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Erythema multiforme

Erythema multiforme is a short-lasting skin condition that occurs as a reaction to an infection or medication. Erythema multiforme mostly affects young adults but may occur in children or older people. It causes a characteristic rash and often blisters in the mouth and elsewhere. It is sometimes called erythema multiforme minor to distinguish it from a related but more serious condition, Stevens Johnson syndrome, which is sometimes known as erythema multiforme major.

The patient with erythema multiforme may be mildly unwell, but recovers in a few days or up to three weeks. The rash may recur from time to time.

What does it look like?

Erythema multiforme results in irritable round skin lesions mainly on the forearms, hands and less often, knees and feet. Few or hundreds of lesions appear over 2 to 3 days. Some lesions favour scratched or injured skin.

Some of the skin patches appear like a target, i.e. three rings of red, white and pink. Often the centre of the patch forms a fluid-filled blister that crusts over within a few days. Often, the rash is accompanied by sores and blisters on the lips.

Erythema multiforme

What is the cause of erythema multiforme?

The usual precipitating factor causing erythema multiforme is a viral infection a few days earlier, especially herpes simplex (cold sores) or orf. Immunisations have also occasionally been reported to cause erythema multiforme.

When herpes simplex virus is the cause the condition tends to recur with every bout of cold sores. The viral infection may be subclinical, i.e. visible cold sores may be absent at the time of the reaction.

Erythema multiforme should be distinguished from urticaria, in which target-shaped lesions may also arise. However individual urticarial plaques never blister, and resolve within 24 hours.

Treatment

Mild cases do not require specific treatment. The following may be helpful if symptoms are troublesome:

• Oral antihistamines
• Topical corticosteroids
• Oral aciclovir longterm to prevent recurrences