Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) — dedicated to using leading-edge science to save and improve lives around the world. The rash is characterized by polymorphous, acrally distributed . Das Stevens-Johnson-Syndrom (SJS) und die toxische epidermale Nekrolyse (TEN) wurden früher aufgrund von Ähnlichkeiten in der Klinik als schwere Verlaufsformen des Erythema exsudativum multiforme angesehen. Int J Dermatol. Drugs, especially sulfa drugs, antiseizure drugs, and antibiotics, are the most common... read more , but it is now considered a different entity. EM is a self-limiting disease. • Use “ “ for phrases Clinical features EM minor. Severe mucosal erythema multiforme can require hospitalization for intravenous fluids and repletion of electrolytes. Oral lesions must be distinguished from aphthous stomatitis Recurrent Aphthous Stomatitis Recurrent aphthous stomatitis (RAS) is a common condition in which round or ovoid painful ulcers recur on the oral mucosa. Your provider will recommend treatment to alleviate or lessen your symptoms, and they should go away within a few weeks. Overview What is erythema multiforme? Erythema Multiforme - Dermatologic Disorders - MSD Manual Professional ... Most often, this disorder is caused by the herpes simplex virus. Some people have only one attack, but some have multiple recurrences. Treatment helps alleviate symptoms to get you feeling better. Lesions spontaneously resolve but frequently recur. Cutaneous adverse reaction to anticonvulsant, erythema multiforme target lesions Erythema multiforme resolves on its own, so treatment is usually not necessary. Erythema multiforme (EM) is an acute skin reaction that comes from an infection or another trigger. Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current perspectives on erythema multiforme. • Use OR to account for alternate terms Often, the rash starts on the arms, hands, legs, and feet, then appears on the face, neck, diaper area, and body. They grow over a few days into round spots that look like targets with red, pink, and pale rings. Wenn zusätzlich eine deutliche Beeinträchtigung des Allgemeinzustandes und Erosionen an den Schleimhäuten auftreten, spricht man von der Major-Form. However, Stevens-Johnson syndrome Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Stevens-Johnson syndrome and toxic epidermal necrolysis are two forms of the same life-threatening skin disorder that cause rash, skin peeling, and sores on the mucous membranes. You may also get mouth sores. Please confirm that you are a health care professional. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Bei leichtem Befall wird zusätzlich lokal mit Kortikosteroiden behandelt, bei ausgeprägtem Verlauf werden orale Glukokortikoide, feuchte Umschläge, Mundspüllösungen, lokale Desinfektiva und breiige Kost verordnet. Etiology is unclear. Vaccines such as measles, mumps, and rubella; smallpox; hepatitis B; meningococcal (Figure 2); pneumococcal; varicella; influenza; and Haemophilus influenzae have also been associated with erythema multiforme, although incidence is low.12–16 Less commonly, erythema multiforme has been associated with autoimmune diseases, such as inflammatory bowel disease17 and malignancies, specifically leukemia and lymphoma.18 Persistent erythema multiforme and refractory erythema multiforme have been found in patients with solid organ cancers, such as renal cell carcinoma and gastric adenocarcinoma.19,20, Erythema multiforme lesions typically begin as pink or red papules, which can then become plaques.21,22 These lesions can cause burning or itching.23 Over the next three to five days, the lesions transform into a variety of appearances.1,3,6,24 The classic lesion of erythema multiforme is called the target or iris lesion. Significant mucosal involvement distinguishes erythema multiforme major from multiforme minor. Am Fam Physician. de Risi-Pugliese T, Sbidian E, Ingen-Housz-Oro S, Le Cleach L. Interventions for erythema multiforme: a systematic review. Treating the infectious disease causing the disorder, Eliminating any medicine causing the disorder. The etiology of pediatric EM involves infections, medications, autoimmune diseases, and genetic factors. Patients may experience recurrent erythema multiforme with multiple episodes. Intervention: For case 1, patient was . Applying topical anesthetics or oral numbing medicine for pain. Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Within the keratinocyte layer, expression of viral DNA fragments induces a cell-mediated immune response, including the production of interferon-γ which upregulates the inflammatory process. It is usually caused by a medicine reaction rather than an infection. Am Fam Physician. Treatment is symptomatic... read more , pemphigus Pemphigus Vulgaris Pemphigus vulgaris is an uncommon, potentially fatal, autoimmune disorder characterized by intraepidermal blisters and extensive erosions on apparently healthy skin and mucous membranes. When a recent infection or drug is the cause of the erythema multiforme eruption, treat the infection or discontinue the medication. Erythema multiforme of eye, Cutaneous adverse reaction to anticonvulsant, erythema multiforme target lesions. If your child has erythema multiforme caused by the cold sore germ, the rash might come back when cold sores come back. [2]Sokumbi O, Wetter DA. Some kids get a few spots in the mouth. Zusätzlich können Fieber und Arthralgien auftreten. [3]Grünwald P, Mockenhaupt M, Panzer R, et al. Am Fam Physician. Erythema multiforme (EM) is a cutaneous, and sometimes mucocutaneous condition that is typically precipitated by viral infections, most commonly herpes simplex virus (HSV), and the use of specific medications [ 1, 2, 3, 4 ]. Erythema multiforme major is also known as Stevens-Johnson syndrome. Erythema Multiforme - Dermatologic Disorders - Merck Manuals ... Target lesions and lesions on the palms and soles can be relatively specific findings. //Recent Updates in the Treatment of Erythema Multiforme - PMC Erythema multiforme is an acute, typically self-limited skin condition with lesions that can be isolated, recurrent, or persistent.1 Erythema minor affects only the skin and erythema major includes mucocutaneous involvement.1,2 Although it was previously thought that erythema multiforme was on the same pathologic spectrum as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis, it is now accepted that erythema multiforme is a distinct disease.3,4, The annual incidence of erythema multiforme is estimated at less than 1%.5,6 It is more common in adults younger than 40.6 There is no apparent association with race.7. Target lesions consist of three concentric rings of colour variation: In severe disease, up to hundreds of lesions may be present in different, Lesions develop as blisters, which then break to reveal shallow, Erythema multiforme favours oral membranes, but may also present with. 2012 Aug;51(8):889-902. Erythema multiforme is a skin reaction usually due to an infection or a medication. Less commonly, cases are caused by drugs, vaccines, other bacterial or viral diseases (especially hepatitis C), or possibly systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. The herpes virus is phagocytosed by mononuclear cells which express cutaneous lymphocyte antigen (a skin-homing receptor). The classic lesion of erythema multiforme is called the target or iris lesion. We do not endorse non-Cleveland Clinic products or services. While it may be painful to eat or drink, make sure you eat and drink regularly to prevent malnutrition or dehydration. It is most commonly triggered by herpes simplex virus infection but may also be precipitated by a host of other conditions or exposures. Lesions spontaneously resolve but frequently recur. It is a hypersensitivity reaction associated with certain infections, vaccinations, and, less commonly, medications. Itching makes people want to scratch. Erythema multiforme 2020 Jun;18(6):547-53. http://www.ncbi.nlm.nih.gov/pubmed/32469468?tool=bestpractice.com. All patients with recurrent erythema multiforme should be tested for herpes simplex virus, including sampling of skin or mucosal lesions. http://www.ncbi.nlm.nih.gov/pubmed/22788803?tool=bestpractice.com Problems in the... read more . KATHRYN P. TRAYES, MD, GILLIAN LOVE, MD, AND JAMES S. STUDDIFORD, MD, Related letter: Skin Disorders in Patients with Skin of Color. Its pathophysiology is not yet completely understood, but it seems there is a lymphocyte-mediated hypersensitivity reaction to . The link you have selected will take you to a third-party website. ??accessibility.screen-reader.external-link_en_US?? Erythema multiforme is characterized by target or iris lesions, which are annular lesions with a violaceous center and pink halo separated by a pale ring. Its name combines the . Most cases are caused by a reaction to infection with the herpes simplex virus Herpes Simplex Virus (HSV) Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. Center for Medical Simulation & Innovative Education, Cores, Shared Resources & Support Offices, Institute for Clinical and Translational Research, Institute for Fundamental Biomedical Research, nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, using antihistamines (like Benadryl, Claritin, Zyrtec, or store brands), putting creams on the skin to help with itchiness, pain that doesn't get better with pain medicine, spots around the eyes or the white part of the eyes look red. UptoDate, abgerufen am 4.2.2021, Autoren: Continuous prophylactic antiviral treatment is recommended for recurrent herpes simplex virus–associated erythema multiforme. Erythema multiforme (EM) is an acute, immune-mediated condition involving the skin and occasionally mucosa which is typically self-limiting. Common medicines to treat erythema multiforme include: Follow your provider’s treatment plan to reduce your symptoms. The most commonly associated infections are herpes simplex virus and Mycoplasma pneumoniae. No documented variation across skin type. The trusted provider of medical information since 1899, Introduction to Hypersensitivity and Reactive Skin Disorders, Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), Reviewed/Revised Apr 2022 | Modified Sep 2022. Soares A, Sokumbi O. Medicina (Kaunas). Help on treatment for Erythema Multiforme Major Less commonly, cases are caused by drugs, vaccines, other bacterial or viral diseases (especially hepatitis C), or possibly systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. doi:10.1007/s12016-017-8667-7. 2019;81(3):813–22. Zoghaib S, Kechichian E, Souaid K, Soutou B, Helou J, Tomb R. Triggers, clinical manifestations, and management of pediatric erythema multiforme: A systematic review. Copyright © 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Oral lesions include target lesions on the lips and vesicles and erosions on the palate and gingivae. Erythema multiforme - References | BMJ Best Practice US Mucous membrane involvement is rare. Erythema multiforme is an inflammatory reaction, characterized by target or iris skin lesions. Cutaneous lesions resolve without scarring, though hyperpigmentation may persist for several months. Common manifestations may include arthralgias and... read more (SLE). • Use OR to account for alternate terms Erythema multiforme usually occurs as a reaction to an infectious agent such as herpes simplex virus or mycoplasma but may be a reaction to a drug. Erythema multiforme is a mild, self-limited, potentially recurring mucocutaneous inflammatory condition. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. However, treatment of any underlying infection is helpful. Typically presents in a symmetrical distribution of lesions over the dorsal surfaces of the extensor extremities with minimal mucous membrane involvement. But someone else who gets the infection may not get the rash too. J Am Acad Dermatol. Ätiologie Zu den möglichen Auslösern des Erythema exsudativum multiforme gehören: Erythema multiforme is an inflammatory skin disorder characterized by patches of red, raised skin that often look like targets and usually are distributed symmetrically over the body. Depending on the severity, you may need to be treated in the hospital. They often develop pale rings inside the patches and purple centers (called “target” or “iris” lesions) and small blisters. o [ “pediatric abdominal pain” ] http://www.ncbi.nlm.nih.gov/pubmed/29352387?tool=bestpractice.com Some medicines that can cause a reaction are: No, the rash can't spread from person to person. Man unterscheidet eine Minor- und eine Major-Form. Prodromi der Erkrankung sind die Symptome einer banalen Infektion. Int J Dermatol. o [ “abdominal pain” –pediatric ] Erythema multiforme usually occurs as a reaction to an infectious agent such as herpes simplex virus or mycoplasma but may be a reaction to a drug. Urgent ophthalmologic consultation is recommended for patients with any ocular erythema multiforme involvement. The cause... read more , and dermatitis herpetiformis Dermatitis Herpetiformis Dermatitis herpetiformis is an intensely pruritic, chronic, autoimmune, papulovesicular cutaneous eruption strongly associated with celiac disease. His Potassium usually drops that he needs IV fluids. Sokumbi O, Wetter DA. 1 Reaction. These lesions can come and go unexpectedly and can affect different parts of your body, including your eyes, mouth and genitals. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. 2018;54(1):177–84. In kids, a germ that causes lung infections also can trigger erythema multiforme. Symptoms are expected to self-resolve within 4 weeks from onset (or up to 6 weeks in severe disease). Hug. Clin Rev Allergy Immunol. The most common trigger is the germ that causes cold sores. Oral valaciclovir was administered. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) — dedicated to using leading-edge science to save and improve lives around the world. Eating a soft or liquid diet if lesions in your mouth make eating difficult. However, in unclear cases, skin biopsies and laboratory tests may be helpful in excluding other diagnoses.1 The results of skin biopsies vary based on the timeline of the lesion and the location of the biopsy within the lesion.3,22 Direct immunofluorescence can help differentiate between erythema multiforme and autoimmune blistering diseases, such as bullous pemphigoid.1, The differential diagnosis includes many conditions, such as pityriasis rosea, urticaria, viral exanthema, fixed drug eruption, bullous pemphigoid, SJS, polymorphous light eruption, paraneoplastic pemphigus, and hypersensitivity reactions1,3,10,34 (Table 21,8,35–37 ). If you have frequent flare-ups, talk to your provider about ways to reduce the frequency of your flares. Episodes can be isolated, recurrent, or persistent. All rights reserved. Dr Areta Kowal-Vern would like to gratefully acknowledge Dr Jonathan Silverberg and Dr Nanette Silverberg, the previous contributors to this topic. Most authors believe that EM is a . These patches often look like "targets" (dark circles with purple-grey centers). Your provider will also diagnose erythema multiforme based on characteristics of your lesions that include: Your provider may need to perform a skin biopsy to diagnose erythema multiforme. Atypical lesions may only have two zones of color and may have poorly defined borders1,25 (Figure 4). It is one of the most common reasons people see doctors who specialize in skin disorders (dermatologists). In recurrent or persistent erythema multiforme without a clear precipitant, consider work up for solid organ or haematological malignancies. Erythema Multiforme: Recognition and Management - PubMed Erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis are immune-mediated epidermal conditions with variable clinical presentations. They do seem to be more noticeable on the fingers and toes. Patients with widely disseminated purpuric macules and blisters and prominent involvement of the trunk and face are likely to have Stevens-Johnson syndrome Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous hypersensitivity reactions. These patches often look like "targets" (dark circles with purple-grey centers). Lesions are initially found symmetrically on the extremities, especially on extensor surfaces. For years, erythema multiforme was thought to represent the milder end of a spectrum of drug hypersensitivity disorders that included Stevens-Johnson syndrome Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous hypersensitivity reactions. Erythema multiforme: Pictures, causes, treatment, and more Talk to your provider about your symptoms, especially if they happen frequently and prevent you from participating in activities in your day-to-day life so they can help you feel better. Some spots can have a small blister or scab in the middle. Copyright © 2019 by the American Academy of Family Physicians. o [ “abdominal pain” –pediatric ] This rash can start small but can increase in size over time. Diagnosis of erythema multiforme is by clinical appearance; biopsy is rarely necessary. Topics A–Z Common severe infections include encephalitis... read more. Distance between each lesion (distribution). Erythema multiforme - DermNet The disease is characterized clinically by target lesions, which can be described as annular erythematous . However, if a person develops a more severe form of erythema multiforme (erythema multiforme major), the condition can become fatal. Drugs, especially sulfa drugs, antiseizure drugs, and antibiotics, are the most common... read more , but it is now considered a different entity. Classic ‘target’ lesions present as concentric rings of colour variation which develop symmetrically in an acral distribution, with or without involvement of mucous membranes. Erythema multiforme is usually triggered by herpes simplex virus (HSV) but can be caused by a drug. Differential diagnosis includes urticaria Urticaria Urticaria consists of migratory, well-circumscribed, erythematous, pruritic plaques on the skin. Hepatitis can be Acute (short-lived) read more ), and certain noninfectious diseases that affect the immune system, such as systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Herpes simplex virus (HSV) infection Herpes Simplex Virus (HSV) Infections Herpes simplex viruses (human herpesviruses types 1 and 2) commonly cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Eye sensitivity, blurred vision, sore eyes and. Erythema Multiforme: Treatment and Symptoms - Healthline Erythema multiforme (air-uh-THEE-muh mul-teh-FOR-mee) starts with pink or red blotches. Erythema multiforme is self-limiting with little to no ongoing complication in most patients. If you have any concerns with your skin or its treatment, see a dermatologist for advice. 2019;33(5):842–9. All Rights Reserved. J Eur Acad Dermatol Venereol. Erythema multiforme (EM) is an acute, immune-mediated condition characterized by the appearance of distinctive, target-like lesions on the skin. Mild symptoms of an upper respiratory infection, including low-grade fever, can sometimes be noted prior to and at the start of an episode. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. 2018 Feb;54(1):177-84. http://www.ncbi.nlm.nih.gov/pubmed/29352387?tool=bestpractice.com.
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