Erythema multiforme may be associated with herpes simplex infection, mycoplasma pneumonia, or other medical conditions such as streptococcal infection, tuberculosis tb, or may result from exposure to chemicals or medications. Erythema multiforme a skin disease characterized by papular or vesicular lesions and reddening or discoloration of the skin often in concentric zones. Erythema multiforme may be present within a wide spectrum of severity. 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 rings. Erythema multiforme pictures, treatment, symptoms, causes.
Dr priya sen, national skin centre, 1 mandalay road, singapore 308205. Erythema multiforme em, in its modern definition, is an acute, selflimited syndrome with distinctive skin lesions with or without mucosal lesions. Erythema multiforme em has been divided into a minor simplex form and a major bullous form. This means that the body is sensitive to something that causes the skin and mucous membranes to react. Despite being listed with many etiological factors, the exact pathogenic mechanism of em remains unclear, and as a consequence, there are no evidencebased. The minor form is additionally subdivided into papular and vesiculobullous variants, and all three have been considered a continuum of the same process. Jun 01, 2016 erythema multiforme can also be an early cutaneous manifestation of a particular disease, such as lyme disease, a multiorgan animalborne disease, caused by spirochetes of borrelia burgdorferi, which typically affect the skin, nervous system, musculoskeletal system and heart. Its pathogenesis is unclear, but most cases are considered to be infection related or drug related.
See also introduction to hypersensitivity reactions and inflammatory skin disorders. The symptoms will vary with the severity of the rash. Erythema multiforme is a skin condition considered to be a hypersensitivity reaction to infections or drugs. Erythema multiforme is a clinical diagnosis, although skin biopsy may be required to exclude other conditions. Erythema multiforme em is an acute, selflimited cutaneous or mucocutaneous disorder, characterized by the development of symmetrically distributed, fixed, red lesions. Immunosuppressive therapy with cyclosporine introduced in the 1970s dramatically improved the survival of kidney, liver, and heart transplants. It is characterized by skin eruptions, with or without oral or other mucus membrane lesions. The numerous descriptive names attached to its multiple manifestations ha. 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. 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. The term erythema multiforme em includes a wide and controversial variety of clinical expressions at the present time. Erythema multiforme is an inflammatory skin disorder characterized by patches of red, raised skin that often look like targets and usually are distributed symmetrically over the body. A case of recurrent erythema multiforme and its therapeutic.
Stevens johnson syndrome erythema multiforme em is an acute, selflimiting disease of the skin and mucous membranes described by hebra in 18661. Erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Association between hsv infection and em has been designated haemherpes associated erythema multiforme. Erythema multiforme major, toxic epidermal necrolysis, stevensjohnson syndrome, stevens johnson syndrome, stevens johnson, druginduced skin reaction. Erythema multiforme em is a rare, acute hypersensitivity reaction most commonly triggered by herpes simplex virus hsv infections. Erythema multiforme is an acute, inflammatory skin condition. In our patient, a role of cmv infection seemed highly plausible. It is an uncommon disorder, with peak incidence in the second and third decades of life.
Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening. It occurs most commonly in association with the herpes simplex virus as an immune response to the infection. The episode was treated with acyclovir, and acyclovir was used. Finally, a wide variety of drugs, most commonly the sulfonamides, may cause this.
Erythema multiforme information mount sinai new york. It is acute and selflimiting, usually resolving without complications. In adults, the main precipitating factor is infection. Erythema multiforme an overview sciencedirect topics. Erythema multiforme merck manuals consumer version. Cyclosporine therapy for bullous erythema multiforme. In bullous erythema multiform, the rash may initially appear small and flat. Erythema multiforme pictures, treatment, causes, symptom. Herpes associated erythema multiformea diagnostic dilemma. Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. Full text full text is available as a scanned copy of the original print version. The resulting lesions are yellowcrusted ulcers erosions. Erythema multiforme stevensjohnson syndrome, erythema multiforme major, erythema multiforme minor, herpesinduced em major, herpesassociated erythema multiforme, druginduced stevensjohnson syndrome.
Clinical features, diagnosis, and treatment of erythema. It occurs with any skin injury, infection, or inflammation. Erythema multiforme major is an acute inflammatory hypersensitivity reaction. 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. Erythema multiforme is a skin condition of unknown cause, possibly mediated by deposition of immune complex mostly igm in the superficial microvasculature of the skin and oral mucous membrane. The type of bulla that may occur in erythema multiforme is shown here. It consists of a polymorphous eruption of macules, papules, and characteristic target lesions that are symmetrically distributed with a propensity for the distal extremities. Below is the list of complications and problems that may arise if erythema multiforme is left untreated. Erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the use of certain medication and presents with cutaneous or. In this severe form you have sores over much of your body and you are very sick. Skin biopsy showed apoptotic individual keratinocytes, degeneration of basal keratinocytes and intercellular oedema, it concluded to diagnosis of erythema multiforme. Nonbullous erythema multiforme in hospitalized children. A bullous lesion is a type of a large lesion that contains fluid. The spots enlarge and become irregularly shaped plaques.
Description erythema multiforme appears on the skin and the mucous membranes the lining of the mouth, digestive tract, vagina, and other organs. Herpes associated erythema multiforme haem is an acute exudative dermatic and mucosal disease caused. Pdf erythema multiforme em is an interesting dermatologic disease which has oral manifestations. Definition erythema multiforme is a skin disease that causes lesions and redness around the lesions. Bullous erythema multiforme jama dermatology jama network. Erythema multiforme presents over a period of 12 to 24 h. Erythema multiforme is often an incomplete diagnosis, and a thorough investigation for underlying pathosis is essential. Erythema from the greek erythros, meaning red a redness of the skin, caused by excessive blood in the superficial capillaries. Erythema multiforme em is an acute skin condition that may be recurrent in some cases.
This reaction causes red, targetshaped or bullseye patches or sores on the skin. It varies with the age of the lesion, its appearance, and which part is biopsied. Yes, erythema multiforme causes complications if it is not treated. It appears as a symmetrical rash and may include the mucous membrane lesions. It presents with a skin eruption characterised by a typical target lesion. Erythema multiforme bullosum stevensjohnson syndrome nejm.
Other tests may be done looking for infections commonly seen in association. The incidence of em has been estimated to be between 0. Erythema multiforme em is a serious cutaneous and or mucocutaneous disorder that typically develops within 1014 days of exposure to an offending medication or infection and resolves within 4. 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. Get a printable copy pdf file of the complete article 976k, or click on a page image below to browse page by page. Erythema multiforme em is a hypersensitivity reaction which tends to develop suddenly. A skin condition proposed to be a result of hypersensitivity reaction from drugs or infectious agents. Usually it will disappear on its own, but sometimes treatment may be. Em is said to be rare in childhood, and very few paediatric series concern. This type of erythema multiform is characterized by bullous lesion formation. It is estimated that 2040% of cases of erythema multiforme are secondary to herpes simplex virus infection. The histology of erythema multiforme is characteristic but not diagnostic. A case of erythema multiforme with unknown etiology. Em is mainly seen in adults between 2040 years of age.
Multiforme numerous occurrences and lesion formations. It may begin at any age, but is most common in children and young adults. Although the existence of photodistributed erythema multiforme has been recognized for years, few cases have been described to date. Erythema multiforme british association of dermatologists. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name. Erythema multiforme em is an acute, selflimiting disease of the skin and mucous membranes described by hebra in 18661. Clinical features include a rash of varied appearance, beginning as macules and papules, which evolve into characteristic.
The diagnosis was con firmed as herpes simplex virusassociated erythema multiforme major. Use of the terminology em minor and em major is a reasonable. When severe, the condition is called stevensjohnson syndrome. An outbreak starts with a reddish macule that turns into a papule. Both hsv 1 and hsv 2 trigger the erythema multiforme lesions. Less commonly used names are ectodermose erosive pluriorificialis of the french authors, dermatostomatitis, erythema multiforme bullosum, eruptive fever 1 and so forth. Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. Large, symmetrical red blotches appear all over the skin in a circular. Erythema multiforme is acute, inflammatory skin disease and has two clinical forms, minor and major. A case of erythema multiforme with unknown etiology oatext. It occurs as erythema multiforme minor in 90% of the cases. 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.
But bacteria, fungi, and other viruses also can cause someone to develop the condition. Erythema multiforme em is an acute mucocutaneous condition caused by a hypersensitivity reaction. Erythema multiforme definition of erythema multiforme by. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. Erythema multiforme em is an acute mucocutaneous hypersensitivity reaction with a variety of etiologies. Photodistributed erythema multiforme actas dermosifiliograficas. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme minor. Erythema multiforme is a rare, acute, selflimiting, immunemediated hypersensitivity reaction in children and it is exceptional in newborns. Some lesions evolve concentric zones of color to form targets, the hallmark of em. Picture of skin diseases and problems erythema multiforme. Papules, scales, plaques and eruptions picture of erythema multiforme 2 erythema multiforme tends to be acral in distribution, and the dorsum of the hand is a particularly common location. These lesions show merger tendency and located predominantly on the skin. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines.
What are erythema multiforme and stevensjohnson syndrome. These are the erythematous popular lesions which are seen post viral infection, these lesions are classified in to em minor and em major, major is a life threatening condition. A number of reports have appeared in the literature in recent years on the condition known as the stevensjohnson syndrome. It is most commonly triggered by herpes simplex virus infection but may also be precipitated by a host of other conditions or exposures. It is an eruption of classic target lesions on the extremities associated with. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. Systemic steroid therapy is the treatment of choice, since this is a self. The clinical presentation began initially with typical bullous erythema multiforme. The erythematous vesicular lesions gradually improved. Abstract herpes simplex virus hsvassociated erythema multiforme haem is an acute and self.
Nonbullous erythema multiforme nbem is an acute, immune. Erythema multiforme em is an ulcerative, blistering inflammatory condition which affects either the skin or the mucous membranes, most often manifesting as a mucocutaneous lesion. Erythema multiforme is often linked to the herpes simplex virus the virus that causes cold sores. Erythema multiforme major this is the form that is more severe. Erythema multiforme genetic and rare diseases information. Erythema multiforme em is a rare skin disorder that mainly affects children. Histologically, each shows varying degrees of dermal and epidermal inflammation and injury. Erythema multiforme syndrome associated with acute acquired.
Erythema multiforme can be induced by adverse drug reaction with a frequency of more than 1%. Erythema multiforme bullosa stevensjohnson syndrome. Erythema multiforme is caused by various insults often from an infectious agents, drugs and food additive 3,4,5. Erythema multiforme syndrome associated with acute. Management of erythema multiforme associated with recurrent. Erythema multiforme knowledge for medical students and. Links to pubmed are also available for selected references. This study revises the em minor characteristics according to the. Multiforme refers to the lesions in the condition having various shapes.
Herpes simplex infection is by far the most common etiologic agent. Erythema multiforme em is a skin condition of unknown cause. Polycyclic target lesions with alternating rings of erythema and dusky desquamation on the arm. Erythema multiforme is an uncommon, acute or recurrent, widespread, immunemediated, mucocutaneous hypersensitivity syndrome of varying severity. Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions.
Erythema multiforme symptoms, causes and cure tabletwise. Diagnosis, classification, and management of erythema. Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. A case of erythema multiforme with unknown etiology duman tt, aktas g, atak bm, kocak mz, erkus e and savli h abant izzet baysal university hospital, department of internal medicine, bolu, turkey abstract erythema multiforme major is an acute inflammatory hypersensitivity reaction usually due to infections and to medications. This page includes the following topics and synonyms.
Erythema multiforme is a hypersensitivity reaction to an infection or, in some cases, a medicine. Erythema multiforme is a selfhealing disease, with an average duration of about 2 weeks. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. If it is mild, you may feel perfectly well, and your rash may be asymptomatic or associated with a mild itch or burning sensation. The topic erythema multiforme bullosum you are seeking is a synonym, or alternative name, or is closely related to the medical condition erythema multiforme. Erythema multiforme mainly affects adults under 40. Erythema multiforme em is conventionally separated into em minor and em major. Clinical features, diagnosis, and treatment of erythema multiforme. Doctors think most cases of erythema multiforme happen when an infection causes the bodys immune system to damage the skin cells.
Em minor, a mild allergic reaction, occurs most commonly. Erythema multiforme nord national organization for rare. Erythema multiforme major, stevensjohnson syndrome and toxic epidermal necrosis are categorized as a common clinical syndrome 1. Em is more common in men than women and 50% are under 20 years of age. Erythema multiforme em is an acute, selflimited, inflammatory cutaneous disorder caused by infection or drugs that is characterized by bulls eye lesions, blisters, and erythematous plaques on the skin fitzpatrick and bernhard 1987. It is the result of cell mediated immune reaction due to hsv antigen and. Erythema multiforme major is a form of rash with skin loss or epidermal detachment. Apr 30, 2015 examination revealed oral painful erosive lesions with genital erythematous purpuric patch mimiking atypical targetlike lesions. In our case 1, the patient had a history of taking multidrugs and case 2 showed lesions due to food additives. Nonbullous erythema multiforme nbem is an acute, immunemediated, selflimiting skin disease with distinctive target lesions. Erythema multiforme em is an acute, benign skin condition with a sudden onset that usually occurs due to medications, infections, illnesses, or for unknown reasons. Erythema multiforme em is an uncommon, immunemediated disorder that presents with cutaneous or mucosal lesions or both. Erythema multiforme is usually a reaction of the skin and mucous membranes that occurs suddenly. It is now separated from stevens johnson syndrome sjs and toxic epidermal necrolysis t.