DEFINITION--An acute inflammatory disorder of the skin and mucous membranes
(thin moist tissues that line body cavities). In the majority of cases, it is a
self-limited, benign disorder, but can be potentially severe. The severe form of the
disorder is known as Stevens-Johnson syndrome or erythema multiforme major; the less
severe form is referred to as erythema multiforme minor.
BODY PARTS INVOLVED--Skin and mucous membranes.
SEX OR AGE MOST AFFECTED--Men more than women; adults age 20-40; rare under age
3 or over age 50.
SIGNS & SYMPTOMS
- Rash spots that are red and symmetrical in shape, frequently appearing as concentric
rings like bull's-eyes.
- Rash usually appears on palms, soles, other areas of arms and legs, may spread to face
and rest of the body.
- Rash is itchy, sometimes painful or has burning sensation.
- Rash develops into blisters, hives or becomes ulcerated.
- In the major form, the mucous membranes of the mouth, eyes and genitals become inflamed.
- Fever; headache; sore throat; diarrhea.
In 50% of the cases, the cause is unknown. Viral infections, particularly the herpes
simplex virus. Bacterial or protozoan infections. Collagen vascular disease. >
Medications, such as: sulfonamides, penicillins, anticonvulsants, salicylates,
barbiturates. The reaction to the drug may not occur until 7-14 days after first using it.
- Malignancy; pregnancy; radiation therapy; premenstrual hormone changes.
RISK INCREASES WITH
- Previous history of erythema multiforme.
- Taking medications that may cause the disorder.
HOW TO PREVENT
- Avoiding suspected causes where feasible.
- Prompt treatment of any illness or infection that may cause erythema multiforme.
- Prevention of herpes simplex virus outbreaks by avoiding sun exposure and reducing
What To Expect
- Medical history and exam by a doctor.
- Skin biopsy (See Glossary).
APPROPRIATE HEALTH CARE
- Self-care after diagnosis for mild cases.
- Doctor's treatment.
- If there is extensive, advanced skin damage present, hospitalization in a special burn
unit for treatment may be required.
- Progression from the minor form to the major form of erythema multiforme.
- Eyes may develop corneal ulcerations, iritis or other serious problems.
- Recurrence of the disorder.
- Serious illness or even death may may result due to shock or inflammation spreading
throughout the body.
PROBABLE OUTCOME--Rash evolves over 1-2 weeks and usually clears up in 2-3
weeks, but may take 5-6 weeks.
How To Treat
- Bed rest, if fever is present.
- Discontinuing any implicated medication.
- Wet dressings and soaks or lotions to soothe the skin.
- Bathing in lukewarm to cool water three times a day for 30 minutes.
- Careful monitoring of any eye involvement to prevent complications.
- If mouth sores are present, good oral hygiene is important to reduce possibility of
infection and to relieve discomfort.
MEDICATION--Your doctor may prescribe:
- Corticosteroids to reduce inflammation and irritation.
- Acyclovir may be prescribed to treat viral infection such as herpes simplex virus.
- Antibacterial medications, if secondary infection present.
- Topical medications or mouthwashes if mouth sores are present, .
- Eyewashes or other topical medications if eyes are involved.
- Pain medications, sedatives or antihistamines to help provide relief of symptoms.
ACTIVITY--As tolerated by your symptoms.
- Usually no special diet is necessary.
- If mouth sores are present, a soft or liquid diet may be better tolerated.
- Increased fluid intake sometimes helpful.
- Intravenous fluids may be required in hospitalized patient.
Call Your Doctor If
- You or a family member has signs or symptoms of erythema multiforme.
- Symptoms worsen during treatment. Complications can be potentially severe.
- New or unexplained symptoms develop.