ERYTHEMA MULTIFORME

 Basic information

description

Erythema multiforme is an inflammatory disorder of the skin and, sometimes, the mucous membranes (thin, moist linings of body cavities). It is called erythema multiforme minor (80% of the cases) when only the skin is involved. It is called erythema multiforme major when the mucous membranes are also involved. Erythema multiforme affects children over age 3, teens, and adults. More severe forms of the disorder are Stevens-Johnson syndrome and toxic epidermal necrolysis.

FREQUENT SIGNS & SYMPTOMS

• Rash spots that are red and evenly shaped. They often appear in rings like bull's-eyes.
• Rash usually appears on palms, soles, and other areas of arms and legs. It may spread to the face and the rest of the body.
• Rash is sometimes painful, may have burning sensation, and is usually not itchy.
• Rash develops into blisters, hives, or becomes ulcerated (open sores).
• With erythema multiforme major, the mucous membranes of the mouth, eyes, and genitals may become inflamed. Fever, headache, sore throat, or diarrhea may also occur.

causes

It is thought to be an immune response. The most common cause is a preceding herpes simplex virus (the same virus that causes cold sores). It is less often caused by drug reactions, cancer, radiation, other viruses, or bacteria. Sometimes, no cause is found.

risk increases with

• Previous history of erythema multiforme.
• Drugs such as sulfonamides, tetracyclines, barbiturates, metronidazole, nonsteroidal anti-inflammatories, oral contraceptives, pseudoephedrine, bupropion, and others. The reaction to the drug may not occur until days or weeks after first using it.
• Cancer.
• Radiation therapy.

PREVENTIVE MEASURES

Therapy to prevent herpes simplex virus outbreaks may be recommended in some cases.

expected outcomes

Rash develops over 1 to 2 weeks. It usually clears up in 2 to 3 weeks, but it may take 5 to 6 weeks.

possible complications

• May progress from the minor form to the major form of erythema multiforme.
• Recurrence of the disorder.

 diagnosis & treatment

general measures

• Your health care provider may diagnose the disorder by the appearance of the skin rash. A biopsy may be done (involves removing a small piece of the affected skin for viewing under a microscope). Blood tests or other skin tests may be done.
• Treatment may involve drug therapy. In some cases, no treatment is needed. If a drug is the cause of the disorder, it will normally be discontinued.
• Wet dressings and soaks or lotions may help to soothe the skin. Bathing in lukewarm to cool water three times a day for 30 minutes is also helpful.
• If mouth sores are present, good oral hygiene is important to reduce risk of infection and to relieve discomfort.
• The more severe forms of the disorder may require hospital care.

medications

• Corticosteroids (topical or oral) may be prescribed to reduce inflammation and irritation.
• Antivirals may be prescribed to treat viral infection such as herpes simplex virus.
• Antibiotics will be prescribed for bacterial infection.
• If mouth sores are present, topical drugs or mouthwashes may be prescribed.
• If eyes are involved, eyewashes or other topical drugs may be prescribed.
• Pain remedies, sedatives, or antihistamines may be prescribed to help provide relief of symptoms.

activity

As tolerated by the extent of the symptoms.

diet

• Usually no special diet is needed.
• If mouth sores are present, a soft or liquid diet may be better tolerated.

 notify our office if

• You or a family member has symptoms of erythema multiforme.
• Symptoms worsen during treatment.

Special Notes: