Department of Pediatrics

Erythema multiforme is a common skin disorder consisting of target-like circular lesions: red center, pale ring, and dark red outer ring. These lesions appear suddenly on the legs, arms, palms, hands, feet, and inside the mouth. Erythema multiforme minor is the most frequent form and is generally mild.

Erythema multiforme major, while rare, can be life-threatening. This severe form of the disorder usually causes target lesions with painful blisters at their center, which tend to appear on the trunk, eyes, inside the mouth, and genitals. It is also called Stevens-Johnson syndrome.

Erythema multiforme is usually caused by a reaction to an infection or certain medications, but oftentimes the cause is unknown. Erythema multiforme minor is most commonly associated with the herpes simplex virus, the same virus that causes cold sores. Other triggers connected with erythema multiforme major include:

• Mycoplasma infection (bacterial lung infection)
• Cocaine use
• History of radiotherapy
• Certain medications, such as:
  • Sulfonamides
  • Tetracyclines
  • Amoxicillin
  • Ampicillin
  • Nonsteroidal anti-inflammatory drugs
  • Anticonvulsants

A risk factor is anything that increases your chance of getting a disease or condition. Exposure to any of the known causes of erythema multiforme increases its risk. The conditions more commonly occurs in:

• Individuals who have had it before
• Individuals with history of cold sores (orolabial herpes) or genital herpes
• Children and young adults
• Males more than females
• Individuals who are HIV positive

Symptoms of erythema multiforme can vary from mild to severe. If you experience any of these symptoms, do not assume it is due to erythema multiforme. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

• Skin lesions or spots
  • Typically appear over 3-4 days
  • Start on hands and feet and spread to legs, arm, and face
  • Spots start out as small, red areas, and progress to look like mini targets
  • Spots may blister
  • Rash appears equally on both sides of the body
  • Rash resolves in 1-6 weeks
  Red Blistered Skin  

  

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• Other possible symptoms include:
  • Itching
  • Fever
  • Overall ill feeling
  • Achy joints
  • Vision problems
  • Bloodshot or dry eyes
  • Burning, painful, or itchy eyes
  • Mouth sores

Your doctor will ask you about your symptoms and medical history. You may be referred to a doctor who specializes in skin problems (dermatologist). Most cases of erythema multiforme can be diagnosed based on your medical history and skin exam. If target lesions are present, then diagnosis is straight-forward. In cases where the skin lesions are not typical, a biopsy of the skin may be taken and examined under a microscope.

Treatment for this condition involves eliminating the trigger or cause (if known), relieving the symptoms, and preventing infection of the lesions (in erythema multiforme major).

Treatment options include the following:

• Symptomatic management
  • Moist compresses
  • Oral antihistamines to help control itching
  • Topical antihistamine or steroid creams to help discomfort and itching
  • Acetaminophen to reduce pain and fever
• Antiviral medications—if the outbreak is caused by herpes simplex, antiviral medications may be given to prevent a recurrence but is not effective to treat the rash already present. This is typically used for people with frequent outbreaks of erythema multiforme.

Severe cases of erythema multiforme major may be treated with oral steroids. Hospitalization is required for widespread lesions that are life threatening.

If you ever develop erythema multiforme, it will be important to understand what triggered it. Avoidance of this medication or infection will help prevent its recurrence. If herpes simplex virus is the trigger, your doctor may prescribe a daily oral antiviral medication to prevent this condition.