erythema multiforme

Erythema Multiforme 

Definition

Erythema multiforme is a skin disease that causes lesions and redness around the lesions.

Description

Erythema multiforme appears on the skin and the mucous membranes (the lining of the mouth, digestive tract, vagina, and other organs). Large, symmetrical red blotches appear all over the skin in a circular pattern. On mucous membranes, it begins as blisters and progresses to ulcers. A more advanced form, called Stevens-Johnson syndrome, can be severe and even fatal.

Causes and symptoms

Erythema multiforme has many causes, most commonly are drugs. Penicillin, sulfonamides, certain epilepsy drugs, aspirin, and acetaminophen are the most likely medication-induced causes. Erythema multiforme can also be caused by certain diseases. Herpes virus and mycoplasma pneumonia are likely infectious causes.

Diagnosis

The appearance of the rash is sufficiently unique to identify it on sight. Having identified it, the physician will determine the underlying cause.

Treatment

Erythema multiforme is inadvertently treated when the causative agent, whether it be a drug or a disease, is treated. In severe cases, cortisone-like medication is often used along with general supportive measures and prevention of infection.

Prognosis

As a rule, the rash abates by itself without damaging the skin. Only in the case of infection, severe blistering, or continued use of an offending drug does complications occur.

Resources

Books

Fauci, Anthony S., et al., editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1997.

Key terms

Herpes virus — Viruses that can infect the skin, mucous membranes, and brain, and they are responsible for such diseases as herpes simplex, chicken pox, and shingles.

Mycoplasma pneumonia — An incomplete bacterium that infects the lung.

---

erythema /er·y·the·ma/ (er″ĭ-the´mah) redness of the skin due to congestion of the capillaries.erythem´atouserythe´mic

---

erythema annula´re  a type of erythema multiforme with ring-shaped lesions.

erythema annula´re centri´fugum  a chronic variant of erythema multiforme usually affecting the thighs and lower legs, with single or multiple erythematous-edematous papules that enlarge peripherally and clear in the center to produce annular lesions that may coalesce.

erythema chro´nicum mi´grans  an annular erythema due to the bite of a tick (Ixodes); it begins as an erythematous plaque several weeks after the bite and spreads peripherally with central clearing. See also Lyme disease, under disease.

cold erythema  a congenital hypersensitivity to cold seen in children, characterized by localized pain, widespread erythema, occasional muscle spasms, and vascular collapse on exposure to cold, and vomiting after drinking cold liquids.

epidemic arthritic erythema  Haverhill fever.

erythema indura´tum  chronic necrotizing vasculitis, usually occurring on the calves of young women; its association with tuberculosis is in dispute.

erythema infectio´sum  a mildly contagious, sometimes epidemic, disease of children between the ages of four and twelve, marked by a rose-colored, coarsely lacelike macular rash and caused by human parvovirus B19.

erythema i´ris  a type of erythema multiforme in which the lesions form concentric rings, producing a target-like appearance.

erythema margina´tum  a type of erythema multiforme in which the reddened areas are disk-shaped with elevated edges.

erythema mi´grans 

1. benign migratory glossitis.

2. e. chronicum migrans.

erythema multifor´me  a symptom complex with highly polymorphic skin lesions, including macular papules, vesicles, and bullae; attacks are usually self-limited but recurrences are the rule.

erythema nodo´sum  an acute inflammatory skin disease marked by tender red nodules, usually on the shins, due to exudation of blood and serum.

erythema nodo´sum lepro´sum  a form of lepra reaction occurring in lepromatous and sometimes borderline leprosy, marked by the occurrence of tender, inflamed subcutaneous nodules; the reactions resemble multifocal Arthus reactions.

toxic erythema , erythema tox´icum a generalized erythematous or erythematomacular eruption due to administration of a drug or to bacterial toxins or other toxic substances.

erythema tox´icum neonato´rum  a self-limited urticarial condition affecting infants in the first few days of life.

---

erythema mul·ti·for·me (mlt-fôrm)

n.

A skin disease associated with allergies, seasonal changes, or drug sensitivities, and characterized by the acute eruption of red macules, papules, or subdermal vesicles on the skin and mucous membranes; the characteristic lesion consists of a papule surrounded by a concentric ring. Also called herpes iris.

---

erythema multiforme (EM)

[mul′tifôr′mē, moo͡l′tēfôr′mā]

any of three major clinical syndromes characterized by lymphocytic infiltrates in the skin that cause keratinocyte necrosis. The patient may experience polymorphous eruption of skin and mucous membranes. Macules, papules, nodules, vesicles or bullae, and target (bullseye-shaped) lesions are seen. The three major classifications of erythema multiforme are EM minor, EM major, and pure plaque toxic epidermal necrosis. EM minor is an acute form of the disease, characterized by three-ring target lesions on the extremities. Symptoms often follow an infection of herpes simplex. The patient may have raised lesions but no fever and no blistering. EM major, also called Stevens-Johnson syndrome , is characterized by the presence of target lesions, blistering, and detachment of the skin and mucous membranes. EM major also tends to follow herpes simplex virus infections. Plaque toxic epidermal necrolysis may not be associated with target lesions. However, the condition is associated with detachment of large sheets of skin. It is generally drug induced. Definitive and preventive treatment depends on finding the specific cause. Use of topical or systemic corticosteroids is helpful in most cases.

---

erythema [er″ĭ-the´mah]

redness of the skin caused by congestion of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation.

erythema chro´nicum mi´grans a ring-shaped erythema due to the bite of a tick of the genus Ixodes; it begins as an erythematous plaque several weeks after the bite and spreads peripherally with central clearing. Often there are also systemic symptoms, including chills, fever, headache, vomiting, backache, and stiff neck. See also lyme disease.

gyrate erythema (erythema gyra´tum) erythema multiforme characterized by the development of lesions that tend to migrate and spread peripherally with central clearing.

erythema ab ig´ne permanent erythema produced by prolonged exposure to excessive nonburning heat. It is seen most often on the legs of women, but under appropriate environmental circumstances, it can occur anywhere on the body in either sex.

erythema indura´tum a chronic necrotizing vasculitis, usually occurring on the calves of young women; see also bazin's disease.

erythema infectio´sum a mild, self-limiting disease of childhood characterized by a lacelike skin rash symmetrically distributed on the hands, arms, and legs, with few or no other symptoms; occasionally there is a low grade fever, and the condition often clears up without specific treatment. The incubation period is six days to two weeks. This disease is contagious and originally was believed to be a form of rubella; because the rash can resemble that of scarlet fever and German measles, it is important to differentiate this mild condition from those more serious ones. Called also fifth disease.

erythema margina´tum a type of erythema multiforme in which the reddened areas are disk-shaped, with elevated edges.

erythema margina´tum rheuma´ticum a superficial, often asymptomatic, form of gyrate erythema associated with some cases of rheumatic fever, which is characterized by the presence on the trunk and extensor surfaces of the extremities of a transient eruption of flat to slightly indurated, nonscaling, and usually multiple lesions.

erythema mi´grans geographic tongue.

erythema multifor´me a symptom complex representing a reaction of the skin and mucous membranes secondary to various known, suspected, and unknown factors, including infections, ingestants, physical agents, malignancy, and pregnancy. The conditions in the complex are characterized by the sudden onset of a reddened macular, bullous, papular, or vesicular eruption, the characteristic lesion being the iris, bull's eye, or target lesion, which consists of a central papule with two or more concentric rings. The complex includes a mild self-limited mucocutaneous form (erythema multiforme minor) and a severe, sometimes fatal, multisystem form (stevens-johnson syndrome).

erythema nodo´sum a type of panniculitis occurring usually as a hypersensitivity reaction to multiple provoking agents, including various infections, drugs, sarcoidosis, and certain enteropathies. It may also be of idiopathic origin. It most often affects young women and is characterized by the development of crops of transient, inflammatory, nonulcerating nodules that are usually tender, multiple, and bilateral, and most commonly located on the shins; the lesions involute slowly, leaving bruiselike patches without scarring. The acute disease is often associated with fever, malaise, and arthralgias. A chronic variant sometimes occurs without any serious associated systemic disease.

toxic erythema (erythema tox´icum) a generalized erythematous or erythematomacular eruption due to administration of a drug or to bacterial or other toxins or associated with various systemic diseases.

erythema tox´icum neonato´rum a benign, idiopathic, very common, generalized, transient eruption occurring in infants during the first week of life, usually consisting of small papules or pustules that become sterile, yellow-white, firm vesicles surrounded by an erythematous halo and some edema.

---

erythema multiforme (EM) (erˈ··thēˑ·m mulˑ·tē·fōrm),

n a skin condition marked by vesicular or papular lesions and discoloration or reddening of the affected area, caused by hypersensitivity reaction to a variety of drugs or viruses.

Erythema multiforme (EM).

---

erythema

redness of the skin caused by congestion of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection or inflammation.

---

erythema ab igne

that due to exposure to radiant heat.

erythema chronicum migrans

the early skin rash at the site of the tick bite which infects humans with Borellia burgdorferi (Lyme disease); rarely seen in dogs.

erythema multiforme

a disease of unknown etiology, but is sometimes drug-related; presumed to be immune-mediated. It occurs in all species and is characterized by an acute onset of erythematous macules, papules, vesicles or bullae. There may also be fever, depression and anorexia.

erythema multiforme major

a rapidly fulminating, ulcerative form of erythema multiforme with involvement of oral mucosa and systemic signs.

necrolytic migratory erythema

in humans, a skin disease associated with glucagon-secreting tumors of the pancreas. The same association has not been observed in dogs, but disease of the liver and pancreas is often present. There are vesicles and crusted, ulcerated lesions, mainly on the face, mucocutaneous areas, distal limbs and feet.

erythema nodosum

a rare disorder in dogs characterized by fever, depression, arthralgia and septal panniculitis.

toxic erythema, erythema toxicum

a generalized erythematous or erythematomacular eruption due to administration of a drug or to bacterial toxins or other toxic substances.

---

erythema multiforme

A mucocutaneous disease that occurs as a hypersensitivity to drugs (e.g. sulfonamides) or as a consequence of infection. The condition, which principally affects young people, is characterized by the sudden appearance of various erosions of the mucous membranes and epidermis. A common complication is conjunctivitis, which may become severe with cicatrization, abnormal lid margin function, symblepharon, corneal ulceration and vascularization and keratoconjunctivitis sicca. The patient complains of pain, discharge, photophobia and reduced vision if the cornea is involved. Treatment includes cleansing of the eyelids with antibiotic ointment and, if severe, topical steroids. Syn. Stevens-Johnson syndrome (although this term applies to the severe form of the disease). See Stevens-Johnson syndrome.