Erythema multiforme is a skin disorder that comes from an allergic reaction or infection.
Lyell's syndrome; Stevens-Johnson syndrome; Erythema multiforme minor; Erythema multiforme major
Erythema multiforme is a type of hypersensitivity reaction. It occurs in response to medicines, infections, or illness. Medicines that can cause this reaction include:
The exact cause is unknown. The disorder may start with damage to the blood vessels of the skin that damages skin tissues.
Some forms of this condition are more severe than others.
Erythema multiforme minor is not very serious. Most erythema multiforme is caused by herpes simplex or mycoplasma infections.
Erythema multiforme major is more severe. It is also known as Stevens-Johnson syndrome. This form is usually caused by reactions to medicines, rather than infections. Acetaminophen and nonsteroidal anti-inflammatory drugs have caused very rare cases of Stevens-Johnson syndrome.
Erythema multiforme occurs mostly in children and young adults.
Controlling the illness that is causing the condition
Treating the symptoms
Your doctor may have you stop taking any medicines that may be causing the problem. Do not stop taking medicines without talking to your doctor first.
Treatment of mild symptoms may include:
Medicines such as antihistamines to control itching
Moist compresses applied to the skin
Oral antiviral medicine if the reaction is caused by herpes simplex
Pain medication recommended by your doctor to reduce fever and discomfort
Topical anesthetics (especially for mouth sores) to ease discomfort that interferes with eating and drinking
Treatment of severe symptoms may include:
Antibiotics for skin infections
Corticosteroids to control inflammation
Treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis (top layer of skin separates from the lower layers)
Intravenous immunoglobulins (IVIG, an injection of healthy cells from donors into a vein) to stop the disease process
Good hygiene and staying away from other people may help prevent secondary infections (infections that occur from treating the first infection).
You may need skin grafting if large areas of your body are affected.
Mild forms of erythema multiforme usually get better in 2 to 6 weeks, but the problem may return. More severe forms may be hard to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis have high death rates.
Weber DJ, Cohen MS, Morrell DS, Rutala WA. The acutely ill patient with fever and rash. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 52.
Richard J. Moskowitz, MD, dermatologist in private practice, Mineola, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.