What are the signs and symptoms of erythema multiforme?

From the Guidelines

Erythema multiforme is characterized by distinctive target-like skin lesions with a central dark area surrounded by pale rings and an outer red ring, typically appearing on the extremities and sometimes spreading to the trunk, accompanied by mucosal involvement and a prodromal phase with flu-like symptoms. The signs and symptoms of erythema multiforme include:

• Target-like skin lesions with a central dark area, pale rings, and an outer red ring
• Lesions typically appear symmetrically on the extremities, especially the palms, soles, backs of hands, and forearms
• Mucosal involvement occurs in about 25-60% of cases, with painful erosions affecting the mouth, lips, eyes, and genitals 1
• A prodromal phase with flu-like symptoms, including fever, malaise, headache, cough, and sore throat, often precedes the skin eruption
• The rash typically develops over 3-5 days and resolves within 1-2 weeks, though recurrence is possible
• Erythema multiforme is usually triggered by infections, particularly herpes simplex virus, medications, or other factors such as autoimmune diseases or malignancies 1 The clinical features of erythema multiforme can be distinguished from those of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) by the presence of typical target lesions, minimal mucosal involvement, and a lack of extensive epidermal necrolysis 1. Treatment focuses on removing the underlying cause, providing supportive care, and managing symptoms with antihistamines, topical steroids, or oral corticosteroids in more severe cases.

From the Research

Signs and Symptoms of Erythema Multiforme

The signs and symptoms of erythema multiforme (EM) include:

• Target-like lesions on the skin, which can be isolated, recurrent, or persistent 2, 3
• Lesions typically present symmetrically on the extremities, especially on extensor surfaces, and spread centripetally 2
• Mucosal involvement, including oral ulcers 3, 4
• Fixed lesions that last for at least seven days, distinguishing EM from urticaria 2
• Symptoms can range from mild to severe, with some cases requiring hospitalization 4

Clinical Features

The clinical features of EM can vary, but common characteristics include:

• Symmetrically distributed lesions on the extremities and trunk 3
• Target or iris lesions 3
• Mucosal involvement, including the oral cavity 3
• Lesions can be accompanied by systemic symptoms, such as fever and malaise 5

Diagnosis and Differentiation

EM can be differentiated from other conditions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), based on:

• Morphology of individual lesions and their pattern of distribution 5, 6
• Etiopathogenesis, with EM primarily caused by infections and SJS/TEN predominantly triggered by drugs 5, 6
• Clinical presentation, including the presence of mucosal involvement and the extent of skin detachment 6