Erythema multiforme

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Alternate names[edit | edit source]

EM; Erythema polymorphe, erythema multiforme type; Erythema multiforme bullosum; Dermatostomatitis, erythema multiforme type; Febrile mucocutaneous syndrome; Herpes iris, erythema multiforme type

Definition[edit | edit source]

Erythema multiforme (EM) refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs.

Summary[edit | edit source]

A hypersensitivity reaction characterized by the sudden appearance of symmetrical cutaneous and mucocutaneous macular or papular lesions which evolve into lesions with bright red borders (target lesions). The lesions usually appear in the hands, feet, extremities, and face. Symptoms include fever, malaise, sore throat, cough, vomiting, diarrhea, arthralgia, and myalgia. Causes include infections (most commonly herpes simplex virus), drugs (e.G., sulfonamides, anticonvulsants, and antibiotics), malignancies, and collagen vascular disorders.

Erythema multiforme EM 02.jpg
Bulls eye lesion of Erythema multiforme.jpg
Erythema Multiforme target lesions on the leg, Nell Brigham, 2011.jpg

Cause[edit | edit source]

EM is a type of allergic reaction. In most cases, it occurs in response to an infection. In rare cases, it is caused by certain medicines or body-wide (systemic) illness.

Infections that may lead to EM include:

Medicines that may cause EM include:

Systemic illnesses that are associated with EM include:

EM occurs mostly in adults 20 to 40 years old. People with EM may have family members who have had EM as well.

Forms[edit | edit source]

There are two forms of EM:

  • EM minor usually involves the skin and sometimes mouth sores.
  • EM major often starts with a fever and joint aches. Besides the skin sores and mouth sores, there may be sores in the eyes, genitals, lung airways, or gut.

Signs and symptoms[edit | edit source]

Symptoms of EM include:

  • Low-grade fever
  • Headache
  • Sore throat
  • Cough
  • Runny nose
  • General ill feeling
  • Itchy skin
  • Joint aches
  • Many skin lesions (sores or abnormal areas)

Skin sores may:

  • Start quickly
  • Come back
  • Spread
  • Be raised or discolored
  • Look like hives
  • Have a central sore surrounded by pale red rings, also called a target, iris, or bulls-eye
  • Have liquid-filled bumps or blisters of various sizes
  • Be located on the upper body, legs, arms, palms, hands, or feet
  • Include the face or lips
  • Appear evenly on both sides of the body (symmetrical)

Other symptoms may include:

  • Bloodshot eyes
  • Dry eyes
  • Eye burning, itching, and discharge
  • Eye pain
  • Mouth sores
  • Vision problems

Diagnosis[edit | edit source]

Tests may include:

  • Skin lesion biopsy
  • Examination of skin tissue under a microscope

Treatment[edit | edit source]

EM usually goes away on its own with or without treatment.

Treatment may include:

  • Medicines, such as antihistamines, to control itching
  • Moist compresses applied to the skin
  • Pain medicines to reduce fever and discomfort
  • Mouthwashes to ease discomfort of mouth sores that interferes with eating and drinking
  • Antibiotics for skin infections
  • Corticosteroids to control inflammation
  • Medicines for eye symptoms
  • Good hygiene may help prevent secondary infections (infections that occur from treating the first infection).
  • Use of sunscreen, protective clothing, and avoiding excessive exposure to sun may prevent the recurrence of EM.

Prognosis[edit | edit source]

Mild forms of EM usually get better in 2 to 6 weeks, but the problem may return.


NIH genetic and rare disease info[edit source]

Erythema multiforme is a rare disease.


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Contributors: Deepika vegiraju, Dr.T