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Erythema Multiforme
Erythema Multiforme
Lyell's syndrome; Stevens-Johnson syndrome; Erythema multiforme minor; Erythema multiforme major
Barbiturates
Penicillins
Phenytoin
Sulfonamides
Infections include:
Herpes simplex
Mycoplasma
The exact cause is unknown. The disorder is believed to involve damage to the blood vessels of the skin, followed
by damage to skin tissues.
Erythema multiforme minor is not very serious. Most erythema multiforme is caused by herpes simplex
or mycoplasma infections.
Erythema multiforme major is more severe, and is known as Stevens-Johnson syndrome. The more
severe form is usually caused by reactions to medications, rather than infections.
Symptoms
Fever
General ill feeling
Itching of the skin
Joint aches
Multiple skin lesions:
May spread
Central sore surrounded by pale red rings, also called a "target", "iris", or "bulls-eye"
Bloodshot eyes
Dry eyes
Vision problems
Nikolsky's sign
Skin lesion biopsy and microscopic examination of the tissue
Treatment
Treatment goals include:
Preventing infection
Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and
drinking
Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson
syndrome, and toxic epidermal necrolysis
Intravenous immunoglobulins (IVIG) to stop the disease process
Practicing good hygiene and staying away from other people may help prevent secondary infections.
Skin grafting may be helpful in cases in which large areas of the body are affected.
Expectations (prognosis)
Mild forms of erythema multiforme usually get better in 2 - 6 weeks, but they may return. More severe forms may
be difficult to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis have high death rates.
Complications
Body-wide infection, sepsis
Loss of body fluids, shock