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Erythema Multiforme

(Erythema Multiforme Minor; Erythema Multiforme Major)

Pronounced: Er-uh-thee-ma Multi-form-aye
En Español (Spanish Version)

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Erythema multiforme is a skin condition often associated with an overreaction to an infection or medication. It can affect skin throughout the body. Erythema multiforme has two forms:

  • Erythema multiforme minor—most common, is generally mild and may go away on its own
  • Erythema multiforme major—rare, usually more severe, less likely go away on its own, and can be life threatening

Causes

Erythema multiforme is an overreaction of the immune system to a certain trigger. Some erythema multiforme is associated with an infection or certain medications, though the exact trigger is not always known. It is not clear why some people have this reaction.

Risk Factors

Erythema multiforme is more common in young adults.

Factors that may increase your chance of getting erythema multiforme include:

  • History of erythema multiforme
  • Infection or history of infection caused by
    • Virus (herpes infection is main cause in erythema multiforme minor)
    • Bacteria
    • Fungus
    • Parasite
  • Certain medications such as:
    • Antibacterials
    • Anticonvulsants
    • Non-steroidal anti-inflammatory medications
  • Certain vaccinations including
    • Diptheria and tetanus vaccine
    • Hepatitis B vaccine
    • Smallpox vaccine

Red Blistered Skin

Skin blister boil
Copyright © Nucleus Medical Media, Inc.

Symptoms

Symptoms can vary from mild to severe. Both erythema multiforme minor and major cause skin lesions that:

  • Are itchy or burning
  • Typically develop over 3-4 days, but at different times. Lesions will look different in various places of the body.
  • Often start on hands and feet and spread to legs, arm, and face
  • Start out as small, red areas, and grow to circular, raised areas. The middle is often a dark red which fades to a pale pink and is surrounded by a bright red edge. The different colors make the lesions look like mini targets.
  • May have a blister or crust in the center
  • Appears equally on both sides of the body
  • May develop in one mucus membrane such as lips, inside mouth, or eyes

Erythema multiforme major may also cause:

  • General ill feeling, fever, and achy joints before the rash appears
  • More extensive rash
  • Lesions that develop in 2 or more mucus membranes such as lips, inside mouth, or eyes

Diagnosis

Your doctor will ask you about your symptoms and medical history. A physical exam will be done. You may be referred to a doctor who specializes in skin problems.

Most cases can be diagnosed based on your medical history and skin exam. The target lesions are usually a key for diagnosis. However, the skin lesions may not be typical and a sample of the skin may be taken. The skin sample is examined under a microscope to look for findings of erythema multiforme.

Treatment

Erythema multiforme will usually go away on its own 4-6 weeks. Mild forms usually will not need treatment.

Treatment may be needed to treat an underlying infection. This may include antiviral, antibiotic, or antifungal medications. If the erythema multiforme is related to a current medication, your doctor will work with you to stop the medication and find a replacement if needed.

Severe lesion due to erythema multiforme major may also require:

  • Treatment to prevent infections of the lesions
  • Hospitalization for widespread, life-threatening lesions

Moist compresses and medications may help relieve discomfort from lesions. Medication options may include:

  • Oral antihistamines to help control itching
  • Topical steroid creams to help discomfort and itching
  • Acetaminophen to reduce pain and fever
  • Medicated mouthwash for lesions in the mouth

Steroids, or steroid-sparing medications may be needed with widespread erythema muliforme major. These medications suppress or enhance the immune system and may decrease the intensity or halt the lesions. These may be given orally or through an IV.

Prevention

If the lesions were due to herpes simplex virus, there are ways to prevent outbreaks:

  • Talk to your doctor about a daily prescription of an oral antiviral medication.
  • Apply sunscreen and zinc sulfate solution to the site of the herpes simplex to help prevent relapse.
RESOURCES:

American Academy of Dermatology

http://www/aad.org

American Family Physician

http://www.aafp.org

CANADIAN RESOURCES:

Canadian Dermatology Association

http://www.dermatology.ca

References:

American Osteopathic College of Dermatology. Erythema multiforme. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/skin/dermatologic_diseases/erythema_multiform.html. Updated October 1, 2013.

British Association of Dermatologists. Erythema multiforme. British Association of Dermatologists website. Available at: http://www.bad.org.uk/site/816/default.aspx. Updated February 2010. Accessed October 1, 2013.

Erythema multiforme. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated June 24, 2011. Accessed October 1, 2013.

New Zealand Dermatological Society. Erythema multiforme. New Zealand Dermatological Society website. Available at: http://www.dermnetnz.org/reactions/erythema-multiforme.html. Updated February 6, 2013. Accessed October 1, 2013.

Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.