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Erythema multiforme

Definition

Erythema multiforme is a skin disorder that comes from an allergic reaction or infection.

Alternative Names

Lyell's syndrome; Stevens-Johnson syndrome; Erythema multiforme minor; Erythema multiforme major

Causes, incidence, and risk factors

Erythema multiforme is a type of hypsersensitivity reaction. It occurs in response to medicines, infections, or illness. Medications that can cause this reaction include:

  • Barbiturates
  • Penicillins
  • Phenytoin
  • Sulfonamides

Infections include:

  • Herpes simplex
  • Mycoplasma

The exact cause is unknown. The disorder may start with damage to the blood vessels of the skin, that is followed by damage to skin tissues.

Some forms of this condition are more severe than others.

  • Erythema multiforme minor is not very serious. Most erythema multiforme is caused by herpes simplex or mycoplasma infections.
  • Erythema multiforme major is more severe. It is also and is known as Stevens-Johnson syndrome. This form is usually caused by reactions to medicines, rather than infections.

Erythema multiforme occurs mostly in children and young adults.

Symptoms

Other symptoms may include:

Signs and tests

You doctor will look at your skin to diagnose this problem and ask if you have a history of risk factors or related diseases.

Tests may include:

Treatment

Treatment goals include:

  • Controlling the illness that is causing the condition
  • Preventing infection
  • Treating the symptoms

Your doctor may have you stop taking any medicines that may be causing the problem. Do not stop taking medicines without talking to your doctor first. 

Treatment of mild symptoms may include:

  • Medicines such as antihistamines to control itching
  • Moist compresses applied to the skin
  • Oral antiviral medicine if reaction is caused by herpes simplex
  • Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort
  • Topical anesthetics (especially for mouth sores) to ease discomfort that interferes with eating and drinking

Treatment of severe symptoms may include:

  • Antibiotics for skin infections
  • Corticosteroids to control inflammation
  •  treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
  • Intravenous immunoglobulins (IVIG) to stop the disease process

Good hygiene and staying away from other people may help prevent secondary infections .

You may need skin grafting if  large areas of the body are affected.

Support Groups

Expectations (prognosis)

Mild forms of erythema multiforme usually get better in 2 - 6 weeks, but the problem may return. More severe forms may be hard to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis have high death rates.

Complications

  • Body-wide infection (sepsis )
  • Loss of body fluids (shock )
  • Occasionally, lesions on internal organs causing:
  • Permanent skin damage and scarring
  • Skin infection (cellulitis )

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of erythema multiforme. Get emergency help immediately if a large area of the body is affected.

Prevention

References

In: Habif TP, ed. . 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 18.

Weber DJ, Cohen MS, Morrell DS, Rutala WA. The acutely ill patient with fever and rash. In: Mandell GL, Bennett JE, Dolin R, eds. . Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 52.

Encyclopedia content is provided as information only and not intended to replace the advice and instruction from your personal physician.