• Erythema Multiforme

    (Erythema Multiforme Minor; Erythema Multiforme Major; Stevens-Johnson Syndrome)

    Definition

    Erythema multiforme is a common skin disorder. It consists of target-like circular lesions. They have a red center, pale ring, and dark red outer ring. These lesions appear suddenly on the legs, arms, palms, hands, feet, and inside the mouth.
    • Erythema multiforme minor is the most frequent form. It is generally mild.
    • Erythema multiforme major, while rare, can be life-threatening. This severe form of the disorder usually causes target lesions with painful blisters at their center. They tend to appear on the trunk, eyes, inside the mouth, and genitals. It is also called Stevens-Johnson syndrome.

    Causes

    In some cases this condition can be caused by a reaction to an infection or certain medications. Often the cause is unknown.
    Erythema multiforme minor is most commonly associated with:
    • Herpes simplex virus—the same virus that causes cold sores
    Other triggers connected with erythema multiforme major include:
    • Mycoplasma infection (bacterial lung infection)
    • Cocaine use
    • History of radiotherapy
    • Certain medications, such as:
      • Sulfonamides
      • Tetracyclines
      • Amoxicillin
      • Ampicillin
      • Nonsteroidal anti-inflammatory drugs
      • Anticonvulsants

    Risk Factors

    Exposure to any of the known causes increase the risk. The conditions more commonly occurs in:
    • Individuals who have had it before
    • Individuals with history of cold sores (orolabial herpes) or genital herpes
    • Children and young adults
    • Males more than females
    • Individuals who are HIV positive

    Symptoms

    Symptoms can vary from mild to severe. If you have any of these do not assume it is due to erythema multiforme. These symptoms may be caused by other health conditions. If you experience any one of them, see your doctor.
      Skin lesions or spots
      • Typically appear over 3-4 days
      • Start on hands and feet and spread to legs, arm, and face
      • Spots start out as small, red areas, and progress to look like mini targets
      • Spots may blister
      • Rash appears equally on both sides of the body
      • Rash resolves in 1-6 weeks
      Red Blistered Skin
      Skin blister boil
      Copyright © Nucleus Medical Media, Inc.
      Other possible symptoms include:
      • Itching
      • Fever
      • Overall ill feeling
      • Achy joints
      • Vision problems
      • Bloodshot or dry eyes
      • Burning, painful, or itchy eyes
      • Mouth sores

    Diagnosis

    Your doctor will ask you about your symptoms and medical history. 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. If target lesions are present, then diagnosis is clear. The skin lesions may not be typical. In this case, a biopsy of the skin may be done. The skin sample is examined under a microscope.

    Treatment

    Treatment for this condition involves:
    • Eliminating the trigger or cause (if known)
    • Relieving the symptoms
    • Preventing infection of the lesions (in erythema multiforme major)
    Treatment options include the following:

    Management of Symptoms

    • Moist compresses
    • Oral antihistamines to help control itching
    • Topical steroid creams to help discomfort and itching
    • Acetaminophen to reduce pain and fever
    • Potassium iodide

    Antiviral Medications

    • Given if the outbreak is caused by herpes simplex
    • Prevent recurrence
    • Not effective in treating the current rash
    • Most often used for people with frequent outbreaks

    Erythema Multiforme Major

    • Oral or IV steroids—for severe cases may be treated with (there is some controversy about the effectiveness of this option)
    • Hospitalization—for widespread, life-threatening lesions

    Prevention

    If you develop this condition, it will be important to find what triggered it. Avoid the trigger to help prevent its recurrence.
    If herpes simplex virus is the trigger, your doctor may prescribe a daily oral antiviral medication. This will help to prevent this condition.

    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/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    American Osteopathic College of Dermatology. Erythema multiforme. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/skin/dermatologic%5Fdiseases/erythema%5Fmultiform.html . Accessed November 4, 2010.

    British Association of Dermatologists. Erythema multiforme. British Association of Dermatologists website. Available at: http://www.bad.org.uk/patients/leaflets/erythema.asp . Accessed September 20, 2005.

    DynaMed Editorial Team. Erythema multiforme. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 12, 2010. Accessed November 4, 2010.

    New Zealand Dermatological Society. Erythema multiforme. New Zealand Dermatological Society website. Available at: http://www.dermnetnz.org/reactions/erythema-multiforme.html . Accessed September 20, 2005.

    Postgraduate Medicine. Katta R. Taking aim at erythema multiforme. Postgraduate Medicine Online. Available at: http://www.postgradmed.com/issues/2000/01%5F00/katta.htm . Accessed September 20, 2005.

    Sterling JB, Heymann WR. Potassium iodide in dermatology: a 19th century drug for the 21st century-uses, pharmacology, adverse effects, and contraindications. J Am Acad Dermatol . 2000 Oct;43(4):691-697.

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