From the Guidelines
Erythema multiforme is a self-limiting condition that typically lasts between 2 to 4 weeks, resolving without treatment in most cases. The condition is a reactive mucocutaneous disorder, usually precipitated by infection, and characterized by typical target lesions that start on acral surfaces and progress proximally 1. According to the British Association of Dermatologists' guidelines, erythema multiforme major (EMM) is typically accompanied by mucosal erosions and ulceration, usually confined to the mouth, and does not progress to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) 1.
Key characteristics of erythema multiforme include:
- Target-like skin lesions that may appear suddenly on the skin, often on the hands, arms, legs, and feet
- Mucosal involvement, usually confined to the mouth
- Typically, patients are constitutionally well, make a good recovery, and are rarely affected by long-term complications
- The condition is usually precipitated by infection, and identification and avoidance of the triggering factor are crucial for management
In terms of management, most mild cases of erythema multiforme will improve on their own within 2-4 weeks with supportive care, such as:
- Pain relief medications (e.g., acetaminophen or ibuprofen)
- Antihistamines for itching
- Cool compresses For more severe cases, especially those with extensive oral involvement, topical corticosteroids or oral prednisone may be prescribed 1. If the condition is triggered by herpes simplex virus, antiviral medications like acyclovir may help prevent recurrences. Patients should seek medical attention if symptoms are severe, involve large body areas, affect breathing or swallowing, or don't improve within a week, as some cases may progress to more serious conditions.
From the Research
Duration of Erythema Multiforme
- The duration of erythema multiforme (EM) can vary, but individual lesions are typically fixed for a minimum of seven days 2.
- In some cases, EM can be recurrent, with episodes occurring over a period of years 3.
- The mean duration of recurrent EM in one study was 6 years, with a range of durations reported 3.
- Treatment for EM is focused on relieving symptoms and can include topical steroids, antihistamines, and antiviral prophylaxis, with the goal of reducing the duration and severity of episodes 4, 2.
- In cases of recurrent EM, treatment may need to be ongoing to manage symptoms and prevent future episodes, with some patients experiencing complete or partial remission with treatment 5, 3.