ERYTHEMA MULTIFORME

General Information

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.

CAUSES

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 stress.

What To Expect

DIAGNOSTIC MEASURES--

• 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.

POSSIBLE COMPLICATIONS

• 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

GENERAL MEASURES--

• 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.

DIET--

• 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.