Erythema multiforme

ICD-10 | L51
DiseasesDB | 4450
MedlinePlus | 000851
eMedicine | derm/137

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Charmaine Patel, M.D. [2] Kiran Singh, M.D. [3]

## Contents

* 1 Overview
* 1.1 Common Causes
* 2 Causes
* 2.1 Causes by Organ System
* 2.2 Causes in Alphabetical Order
* 3 Diagnosis
* 3.1 History and Symptoms
* 3.2 Physical Examination
* 3.2.1 Skin
* 3.2.1.1 Extremities
* 3.2.1.2 Trunk
* 3.2.1.3 Neck
* 3.2.1.4 Face
* 3.3 Laboratory Findings
* 4 References

## Overview

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Erythema multiforme is a skin condition of unknown etiology, but some authors suggest that the disease is mediated by deposition of immune complex (mostly IgM) in the superficial microvasculature of the skin and oral mucous membrane. It can occur due to drug exposure,as well in association with some types of infections. It varies from a mild, self-limited rash (E. multiforme minor) to a severe, life-threatening form (E. multiforme major, or Stevens-Johnson syndrome) that also involves mucous membranes.

### Common Causes

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E. multiforme may also be caused by drug reactions, most commonly sulfa drugs, Hydrochlorothiazide, phenytoin, barbiturates, penicillin, and allopurinol, Ethynodiol diacetate and ethinyl estradiol, or a host of internal ailments. The most common predisposing infection for E. multiforme is Herpes simplex, but bacterial infections (commonly Mycoplasma) and fungal diseases are also implicated.

## Causes

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### Causes by Organ System

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Cardiovascular | No underlying causes

|

Chemical/Poisoning | No underlying causes
Dental | No underlying causes
Dermatologic | No underlying causes
Drug Side Effect | Amifostine, amoxicillin, atovaquone and proguanil hydrochloride, aztreonam, butalbital, cefaclor, cefadroxil, cefotaxime sodium, ceftazidime, certolizumab pegol, choline magnesium trisalicylate, clomiphene, cytomegalovirus immune globulin, dactinomycin, etravirine, desogestrel and ethinyl Estradiol, ibritumomab tiuxetan, indinavir, isotretinoin, ixabepilone, lincomycin hydrochloride, meropenem, oxaprozin, piperacillin, piperacillin/tazobactam, sulfasalazine, rifampin, tolmetin, trimethadione, valdecoxib.
Ear Nose Throat | No underlying causes
Endocrine | No underlying causes
Environmental | No underlying causes
Gastroenterologic | No underlying causes
Genetic | No underlying causes
Hematologic | No underlying causes
Iatrogenic | No underlying causes
Infectious Disease | No underlying causes
Musculoskeletal/Orthopedic | No underlying causes
Neurologic | No underlying causes
Nutritional/Metabolic | No underlying causes
Obstetric/Gynecologic | No underlying causes
Oncologic | No underlying causes
Ophthalmologic | No underlying causes
Overdose/Toxicity | No underlying causes
Psychiatric | No underlying causes
Pulmonary | No underlying causes
Renal/Electrolyte | No underlying causes
Rheumatology/Immunology/Allergy | No underlying causes
Sexual | No underlying causes
Trauma | No underlying causes
Urologic | No underlying causes
Miscellaneous | No underlying causes

### Causes in Alphabetical Order

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* Amoxicillin
* Aztreonam
* Cefadroxil
* Ceftazidime
* Certolizumab pegol
* Choline Magnesium Trisalicylate
* Cytomegalovirus immune globulin
* Desogestrel and Ethinyl Estradiol
* Indinavir
* Isotretinoin
* Oxaprozin

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|

## Diagnosis

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### History and Symptoms

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The skin form of E. multiforme, far more common than the severe form, usually presents with mildly itchy, pink-red blotches, symmetrically arranged and starting on the extremities. It often takes on the classical "target lesion" appearance, with a pink-red ring around a pale center. Resolution within 7-10 days is the norm.

Erythema multiforme target lesions

* Erythema Multiforme Major

* Erythema Multiforme reaction to an antibiotic

### Physical Examination

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#### Skin

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##### Extremities

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* Erythema multiforme Adapted from Dermatology Atlas.[1]

* Erythema multiforme Adapted from Dermatology Atlas.[1]

* Erythema multiforme Adapted from Dermatology Atlas.[1]

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.[1]

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.[1]

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

##### Trunk

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* Erythema multiforme Adapted from Dermatology Atlas.[1]

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.

* Erythema multiforme Adapted from Dermatology Atlas.[1]

##### Neck

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* Erythema multiforme Adapted from Dermatology Atlas.[1]

##### Face

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* Erythema multiforme Adapted from Dermatology Atlas.[1]

Image:Erythema multiforme24.jpg| Erythema multiforme Adapted from Dermatology Atlas.[1]</gallery>

</gallery>

### Laboratory Findings

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Laboratory findings are non-specific and can include an elevated erythrocyte sedimentation rate (ESR), elevated white blood cell count (WBC), and elevated liver enzymes.

## References

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1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 "Dermatology Atlas".

* v
* t
* e

Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709)

Infections|

Template:Navbox subgroup

Bullous disorders|

acantholysis (Pemphigus, Transient acantholytic dermatosis) * Pemphigoid (Bullous, Cicatricial, Gestational) * Dermatitis herpetiformis

Inflammatory|

Template:Navbox subgroup

Radiation-related disorders|

Sunburn * actinic rays (Actinic keratosis, Actinic cheilitis) * Polymorphous light eruption (Acne aestivalis) * Radiodermatitis * Erythema ab igne

Pigmentation disorder|

hypopigmentation (Albinism, Vitiligo) * hyperpigmentation (Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans, Acral acanthotic anomaly)

Other skin|

keratosis/hyperkeratosis (Seborrheic keratosis, Callus) * other epidermal thickening (Ichthyosis acquisita, Palmoplantar keratoderma)

skin ulcer (Pyoderma gangrenosum, Bedsore)

Cutaneous Markers of Internal Malignancy (Florid cutaneous papillomatosis, acanthosis nigricans, sign of Leser-Trelat)

atrophic (Lichen sclerosus, Acrodermatitis chronica atrophicans)

necrobiosis (Granuloma annulare, Necrobiosis lipoidica) * other granuloma (Granuloma faciale, Pyogenic granuloma)

cutaneous vasculitis (Livedoid vasculitis, Erythema elevatum diutinum)

Connective tissues|

collagen disease: Keloid
localized connective tissue disorders: Lupus erythematosus (Discoid lupus erythematosus, Subacute cutaneous lupus erythematosus) * Scleroderma/Morphea * Linear scleroderma * Calcinosis cutis * Sclerodactyly * Ainhum

see also congenital, neoplasia

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