From the Guidelines
I cannot show you images of erythema multiforme as I don't have the capability to display pictures. Erythema multiforme is a reactive mucocutaneous disorder that is distinct from Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) 1. It is usually precipitated by infection and characterized by typical target lesions that start on acral surfaces and progress proximally. Some key characteristics of erythema multiforme include:
- Target-like lesions with a central dark area surrounded by a pale ring and an outer red ring
- Lesions typically appear symmetrically on the extremities, especially the palms, soles, and extensor surfaces
- Often triggered by herpes simplex virus infections, medications, or other infections Management of erythema multiforme includes:
- Identifying and removing the trigger
- Providing supportive care with antihistamines for itching, pain control, and cool compresses
- For herpes-associated cases, antiviral medications like acyclovir may help
- Severe cases may require short courses of oral corticosteroids 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 SJS/TEN 1. Patients with EMM are typically constitutionally well, make a good recovery, and are rarely affected by long-term complications.
From the Research
Erythema Multiforme Description
- Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa, characterized by target-like lesions that can be isolated, recurrent, or persistent 2.
- The lesions of erythema multiforme typically present symmetrically on the extremities, especially on extensor surfaces, and spread centripetally 2.
- Erythema multiforme can be differentiated from urticaria by the duration of individual lesions, with erythema multiforme lesions being fixed for a minimum of seven days, whereas individual urticarial lesions often resolve within one day 2.
Causes of Erythema Multiforme
- Infections, especially herpes simplex virus and Mycoplasma pneumoniae, and medications constitute most of the causes of erythema multiforme 2.
- Immunizations and autoimmune diseases have also been linked to erythema multiforme 2.
- Other infectious agents like Mycoplasma pneumoniae, hepatitis C virus, Coxsackie virus, and Epstein Barr virus may also trigger erythema multiforme 3.
- Drugs, such as allopurinol, phenobarbital, and antibacterial sulfonamides, have been reported as possible implicated drugs 3.
Clinical Features
- Target or iris lesions distributed symmetrically on the extremities and trunk characterize the condition 4.
- Erythema multiforme can involve both mucosal and cutaneous sites, and can be confused with other more serious conditions like Stevens-Johnson syndrome (SJS) 5.
- Atypical erythema multiforme manifestations include lichenoid or granulomatous lesions as well as lesional infiltrates of T cell lymphoma and histiocytes 3.
Treatment of Erythema Multiforme
- Treatment of erythema multiforme involves symptomatic treatment with topical steroids or antihistamines and treating the underlying etiology, if known 2.
- Recurrent erythema multiforme associated with the herpes simplex virus should be treated with prophylactic antiviral therapy 2.
- Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines, while treatment for recurrent EM is most successful when tailored to individual patients 5.
- Systemic therapies, such as corticosteroid therapy and antiviral prophylaxis, and topical therapies, such as high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement, may be used to treat recurrent EM 5.