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Erythema multiforme
EM; Erythema multiforme minor; Erythema multiforme major; Erythema multiforme minor - erythema multiforme von Hebra; Acute bullous disorder - erythema multiforme; Herpes simplex - erythema multiforme
Erythema multiforme (EM) is a skin reaction that comes from an infection or another trigger.
Causes
EM is a type of allergic reaction . In most cases, it occurs in response to an infection. In rare cases, it is caused by certain medicines or body-wide (systemic) illness.
Allergic reaction
Allergic reactions are sensitivities to substances called allergens that come into contact with the skin, nose, eyes, respiratory tract, and gastroin...
Infections that may lead to EM include:
-
Viruses, such as
herpes simplex
that cause cold sores and genital herpes (most common)
Herpes simplex
Oral herpes is an infection of the lips, mouth, or gums due to the herpes simplex virus. It causes small, painful blisters commonly called cold sore...
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Bacteria, such as
Mycoplasma pneumoniae
that cause lung infection
Mycoplasma pneumoniae
Pneumonia is inflamed or swollen lung tissue due to infection with a germ. Mycoplasma pneumonia is caused by the bacteria Mycoplasma pneumoniae (M pn...
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Funguses, such as
Histoplasma capsulatum
, that cause
histoplasmosis
Histoplasmosis
Histoplasmosis is an infection that occurs from breathing in the spores of the fungus Histoplasma capsulatum.
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Medicines that may cause EM include:
- NSAIDs
- Allopurinol (treats gout)
- Certain antibiotics, such as sulfonamides and aminopenicillins
- Anti-seizure drugs
Systemic illnesses that are associated with EM include:
-
Inflammatory bowel disease, such as
Crohn disease
Crohn disease
Crohn disease is a disease where parts of the digestive tract become inflamed. It most often involves the lower end of the small intestine and the be...
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Systemic lupus erythematosus
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the body's immune system mistakenly attacks healthy tissue. It can af...
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EM occurs mostly in adults 20 to 40 years old. People with EM often have family members who have had EM as well.
Symptoms
Symptoms of EM include:
-
Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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General ill feeling
General ill feeling
Malaise is a general feeling of discomfort, illness, or lack of well-being.
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Itchy
skin
Itchy
Itching is a tingling or irritation of the skin that makes you want to scratch the area. Itching may occur all over the body or only in one location...
ImageRead Article Now Book Mark Article - Joint aches
-
Many
skin lesions
(sores or abnormal areas)
Skin lesions
Rashes involve changes in the color, feeling or texture of your skin.
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Skin sores may:
- Start quickly
- Come back
- Spread
- Be raised or discolored
- Look like hives
- Have a central sore surrounded by pale red rings, also called a target, iris, or bulls-eye
- Have liquid-filled bumps or blisters of various sizes
- Be located on the upper body, legs, arms, palms, hands, or feet
- Include the face or lips
- Appear evenly on both sides of the body (symmetrical)
Other symptoms may include:
-
Bloodshot eyes
Bloodshot eyes
Eye redness is most often due to swollen or dilated blood vessels. This makes the surface of the eye look red or bloodshot.
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-
Eye burning, itching, and discharge
Eye burning, itching, and discharge
Eye burning with discharge is burning, itching, or drainage from the eye of any substance other than tears.
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Eye pain
Eye pain
Pain in the eye may be described as a burning, throbbing, aching, or stabbing sensation in or around the eye. It may also feel like you have a forei...
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Mouth sores
Mouth sores
There are different types of mouth sores. They can occur anywhere in the mouth including bottom of the mouth, inner cheeks, gums, lips, and tongue....
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There are 2 forms of EM:
- EM minor usually involves the skin and sometimes mouth sores.
- EM major often starts with a fever and joint aches. Besides the skin sores and mouth sores, there may be sores in the eyes, genitals, lung airways, or gut.
Exams and Tests
Your health care provider will look at your skin to diagnose EM. You'll be asked about your medical history, such as recent infections or medicines you've taken.
Tests may include:
-
Skin lesion biopsy
Skin lesion biopsy
A skin lesion biopsy is when a small amount of skin is removed so it can be examined. The skin is tested to look for skin conditions or diseases. A...
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Treatment
EM usually goes away on its own with or without treatment.
Your provider will have you stop taking any medicines that may be causing the problem. But, don't stop taking medicines on your own without talking to your provider first.
Treatment symptoms may include:
- Medicines, such as antihistamines, to control itching
- Moist compresses applied to the skin
- Pain medicines to reduce fever and discomfort
- Mouthwashes to ease discomfort of mouth sores that interferes with eating and drinking
- Antibiotics for skin infections
- Corticosteroids to control inflammation
- Medicines for eye symptoms
Good hygiene and staying away from other people may help prevent secondary infections (infections that occur from treating the first infection).
Secondary infections
A secondary infection is an infection that occurs during or after treatment for another infection. It may be caused by the first treatment or by cha...
Outlook (Prognosis)
Mild forms of EM usually get better in 2 to 6 weeks, but the problem may return.
Possible Complications
Complications of EM may include:
- Patchy skin color
- Return of EM, especially with HSV infection
When to Contact a Medical Professional
Call your provider right away if you have symptoms of EM.
References
French LE, Prins C. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 20.
Revuz J. Erythema multiforme. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 72.
Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol . 2012;51(8):889-902. PMID: 22788803 www.ncbi.nlm.nih.gov/pubmed/22788803 .
-
Erythema multiforme on the hands - illustration
Erythema multiforme on the hands: These lesions are circular and may appear in concentric rings (often called target lesions). They may be associated with other medical conditions such as infections or medications. Cold sores (herpes simplex on the lips) is often associated with this condition.
Erythema multiforme on the hands
illustration
-
Erythema multiforme, circular lesions - hands - illustration
Erythema multiforme lesions are circular and may appear in concentric rings (often called target lesions). Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.
Erythema multiforme, circular lesions - hands
illustration
-
Erythema multiforme, target lesions on the palm - illustration
Erythema multiforme lesions are often referred to as target lesions because of the concentric rings the lesions produce. The "target" appearance is well demonstrated in this photograph.
Erythema multiforme, target lesions on the palm
illustration
-
Erythema multiforme on the leg - illustration
The red spots on this person's back appear where blisters (bullae) caused by Erythema multiforme have ruptured and the overlying skin removed (denuded). The resulting lesions are yellow-crusted ulcers (erosions). Erythema multiforme may be associated with herpes simplex infection, mycoplasma pneumonia, or other medical conditions such as streptococcal infection, tuberculosis (TB), or may result from exposure to chemicals or medications.
Erythema multiforme on the leg
illustration
-
Erythema multiforme on the hand - illustration
This individual has erythema multiforme minor, with "target" lesions on his hands. His condition may result from a recurrent herpes simplex virus infection on the lip.
Erythema multiforme on the hand
illustration
-
Exfoliation following erythroderma - illustration
This picture shows diffuse redness (erythema) and scaling on the arm.
Exfoliation following erythroderma
illustration
-
Erythema multiforme on the hands - illustration
Erythema multiforme on the hands: These lesions are circular and may appear in concentric rings (often called target lesions). They may be associated with other medical conditions such as infections or medications. Cold sores (herpes simplex on the lips) is often associated with this condition.
Erythema multiforme on the hands
illustration
-
Erythema multiforme, circular lesions - hands - illustration
Erythema multiforme lesions are circular and may appear in concentric rings (often called target lesions). Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.
Erythema multiforme, circular lesions - hands
illustration
-
Erythema multiforme, target lesions on the palm - illustration
Erythema multiforme lesions are often referred to as target lesions because of the concentric rings the lesions produce. The "target" appearance is well demonstrated in this photograph.
Erythema multiforme, target lesions on the palm
illustration
-
Erythema multiforme on the leg - illustration
The red spots on this person's back appear where blisters (bullae) caused by Erythema multiforme have ruptured and the overlying skin removed (denuded). The resulting lesions are yellow-crusted ulcers (erosions). Erythema multiforme may be associated with herpes simplex infection, mycoplasma pneumonia, or other medical conditions such as streptococcal infection, tuberculosis (TB), or may result from exposure to chemicals or medications.
Erythema multiforme on the leg
illustration
-
Erythema multiforme on the hand - illustration
This individual has erythema multiforme minor, with "target" lesions on his hands. His condition may result from a recurrent herpes simplex virus infection on the lip.
Erythema multiforme on the hand
illustration
-
Exfoliation following erythroderma - illustration
This picture shows diffuse redness (erythema) and scaling on the arm.
Exfoliation following erythroderma
illustration
Review Date: 10/24/2016
Reviewed By: David L. Swanson, MD, Vice Chair of Medical Dermatology, Associate Professor of Dermatology, Mayo Medical School, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
