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Erythema multiforme

Show Alternative Names
EM
Erythema multiforme minor
Erythema multiforme major
Erythema multiforme minor - erythema multiforme von Hebra
Acute bullous disorder - erythema multiforme
Herpes simplex - erythema multiforme

Erythema multiforme (EM) is an acute skin reaction that comes from an infection or another trigger. EM is a self-limiting disease. This means it usually resolves on its own without treatment.

Causes

EM is a type of allergic reaction. In most cases, it occurs in response to an infection. In rare cases, it is caused by certain medicines or body-wide (systemic) illness.

Infections that may lead to EM include:

  • Viruses, such as herpes simplex that cause cold sores and genital herpes (most common)
  • Bacteria, such as Mycoplasma pneumoniaethat cause lung infection
  • Funguses, such as Histoplasma capsulatum, that cause histoplasmosis

Medicines that may cause EM include:

  • NSAIDs
  • Allopurinol (treats gout)
  • Certain antibiotics, such as sulfonamides and aminopenicillins
  • Anti-seizure medicines

Systemic illnesses that are associated with EM include:

EM occurs mostly in adults 20 to 40 years old. People with EM may have family members who have had EM as well.

Symptoms

Symptoms of EM include:

Skin sores may:

  • Start quickly
  • Come back
  • Spread
  • Be raised or discolored
  • Look like hives
  • Have a central sore surrounded by pale red rings, also called a target, iris, or bulls-eye
  • Have liquid-filled bumps or blisters of various sizes
  • Be located on the upper body, legs, arms, palms, hands, or feet
  • Include the face or lips
  • Appear evenly on both sides of the body (symmetrical)

Other symptoms may include:

There are two forms of EM:

  • EM minor usually involves the skin and sometimes mouth sores.
  • EM major often starts with a fever and joint aches. Besides the skin sores and mouth sores, there may be sores in the eyes, genitals, lung airways, or gut.

Exams and Tests

Your health care provider will look at your skin to diagnose EM. You'll be asked about your medical history, such as recent infections or medicines you've taken.

Tests may include:

  • Skin lesion biopsy
  • Examination of skin tissue under a microscope

Treatment

EM usually goes away on its own with or without treatment.

Your provider will have you stop taking any medicines that may be causing the problem. But, don't stop taking medicines on your own without talking to your provider first.

Treatment may include:

  • Medicines, such as antihistamines, to control itching
  • Moist compresses applied to the skin
  • Pain medicines to reduce fever and discomfort
  • Mouthwashes to ease discomfort of mouth sores that interferes with eating and drinking
  • Antibiotics for skin infections
  • Corticosteroids to control inflammation
  • Medicines for eye symptoms

Good hygiene may help prevent secondary infections (infections that occur from treating the first infection).

Use of sunscreen, protective clothing, and avoiding excessive exposure to sun may prevent the recurrence of EM.

Outlook (Prognosis)

Mild forms of EM usually get better in 2 to 6 weeks, but the problem may return.

Possible Complications

Complications of EM may include:

  • Patchy skin color
  • Return of EM, especially with HSV infection

When to Contact a Medical Professional

Call your provider right away if you have symptoms of EM.

Text only

Review Date: 11/10/2020

Reviewed By

Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

References

Duvic M. Urticaria, drug hypersensitivity rashes, nodules and tumors, and atrophic diseases. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 411.

Holland KE, Soung PJ. Acquired rashes in the older child. In: Kleigman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 48.

Rubenstein JB, Spektor T. Conjunctivitis: infectious and noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 4.6.

Shah KN. Urticaria and erythema multiforme. In: Long SS, Prober CG, Fischer M, eds. Principles and Practice of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 72.

Disclaimer

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Images
Erythema multiforme on the hands - Illustration Thumbnail

Erythema multiforme on the hands

Erythema multiforme on the hands. These lesions are circular and may appear in concentric rings (often called target lesions). They may be associated with other medical conditions such as infections or medications. Cold sores (herpes simplex on the lips) is often associated with this condition.

Illustration

Erythema multiforme, circular lesions - hands - Illustration Thumbnail

Erythema multiforme, circular lesions - hands

Erythema multiforme lesions are circular and may appear in concentric rings (often called target lesions). Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.

Illustration

Erythema multiforme, target lesions on the palm - Illustration Thumbnail

Erythema multiforme, target lesions on the palm

Erythema multiforme lesions are often referred to as target lesions because of the concentric rings the lesions produce. The "target" appearance is well demonstrated in this photograph.

Illustration

Erythema multiforme on the leg - Illustration Thumbnail

Erythema multiforme on the leg

The red spots on this person's back appear where blisters (bullae) caused by Erythema multiforme have ruptured and the overlying skin removed (denuded). The resulting lesions are yellow-crusted ulcers (erosions). Erythema multiforme may be associated with herpes simplex infection, mycoplasma pneumonia, or other medical conditions such as streptococcal infection, tuberculosis (TB), or may result from exposure to chemicals or medications.

Illustration

Erythema multiforme on the hand - Illustration Thumbnail

Erythema multiforme on the hand

This individual has erythema multiforme minor, with "target" lesions on his hands. His condition may result from a recurrent herpes simplex virus infection on the lip.

Illustration

Exfoliation following erythroderma - Illustration Thumbnail

Exfoliation following erythroderma

This picture shows diffuse redness (erythema) and scaling on the arm.

Illustration

Erythema multiforme on the hands - Illustration Thumbnail

Erythema multiforme on the hands

Erythema multiforme on the hands. These lesions are circular and may appear in concentric rings (often called target lesions). They may be associated with other medical conditions such as infections or medications. Cold sores (herpes simplex on the lips) is often associated with this condition.

Illustration

Erythema multiforme, circular lesions - hands - Illustration Thumbnail

Erythema multiforme, circular lesions - hands

Erythema multiforme lesions are circular and may appear in concentric rings (often called target lesions). Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.

Illustration

Erythema multiforme, target lesions on the palm - Illustration Thumbnail

Erythema multiforme, target lesions on the palm

Erythema multiforme lesions are often referred to as target lesions because of the concentric rings the lesions produce. The "target" appearance is well demonstrated in this photograph.

Illustration

Erythema multiforme on the leg - Illustration Thumbnail

Erythema multiforme on the leg

The red spots on this person's back appear where blisters (bullae) caused by Erythema multiforme have ruptured and the overlying skin removed (denuded). The resulting lesions are yellow-crusted ulcers (erosions). Erythema multiforme may be associated with herpes simplex infection, mycoplasma pneumonia, or other medical conditions such as streptococcal infection, tuberculosis (TB), or may result from exposure to chemicals or medications.

Illustration

Erythema multiforme on the hand - Illustration Thumbnail

Erythema multiforme on the hand

This individual has erythema multiforme minor, with "target" lesions on his hands. His condition may result from a recurrent herpes simplex virus infection on the lip.

Illustration

Exfoliation following erythroderma - Illustration Thumbnail

Exfoliation following erythroderma

This picture shows diffuse redness (erythema) and scaling on the arm.

Illustration

 
 
 
 

 

 
 

 
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