Erythema Multiforme (quick review)

3 Dec


Acute, immune mediated skin reaction often caused by infections (HSV most common) or medication use

-Often distributed in arms/legs with distincttargetoid lesions

-Can also have oral/genital/ocular lesions similar to SJS/TEN

-When EM includes any mucosal involvement it is classified as EM Major   -Without Mucosal involvement, it is called EM Minor


Extremely rare skin condition that occurs most often in young adults, with a slightly increased rate among women


Infections are a common cause (>90% of cases)

HSV infection is the most common cause

Mycoplasma pneumonia is also a known infection source

Medication exposure (<10% of cases) –e.g. Sulfonamides, Antiepileptics, and antibiotics

Clinical Features

-Called “multiforme” because of the many different presentations of the disease

-Lesions occur bilaterally on the upper and lower extremities, with a preference for the extensor surface. The trunk can be affected, but usually less often.

-Typical target lesions start out as round erythematous papules that evolve into target lesions with dusky central area with/without blister, an erythematous border with a pale ring of edema with another large erythematous halo

-Mucous membrane involvement can be present

-Prodromal symptoms can occur including fever and myalgias.


-For most cases, disease is self limiting

-For patients with mucosal involvement, oral steroids are often used

-For drug-related EM, cessation of the medication is essential

-For HSV associated EM, antiviral prophylaxis is first line treatment

Submitted by J. Grover.

References: Sokumbi O, et al. “Clinical Features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist.” International Journal of Dermatology. 2012. 51:889-902.  Uptodate. Pathogenesis, Clinical Features, and Diagnosis of Erythema Multiforme.; picture


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