Erythema multiforme Definition
Erythema multiforme is a skin disorder that comes from an
allergic reaction or infection.
Lyell's syndrome; Stevens-Johnson syndrome; Erythema multiforme minor; Erythema multiforme major
Causes, incidence, and risk factors
Erythema multiforme is a type of hypsersensitivity reaction. It occurs in response to medicines, infections, or illness. Medications that can cause this reaction include:
The exact cause is unknown. The disorder may start with damage to the blood vessels of the skin, that is followed by damage to skin tissues.
Some forms of this condition are more severe than others.
Erythema multiforme minor is not very serious. Most erythema multiforme is caused by herpes simplex or mycoplasma infections.
Erythema multiforme major is more severe. It is also and is known as Stevens-Johnson syndrome. This form is usually caused by reactions to medicines, rather than infections.
Erythema multiforme occurs mostly in children and young adults.
General ill feeling
Itching of the skin
Multiple skin lesions that:
Start quickly and may return
May appear as a nodule, papule, or macule and may look like hives
Have a central sore surrounded by pale red rings, also called a "target", "iris", or "bulls-eye"
May have vesicles and blisters of various sizes (bullae)
Are located on the upper body, legs, arms, palms, hands, or feet
May involve the face or lips
Are usually even on both sides (symmetrical)
Other symptoms may include:
Signs and tests
You doctor will look at your skin to diagnose this problem and ask if you have a history of risk factors or related diseases.
Tests may include:
Treatment goals include:
Controlling the illness that is causing the condition
Treating the symptoms
Your doctor may have you stop taking any medicines that may be causing the problem. Do not stop taking medicines without talking to your doctor first.
Treatment of mild symptoms may include:
Medicines such as antihistamines to control itching
Moist compresses applied to the skin
Oral antiviral medicine if reaction is caused by herpes simplex
Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort
Topical anesthetics (especially for mouth sores) to ease discomfort that interferes with eating and drinking
Treatment of severe symptoms may include:
Antibiotics for skin infections
Corticosteroids to control inflammation
treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
Intravenous immunoglobulins (IVIG) to stop the disease process
Good hygiene and staying away from other people may help prevent
You may need skin grafting if large areas of the body are affected.
Mild forms of erythema multiforme usually get better in 2 - 6 weeks, but the problem may return. More severe forms may be hard to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis have high death rates.
Complications Body-wide infection ( sepsis)
Loss of body fluids ( shock)
Occasionally, lesions on internal organs causing:
Heart inflammation ( myocarditis)
Lung inflammation (pneumonitis)
Kidney inflammation (nephritis)
Liver inflammation (hepatitis) Permanent skin damage and scarring
Skin infection ( cellulitis) Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of erythema multiforme. Get emergency help immediately if a large area of the body is affected.
In: Habif TP, ed.
Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 18.
Weber DJ, Cohen MS, Morrell DS, Rutala WA. The acutely ill patient with fever and rash. In: Mandell GL, Bennett JE, Dolin R, eds.
Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 52.
Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
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