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Erythema multiforme Causes and Risks:
Erythema multiforme is a type of hypersensitivity (allergic) reaction that occurs in response to medications, infections, or illness. Medications associated with erythema multiforme include sulfonamides, penicillins, barbiturates, and phenytoin. Associated infections include herpes simplex and mycoplasma infections.
The exact cause is unknown. The disorder is believed to involve damage to the blood vessels of the skin with subsequent damage to skin tissues. Approximately 90% of erythema multiforme cases are associated with herpes simplex or Mycoplasma infections. The disorder occurs primarily in children and young adults.
Erythema multiforme may present with a classic skin lesion with or without systemic (whole body) symptoms. In Stevens-Johnson syndrome, the systemic symptoms are severe and the lesions are extensive, involving multiple body areas (especially the mucous membranes). Toxic epidermal necrolysis (TEN syndrome, or Lyell's syndrome) involves multiple large blisters ( bullae ) that coalesce, followed by sloughing of all or most of the skin and mucous membranes.
Prevention:
No prevention is known. Avoidance of known allergens (substances that cause allergic reaction ) may reduce the risk.
Symptoms:
Additional symptoms that may be associated with this disease:
Signs and Tests:
The diagnosis is primarily based on the classic skin lesion appearance and typical symmetrical distribution, especially if there is a history of risk factors or associated diseases.
A skin lesion biopsy and microscopic examination may be helpful to differentiate erythema multiforme from other disorders. Erythema multiforme may show keratinocyte necrosis (tissue death) and other changes. Microscopic examination of the tissue may also show deposits of immune complexes ( antibody deposits).
Treatment:
Treatment goals include control of the underlying causes or illnesses, treatment of the symptoms, and prevention of infection. Suspected medications should be discontinued.
Treatment of mild symptoms may include: - moist compresses applied to skin lesions
- medications such as antihistamines to control itching .
- over-the-counter medications such as acetaminophen to reduce fever and discomfort
- topical anesthetics (especially for mouth lesions ) to ease discomfort that interferes with eating and drinking
Treatment of severe symptoms may include: - hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
- systemic corticosteroids to control inflammation
- antibiotics to control secondary skin infections
Good hygiene and isolation from others may be required to prevent secondary infections .
Extensive skin involvement may cause the loss of large quantities of body fluids, causing shock in addition to the risk of infection. Intensive care with support of body systems may be required.
Skin grafting may be helpful in cases in which large areas of the body are affected.
Prognosis:
Mild forms of erythema multiforme usually resolve without difficulty in 2 to 6 weeks but may recur. More severe forms may be difficult to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis are associated with high death rates.
Complications:
- permanent skin damage and scarring
- occasionally, lesions on internal organs causing:
- a secondary skin infection ( cellulitis )
- systemic infection, sepsis
- the loss of body fluids, shock
Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms indicate erythema multiforme. Involvement of a large area of the body is an emergency situation.
Stevens-Johnson Syndrome: This severe form of erythema multiforme is characterized by involvement of the mucous membranes in the mouth, eyes, and genital area. This syndrome may be caused by exposure to medication or result from bacterial or viral infections.
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 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 the herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.
Erythema multiforme - close-up of 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 the herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.
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 lesions are circular and may appear in concentric rings (often called target lesions). When erythema multiforme affects the mouth and mucous membranes, it is called erythema multiforme major or Steven's Johnson Syndrome.
Stevens-Johnson syndrome - back view: Stevens-Johnson syndrome (also called erythema multiforme major) is a systemic illness that frequently follows an upper respiratory infection. Blistering of the skin and mucous membranes (including the mouth, nose, eyes, genital lining, and anus) is followed by crusting and scabbing. Large areas of skin may be damaged because of the blistering. This photograph demonstrates extensive skin involvement.
Stevens-Johnson syndrome (also called erythema multiforme major) is a systemic illness that frequently follows an upper respiratory infection. Blistering of the skin and mucous membranes (including the mouth, nose, eyes, genital lining, and anus) is followed by crusting and scabbing. Large areas of skin may be damaged because of the blistering. This photograph demonstrates extensive skin involvement.
Stevens-Johnson syndrome (also called erythema multiforme major) is a systemic illness that frequently follows an upper respiratory infection. Blistering of the skin and mucous membranes (including the mouth, nose, eyes, genital organs, and anus) is followed by crusting and scabbing. Large areas of skin may be damaged because of the blistering. This photograph demonstrates the eye lesions.
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.
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.
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.
This picture shows diffuse redness (erythema) and scaling on the arm.
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