| Erythema multiforme |
Minor erythema multiforme of the hands (note the bleached centers of the lesion)
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| Speciality |
dermatology |
| eMedicine |
derm/137 |
| Synonym |
| Lyell syndrome; Stevens-Johnson syndrome; Erythema multiforme minor; Erythema multiforme major |
 Medical Notice |
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Erythema multiforme or polymorphous erythema is a skin disease of acute or chronic recurrent presentation, of an immunological nature, characterized by erythematous lesions of the skin and vesicles or blisters of the mucous membranes. It can be triggered after infection or exposure to drugs.1
Epidemiology
Erythema multiforme can occur at any age, most often between the second and third decade of life. It is rare in children. The overall annual incidence ranges from 0.8 to 6 per million per year. It occurs more in men than in women, in a ratio of 3:2.1
Aetiology
The etiology of erythema multiforme is unknown. However, its occurrence has been associated with a number of infections. The most frequent association is with Herpes simplex infection, followed by hepatitis and infectious mononucleosis. Some bacterial infections (commonly Mycoplasma) and fungal diseases are also associated. Listed below are the infections that have been associated with the diseasead.1
Other causes include reactions to drugs, most commonly to sulfas, phenytoin, barbiturates, penicillins, and allopurinol, or a host of internal ailments. Persistent (chronic) erythema multiforme has been linked to the ingestion of benzoates in natural and artificial forms, including benzoic acid, which exists naturally in some fruits, and sodium benzoate, a common food preservative.
Clinical picture
The condition ranges from a mild, self-limiting rash of minor erythema multiforme.2to a severe, deadly form known as Erythema multiforme major (or Erythema multiforme majus) that also involves mucous membranes. This severe form may be related to Stevens–Johnson syndrome. The mild form is much more common than the severe form. The diagnosis is confirmed by biopsy. The mild form usually presents with mild pruritus (although it can also be very severe), red patches, symmetrically arranged and from the extremities. It often takes on the appearance of classic lesion on target,3with a red ring around a pale center. Usually the resolution occurs between 7 and 10 days. Individuals with persistent (chronic) erythema multiforme often present in the first week with a painful form at a site of injury, for example, a minor scratch or abrasion. Irritation or pressure even from clothing can cause erythema pain to continue to expand along its margins for weeks or months, long after the original pain in the center heals.
Treatment
Erythema multiforme is self-limiting, often disappears spontaneously and does not require any treatment. The appropriateness of glucocorticoid therapy may be uncertain, as it is difficult to determine whether the course will be self-limiting.4
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Reaction of Erythema multiforme to an antibiotic.
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"Eritema multiforme major" (Stevens–Johnson syndrome); which resembles "erythema multiforme"
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Blank lesions of Erythema Multiforme in the leg, Nell Brigham, 2011
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See also
References
Bibliography
- Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:pp 710–714.
- Weber DJ, Cohen MS, Morrell DS, Rutala WA. The acutely ill patient with fever and rash. In: *Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 52.
- María Soledad Zegpi T. , Celso Castillo A. Claudia Salomone B., Caso clínico dermatológico, Revista chilena de pediatría, printed version ISSN 0370-4106 Rev. chil. pediatric. v.73 n.4 Santiago Jul. 2002 doi: 10.4067/S0370-41062002000400010 Rev. Chil. Pediatrics. 73 (4); 390-391, 2002
- Léauté-Labréze C, Lamireau T: Diagnosis, classification, and management of erythema multiforme and Stevens- Johnson syndrome. Arch Dis Child 2000; 83: 347-52.
- Weston W: Erytema Multiforme, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. In: Textbook of Pediatric Dermatology. Vol 1. Ed. Blackwell Science 2000; 628-36.
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