Erythema Multiforme – Symptoms, Treatment, Pictures

Erythema multiforme or EM refers to a disorder that causes hypersensitive skin to react abnormally and result in the formation of lesions. The skin reaction is usually caused due to infection with the herpes simplex virus. It may occur in the mucous membranes. It is acute, self-restrictive and tends to resolve without health complications

Erythema multiforme is categorized as major and minor types, and is different from Toxic Epidermal Necrolysis and Stevens Johnson syndrome. It can occur in individual of any race and gender, but is primarily found in males and individuals between the ages of 20 to 40 years.

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Erythema multiforme has a tendency to incline genetically, as some tissue types are more likely to be present in people with herpes. For example: Recurrent EM (-DQB1*0301, -A33, HLA-B15, -DR53, -B35) and Associated EM (HLA-DQw3)

Symptoms of erythema multiforme

Erythema multiforme minor generally does not elicit any prodromal symptoms. However, EM major may elicit mild symptoms such as joint pain, fever, chills and overall weakness

Skin lesions:

  • A few or several lesions may develop within a period of 24 hours. They are initially visible on the tops of the feet and/or the back part of the hands. The lesions then migrate to other regions. Some of the commonly affected areas include the knees, elbows, face, neck and torso. Affected individuals may experience itchiness and burning sensations at the lesion sites.
  • The lesions are singular, flat, reddish or pinkish in the early stages and gradually raise and enlarge to form papules. These papules may eventually become patches of plaques that are dark in the center and tend to blister and crust over.

The common lesion of erythema multiforme is usually rounded with sharp borders and three concentric colored areas. They can be seen as:

  • A center that is dark red with blister crust
  • The next concentric ring is light pink in color and raised due to fluid composition and swelling
  • The third circle is bright red in color

The uncommon lesions of erythema multiforme may have two zones with no distinct margins.

A full examination of the skin may be needed to verify the stage of lesion formation. The rash sites may not experience swelling. However, in ED major, the lips may become swollen.

Involvement of mucous membranes:

  • Mucosal lesions tend to form a few days after the commencement of the skin rash.
  • In erythema multiforme minor cases, there may be mild or absent involvement of the mucous membranes. The early stages of mucosal change show up as excessive redness of the lips and inside the cheeks. Occasionally, blisters may develop, rupture and turn into ulcers

Any of the following mucous membranes can get affected in erythema multiforme major:

  • The lips, tongue or interiors of the cheeks
  • The gastrointestinal tract
  • The palate, gums and floor of the mouth may be uncommonly affected.
  • The eyes
  • The genitals or the anus
  • The trachea/bronchi

The mucosal lesions generally elicit redness and swelling accompanied by formation of blisters. The breaking of such blisters can cause the formation of painful, shallow ulcers enveloped by whitish pseudomembrane. The presence of swollen lips that have hemorrhagic crusts can pose problems in swallowing and speaking.

Mycoplasma pneumonia occurs only in the mucous membranes. Severe cases may require hospitalization of the patient

Recurrence of erythema multiforme:

Erythema multiforme can recur several times in a year and can persist for several years. The major cause of such reoccurrence of erythema multiforme is believed to be the HSV-1 infection

Causes of erythema multiforme

Most of the cases of erythema multiforme are related to infections.

  • The most common cause of erythema multiforme is herpes simplex virus infection. Erythema multiforme is mostly triggered by herpes labialis infection and sometimes by genital herpes infection. HSV type 1 is more commonly associated with erythema multiforme than HSV type 2. The infection with herpes happens first which triggers the development of skin rashes in 3 to 14 days.
  • Erythema multiforme is also caused or triggered by Mycoplasma pneumonia, which is a lung disease caused by Mycoplasma pneumonia

Some of the different types of viruses that are responsible for causing erythema multiforme are listed below:

  • Adenovirus
  • Hepatitis viruses
  • HIV
  • Parapoxvirus
  • Viral vaccines
  • Cytomegalovirus
  • Herpes varicella zoster

A minor percentage of erythema multiforme cases are known to be triggered as a reaction to certain drugs. Many medications such as phenothiazines, barbiturates, sulphonamides, NSAIDs, penicillin, and anticonvulsants have been found to cause erythema multiforme.

Erythema Multiforme treatment

Most cases of erythema multiforme resolve on their own without any treatment. HSV infection can be treated with oral acyclovir and Mycoplasma pneumonia with antibiotics

The symptoms associated with erythema multiforme can be treated as follows:

  • Difficulties in swallowing and drinking due to erythema multiforme major may need hospitalization.
  • Itching can be reduced via oral antihistamines or topical corticosteroids
  • Antiseptic mouth wash and local anesthetic can be used for alleviation of oral infection and pain
  • Eye problems has to be treated by an eye specialist.

Erythema Multiforme Pictures

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