Feb 20, 2020 erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. Erythema multiforme primary care dermatology society uk. The lesions may resemble urticaria early in the course of the disease. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. The treatment will then depend on the severity and symptoms of the erythema multiforme. Subepidermal erotema with basement membrane in bullae roof due to dermal edema severe dermal inflammatory infiltrate includes lymphocytes, histiocytes eosinophils may be present, but neutrophils are sparse or absent overlying epidermis often. Erythema multiforme em is an acute, immunemediated condition characterized by the appearance of. Nov 14, 2011 erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Moisturisers and topical corticosteroids can be given to speed up the recovery and reduce symptoms of itch or burn. It is now separated from stevens johnson syndrome sjs and toxic epidermal necrolysis t. Erythema multiforme is a skin condition that can develop as a hypersensitivity reaction to drugs or an infection, although there are many other causes of this disorder, with new ones being found every year. Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm.
Erythema multiforme is a rare disorder that affects slightly more males than females. Treatment management of erythema multiforme involves determining the. Medicinenet does not provide medical advice, diagnosis or treatment. Erythema multiforme remains incompletely understood but appears to be the result of a t h 1mediated immune response to an inciting event, such as drug exposure or other infections such as hsv, hcv, and mycoplasma pneumoniae. Cutaneous lesions and at least 2 mucosal sites typically oral mucosa affected. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an. Erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Feb 20, 2020 erythema multiforme em major may require hospitalization for the treatment of complications and sequelae eg, severe mucous membrane involvement is present or with impaired oral intake, dehydration, or secondary infection and to manage the patients fluid and electrolytes. Herpes associated erythema multiformea diagnostic dilemma. These lesions are often accompanied by erosions or bullae involving the oral, genital, andor ocular mucosae picture 1af.
Both hsv 1 and hsv 2 trigger the erythema multiforme lesions. Em is selflimiting, usually resolving without complications, and. This means it usually resolves on its own without treatment. In our case 1, the patient had a history of taking multidrugs and case 2 showed lesions due to food additives. Erythema multiforme is an acute, inflammatory skin condition. Erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. Erythema multiforme manifests as the sudden onset of asymptomatic, erythematous macules, papules, wheals, vesicles, bullae, or a combination on the distal extremities often including palms and soles and face. The main risk factors appear to be concomitant with use of valproate and exceeding the recommended initial dose of lamotrigine or the recommended rate of dose escalation sachs et al. The most severe cases should be managed in intensive care or burn units. Erythema multiforme dermatologic disorders merck manuals. Large, symmetrical red blotches appear all over the skin in a circular.
Two types, one mild to moderate and one severe, are recognized erythema multiforme minor and erythema multiforme major. Antiplakin autoantibodies are found in some patients. It is an uncommon disorder, with peak incidence in. Recurrent erythema multiforme dermatology jama network.
Erythema multiforme is divided into major and minor forms and is now regarded as distinct from stevensjohnson syndrome sjs and toxic epidermal. Erythema multiforme genetic and rare diseases information. Description erythema multiforme appears on the skin and the mucous membranes the lining of the mouth, digestive tract, vagina, and other organs. As always, a dermatologist should be consulted if this concern does not resolve itself or gets worse. Erythema multiforme is caused by various insults often from an infectious agents, drugs and food additive 3,4,5. Erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages. Mucous membrane lesions without cutaneous involvement em is usually called minor when mucous membranes are spared or minimally affected, for example, lips, and majus or major when at. Erythema multiforme can be induced by adverse drug reaction with a frequency of more than 1%. Jun 01, 2016 erythema multiforme presents over a period of 12 to 24 h. Erythema multiforme em is an acute, selflimited cutaneous or mucocutaneous disorder, characterized by the development of symmetrically distributed, fixed, red lesions. Em is more common in men than women and 50% are under 20 years of age. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. Erythema multiforme major this is the form that is more severe. Erythema multiforme is a selfhealing disease, with an average duration of about 2 weeks.
After 14 days of treatment, skin and oral lesions were controlled. Systemic steroid therapy is the treatment of choice, since this is a self. A recent update article pdf available in biomedical and pharmacology journal 111. Erythema multiforme airuhtheemuh multehformee starts with pink or red blotches. Em has a chronic course ie, recurrent or subintrant in 40% of cases. Erythema multiforme presents over a period of 12 to 24 h. Erythema multiforme syndrome associated with acute acquired.
Erythema multiforme is a skin condition of unknown etiology, but some authors suggest that the disease is mediated by deposition of immune complex mostly igm in the superficial microvasculature of the skin and oral mucous membrane. Multiforme refers to the lesions in the condition having various shapes. Erythema multiforme em is a hypersensitivity reaction which tends to develop suddenly. The patient was started oral prednisolone therapy 30 mgday in. Finally, a wide variety of drugs, most commonly the sulfonamides, may cause this syndrome. Dec 01, 2006 erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages. Erythema multiforme natural treatment consumer reports. Multiforme pediatria pdf yearmonth, html, pdf, epub, total.
Erythema multiforme resolves on its own, so treatment is usually not necessary. A relatively mild prodromal phase that resembles an upper respiratory infection usually occurs before the skin eruption. It is estimated that 2040% of cases of erythema multiforme are secondary to herpes simplex virus infection. Viral skin diseases picture of erythema multiforme minor erythema multiforme em minor is a bullseye rash with alternating rings of red erythema and flaky skin desquamation. Erythema multiforme em is an acute, immunemediated condition characterized by the appearance of distinctive targetlike lesions on the skin. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines.
Erythema multiforme for parents nemours kidshealth. Usually it will disappear on its own, but sometimes treatment may be. These lesions appear suddenly on the legs, arms, palms, hands, feet, and inside the mouth. Lenalidomide treatment for recurrent erythema multiforme jama. The goal of treatment of erythema multiforme is to treat the underlying disease that caused em, or discontinue the medications that resulted in em, and treat the symptoms of the disorder. Pdf erythema multiforme em is an acute, selfhealing inflammatory mucocutaneous disorder. Erythema multiforme em is a hypersensitivity skin condition involving tcell and bcell responses for which the main causes are infectious factors eg, herpes simplex virus, mycoplasma pneumoniae. Although the specific mechanism of the disease isnt known, it appears that sensitivity to bacterial, viral, and chemical irritants leads. It may begin at any age, but is most common in children and young adults. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome 3. The em rash can consist of dozens of targetshaped bullseye pattern lesions that develop over a 24hour period. Management of erythema multiforme associated with recurrent.
Herpes simplex infection is by far the most common etiologic agent. Picture of skin diseases and problems erythema multiforme minor. Erythema multiforme mainly affects adults under 40. Treatment of erythema multiforme, erythema multiforme. Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. It is a hypersensitivity reaction usually caused by drugs e. Jan 07, 2015 this is the main reason why you should try and look for an erythema multiforme natural treatment, because thanks to it you can get impressive, quick results that will last for a long period of time. Mucosal erythema multiforme fuchs syndrome, ectodermosis pluriorificialis. Erythema multiforme british association of dermatologists. December, 62, 8, 2, november, 27, 5, october, 36, 0, september, 30, 3. Erythema multiforme is a hypersensitivity reaction to an infection or, in some cases, a medicine. The rash usually starts off looking like pink or red blotches that develop over a few days into round shapes that look like targets with red, pink, and pale. It is acute and selflimiting, usually resolving without complications.
Lenalidomide treatment for recurrent erythema multiforme. Treatment of erythema multiforme is a common skin disorder consisting of targetlike circular lesions. See treatment of herpes simplex virus type 1 infection in. These lesions can start on the backs of hands and tops of feet before spreading to the trunk. The papular lesions appear symmetrically on the extremities and are targetshaped, with 3 differentcolored zones and a blister in the center clearly demarcated from. Diagnosis, classification, and management of erythema multiforme. Figure 5 course of illness em is generally regarded as a.
Lenalidomide as an alternative to thalidomide for treatment of recurrent erythema multiforme. Most doctors can diagnose the problem by looking at your skin. An outbreak starts with a reddish macule that turns into a papule. Erythema multiforme em is an acute skin reaction that comes from an infection or another trigger. If itching is bothersome, standard itching treatments, such as anesthetics and corticosteroids applied to the skin, may be helpful. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Another great natural treatment for erythema multiforme is the use of flavonoid herbs. Subepidermal erotema with basement membrane in bullae roof due to dermal edema severe dermal inflammatory infiltrate includes lymphocytes, histiocytes eosinophils may be present, but neutrophils are sparse or absent overlying epidermis often demonstrates. Erythema multiforme em is conventionally separated into em minor and em major. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. Some spots can have a small blister or scab in the middle. However, treatment of any underlying infection is helpful. Erythema multiforme em is a skin condition of unknown cause. The classic lesion is annular with a violaceous center and pink halo separated by.
In order to treat mild erythema multiforme, the following may be considered. This is the main reason why you should try and look for an erythema multiforme natural treatment, because thanks to it you can get impressive, quick results that will last for a long period of time. The rash that is associated with erythema multiforme will usually develop quickly and could be the only symptom that a person has with this medical condition. Clinically, em is characterised by macular, papular or urticated lesions, as well as the classical target lesions distributed preferentially on the distal extremities. Erythema multiforme pictures, treatment, symptoms, causes.
A final diagnosis of hsv induced recurrent erythema multiforme was made. Erythema multiforme definition of erythema multiforme by. Erythema multiforme skin disorders merck manuals consumer. Erythema multiforme is often an incomplete diagnosis, and a thorough investigation for underlying pathosis is essential. The incidence of em has been estimated to be between 0. Clinical features, diagnosis, and treatment of erythema multiforme. Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening. Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions. Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv.
Erythema multiforme nord national organization for rare. It presents with a skin eruption characterised by a typical target lesion. No treatment is necessary for e rythema multiforme minor. Oral blistering report of two cases of erythema multiforme. Characteristics of the oral lesions in patients with cutaneous recurrent erythema multiforme. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme. Picture of skin diseases and problems erythema multiforme. This reaction causes red, targetshaped or bullseye patches or sores on the skin. Mild rashes will clear up in a few weeks spontaneously.