What is Erythema multiforme ?

 Erythema Multiforme 

Erythema multiforme is a skin reactions that can be triggered by an infection or some medicine . Its usually mild and goes away in a few weeks . There also a rare , severe  form that can affect the mouth , gentials and eyes and can be life - threatening. This is known as erythema multiforme major . Erythema multiform is an immune - mediated , typically self- limiting , mucocutaneous condition charactertised by target lesions. Significant  mocosal involvement distinguishes erythema  multiforme major from multiform minor. Episode can be isolated , recurrent , or persistent . 

In most cases , erythema multiforme is precipitated by herpes  simplex virus {HSV } infection , alternative  trigger include  other infections , medications, and vaccinations. Classic  target  lesion present as concentric rings of color  variation which  develop symmetrically in an acral distribution , with or without involvement of mucous membranes . 

Erythema Multiforme Pictures :



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What are the causes of erythema multiforme ?

Infection precipitates 90% of cases , with HGV type 1 being the predominant cause . other infectious triggers include :
- HSV type 2 
- Cytomegalovirus 
- Epstein - barr virus 
- Infuenze virus 
- Vulvovaginal candidiasis 
- Sars- cov 2 
- Orf

Mycoplasma pneumoniae infection is often listed as a trigger of erythema multiforme , however mucocutaneous manifestation associated with this infection have recently been classified as their own independent entity , Mycoplasma pneumoniae induced  rash and mucositis [ MIRM ]. Medication which may trigger erythema multiforme include :
Antibiotics 
Anti - epileptics 
Non- steroidal anti- inflammatory drugs 
Vaccinations 

Other conditions associated with erythema multiforme include :
Inflammatory bowel disease 
Hepatitis C
Leukaemia 
Lymphoma 
Solid organ cancer malignancy 

Sign & Symptoms of erythema multiforme :

A person with erythema multiforme  may also experience the following  symptoms :
  • itching and burning rash, which is the most common symptom
  • fever or body temperature of 100.4F or higher 
  • Headache 
  • joint pain and swelling 
  • sores in the moth 
  • sores in the moth 
  • sores and redness in the eyes
  • sensitivity to light 
  • joint pain 

How to treat erythema multiforme ?

 Treatment is often not neended as episodes are typically self limiting with no ongoing complications . However , ocular involvement should always prompt ophthalmology referral given the risk for more serious  sequelae . 
Treatment of symptomatic mild cases :
 -itch oral antihistamines and / or topical steroids for itch or discomfort associated with cutaneous lesion 
- pain for mild mucosal involvement , oral washes containing antiseptic or local anaesthetic . 
- precipitating infections - treat appropriately 
- offending medications - cease and  avoid in future 
- may require hospital admission for support of  oral intake 
Although evidence is  limited , prednisone has beeb suggested to reduce the severity  and duration of symptoms in these cases. 

What are the features of erythema multiforme ?

Many patients report prodromal symptoms including fatigue , malaise myalgia or fever .  these likely represent the course  of precipitating illness rather than true prodrome . 

CUTANEOUS FEATURES :
Cutaneous  lesions develop at the peripheries before spreading  centrally .
Distrubution is usually  symmetrical  with a preference for extensor surfaces. 
May be painful , pruritic , or swollen 
Early lesion  present  as round , erythematous papules which later develop into target lesions . 
Atypical lesions may be present with typical lesions. Atypical lesions are raised with poorly defined borders and / or fewer zones  of color variation . 
In severe disease , up to hundred  of lesion may be present in different developmental stages , at times making it difficult to identify characteristic lesion . 

MUCOSAL FEATURES :
 Lesions develop as blisters , which then break to reveal shallow erosion with a white overlying pseudo - membrane . 
Erythema multiforme favours oral membranes , but may also present with urogenital and rarely , ocuklar lesions . 
Mucous memebrane involvement  can be painful and significantly limit oral intake  lesion may be precede or follow cutaneous lesions . 
 

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