fixed and present for at least one week, and lesions have the characteristic “iris” appearance or the so called “target-like” lesions. Other lesions only emerge for less than 24 hours (urticaria), and do not resemble the target appearance of erythema multiforme.

Erythema Multiforme Treatment

Oral Antihistamines and Steroids

This relieves the symptoms of inflammation such as redness and itchiness. These medications work by suppressing the release of chemicals that cause the inflammatory reaction of redness and itching.

Side effects of antihistamines and steroids

Antihistamines can cause dizziness, and so it must not be taken with alcohol or sleeping pills. Short term steroid use can cause sudden weight gain, facial flushing and increase in appetite. If steroids are used for a long period of time, gastric acidity and immunosuppression are the common side effects.

Oral Acyclovir

Oral acyclovir is given to patients with ongoing HSV infection. Acyclovir is an antiviral drug that destroys the virus and prevents it from replicating. Acyclovir lessens the duration of the eruptions and so is the number of lesions

Side effects of Oral Acyclovir are he following:

  • Nausea
  • Abdominal pain
  • Vomiting
  • Dizziness
  • Confusion


Prednisone 40-80 mg/day is given for patients with multiple lesions. Its dosage lessened gradually as the lesions subside. Prednisone has an anti-inflammatory effect, suppressing the immune response that causes the inflammation we see in erythema multiforme

Side effects of prednisone

  • Water retention
  • Insomnia
  • Abdominal pain
  • Osteoporosis
  • Facial swelling

Valacyclovir and Famciclovir

This is given for patients with recurring condition and does not respond to Acyclovir treatment. A dose of Valcyclovir 500-1000 mg and Famciclovir 120-250 mg per day can be given. These are antivirals which halt the viruses’’ capability to strike damage to the cells.

Dapsone treatment

This is given for those with recurrent erythema multiforme who are not responsive to antiviral therapy. Dapsone 100-150 mg per day is given and is seen to partially and completely relieve erythema multiforme. Dapsone has anti-inflammatory and immunosuppressing action, this mechanism helps in suppressing erythema multiforme.

Side effects of Dapsone

  • Headache
  • Possible hemolysis (related to doses given)
  • Nausea
  • Peripheral neuritis

Azathioprine or Immuran

This is given if other treatments were not effective; Azathioprine has immunosuppressing effects, modulating the overactive immune response we see in erythema multiforme. This is a potent drug which suppresses the production of chemicals that spark the immune response.

Side effects of Azathioprine or Immuran

  • Susceptibility to other infections (because of bone marrow suppression)
  • Fatigue
  • Hair loss
  • Nausea
  • Can be a carcinogen if used as a long term treatment

Erythema Multiforme in Children

In children, erythema multiforme is commonly caused by an infection rather than exposure to medications. Primarily causing erythema multiforme in children is the Herpes simplex virus and Mycoplasma pneumoniae. Since this is an infection, erythema multiforme in children is most often coupled with other symptoms such as fever, body weakness, sore throat, muscle pain and joint pain.

Is Erythema Multiforme Contagious?

No, erythema multiforme itself is not a contagious disease. This is a condition that is caused by an allergic reaction to medications or an inflammatory reaction to viruses and fungi. Erythema multiforme is not indicative of a contagious disease and must not be mistaken as a sign of measles and other viral exanthems.

Erythema Multiforme Terminology

Erythema Multiforme Major

This is a severe life-threatening form of erythema multiforme; this type can be related to Steven-Johnson’s syndrome. A condition characterized by severe allergic reactions. Severe allergic reactions can cause anaphylactic shock, the event where a person’s airway is blocked and the blood pressure drops due to severe allergic reaction.

Erythema Multiform Minor

This is the less severe and most common form of erythema multiform. This is highly associated with a Herpes simplex infection. This form is only limited to cutaneous lesions, and is not systemic as compared to erythema multiform major.

Bullous Erythema Multiforme

This type of erythema multiform is characterized by bullous lesion formation. A bullous lesion is a type of a large lesion that contains fluid. In bullous erythema multiform, the rash may initially appear small and flat; as the condition progresses the lesions enlarge and resemble vesicles that contain fluids. This is called a bullous lesion.

Recurrent Erythema Multiforme

If the lesions are treated, but re-emerges again after sometime, the condition is called recurrent erythema multiforme. This usually happens as result of HSV infection which was unresponsive to the previous treatment. Suppression of the virus and prophylactic treatment of acyclovir is employed to prevent recurrent erythema multiforme, but in some cases higher dosage of antivirals and dermatological treatments are needed to prevent recurring episodes.

Erythema Multiforme Pictures

Erythema multiforme image

erythema multiforme pic

erythema multiforme on hands


What is Myelosuppression?

Myelosuppression otherwise known as bone marrow suppression is a reduction in the capacity of the bone marrow to generate blood cells. Bone marrow suppression results in decreased numbers of circulating leukocytes (leukopenia), erythrocytes (erythrocytopenia), and platelets (thrombocytopenia). Decreased leukocyte numbers cause immunosuppression. Decreased erythrocytes and platelets cause hypoxia, fatigue, and increased bleeding tendency. Myelosuppression can be mild to severe (fatal) based on the number of cells produced.
Most chemotherapeutic agents suppress bone marrow function to some degree. The agents associated with severe bone marrow suppression include busulfan, cyclophosphamide, cytosine arabinoside, dactinomycin, doxorubicin, daunorubicn, etoposide, mitomycin C, nitrogen mustard, and triethylenethiophosphoramide. Immunosuppression, which places the client at extreme risk for infection, is the major dose-limiting side-effect of cancer chemotherapy. Suppression of immune function is the main life-threatening side-effect and presents the nurse with serious challenge of providing the client with understanding, environment, and support to withstand this potentially devastating Complication.

Myelosuppression Symptoms & Signs

The signs and symptoms of myelosuppression are largely related to the decrease in the levels of the blood components. Manifestations of myelosuppression include the following:

  1. Fever as a sign of infection
  2. The patient have bleeding tendencies and bruises (excessive bleeding) because of thrombocytopenia
  3. Increased risks of having infections because of leukopenia
  4. Symptoms of having an infection
  5. Fatigue because of anemia

Myelosuppression can result in diminished production of red blood cells, white blood cells and platelets. When the number of red blood cells decreases the patient may have anemia and easy fatigability. On the other hand, decrease production of white blood cells may cause leukopenia or neutropenia (decrease in the number of neutrophils), and when this happens the patient will be more prone to infection especially that neutrophils combat bacteria. The patient will be immunocompromised and his body will have a hard time combating infections. While when the platelets start to lessen it may cause thrombocytopenia and will result in bleeding tendencies and bruising.

Myelosuppression Causes & Risk factors

Causes and Risk factors for bone marrow suppression include:


Majority in all the cases the cause of myelosuppression is chemotherapy and other cancer treatments. This is because a lot of the medicines used in chemotherapy momentarily repress the bone marrow.

Therapeutic x-rays

These are also devastating when it reaches the bone marrow. The radiation combats the function of the bone marrow in producing RBC, WBCs and platelets when given in large proportions in increased frequency.


The cancer cells themselves can also lead to myelosuppression. A number of cancers attack the bone marrow and squeeze out the cells usually residing there. However, there are others that can suppress the bone marrow without attacking them directly such as deficiencies in nutrition, which is very frequent in people who suffer from cancer, gradually slow production of the blood cells as well as viral infections and several non-chemotherapeutic medications.
The condition more often than not initiates more than a week following damage to the bone marrow. Nevertheless, the bone marrow usually goes back to normal throughout the next several weeks. Not as much of, increasing injury can be brought about by infrequently, permanent damage that causes irreversible myelosuppression. Extremely rigorous radiation, chemotherapy or other cancer treatments have the ability to demolish every one of the cells in the bone marrow.

Myelosuppression Diagnostic Tests

Laboratory tests employed for the diagnosis of myelosuppression include the following:

Blood Count Tests

Having the blood extracted is a common practice among cancer patients. Especially that myelosuppression is one of the side-effects of the chemotherapy, it is important for a routine blood test to de done in a regular way. A significant decrease in red blood cells, white blood cells and platelets should be reported to the doctor immediately. There are many lab tests to be done to find the red blood cell count, leukocyte and neutrophil count and platelet count and clotting function examinations. Anemia may initially be noticed using a Complete Blood Count (CBC). It is a usual test that calculates the number and relation of the proportion of every dissimilar kind of cells in your blood stream.

Bone Marrow Biopsy

When CBC is not that efficient the doctor may suggest bone marrow biopsy. This test also determines the presence of cancer cells in the bone marrow as a result of leukemia or other malignancies involving the bone marrow. This test is done by aspirating bone marrow cells on the ischium part of the pelvis. The aspiration is extremely painful so patient support is needed throughout the procedure.

Myelosuppression Treatment

Management of myelosuppresion includes treatments aimed to reduce the cause of myelosuppression as well as symptomatic management. A mild case of myelosuppression is not constantly managed.

Limiting Cancer Therapy

If the case is caused by chemotherapy or radiation therapy, the cancer treatments may be suggested stopping, lessening or postponing them. This is done to reduce the damage or to give the patient’s bone marrow a time to improve. The full dose of the cancer treatment should not be given.

Blood Transfusions

Meanwhile, the red blood cells and platelets can be simply replaced by blood transfusions (packed RBC’s or platelets). This will give a short-term solution to the problem and the bad news is the treatment may need to be done over and over because the transfused cells live only for a short period of time. There is also small risk of having a transfusion reaction and infection if the blood that is being transfused is contaminated by virus. In addition, sad to say, but transfusions of WBCs’ are not that effective and infrequently given by the doctors.

Growth Factor Therapy

Growth factor injections may be successful. Growth factors are defined as natural substances that can be found in the human body. This growth factor promotes blood cell production of the bone marrow. There are specific types of growth factor for certain blood cells, these are the examples:

  1. Erythropoietin injections
  2. granulocyte colony-stimulating factor
  3. granulocyte-macrophage colony-stimulating factor
  4. interleukin 11

The growth factor injections can lessen the need for blood transfusion and to make the life better for cancer patients. However, this has several side-effects if the kidneys are healthy and may not be successful if the body is producing enough erythropoietin. Other side-effects include pain in the bones, rashes, muscle soreness, nausea, and fever, retention of fluid, tachycardia, reddish eyes and dyspnea.

Bone Marrow Transplant

Bone marrow transplant is required if the bone marrow has permanent and severe damage. Bone marrows are taken from compatible donors.

Myelosuppression Complications

Complications of myelosuppression may include:

  1. Sepsis- Presence of severe infection as a result of very low white blood cells may eventually to systemic infection.
  2. Hemorrhage- The presence of thrombocytopenia or low platelet count results in poor platelet aggregation. This will eventually lead to profuse bleeding in all areas of the body including nose bleeding, hematochezia (bright red blood in the stool), severe bruising and the like.
  3. Severe anemia- Unmanaged bone marrow suppression often leads to severe reduction in RBCs. This condition results in excessive weakness, fatigability, difficulty of breathing and hypoxia.

Myelosuppresion Prevention

Prevention of bone marrow suppression depends on limiting or avoiding the cause such as:

  1. Exercising caution in administering chemotherapeutic agents.
  2. Avoiding exposure to high doses of radiation.
  3. Increasing the immune system by means of healthy diet, exercise and vitamin supplementation.