erythema multiforme

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Erythema Multiforme



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


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.


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


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.


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.



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.


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.

er·y·the·ma mul·ti·for·me

an acute eruption of macules, papules, or subepidermal vesicles presenting a multiform appearance, the characteristic lesion being the target or iris lesion over the dorsal aspect of the hands and forearms; its origin may be allergic, including drug sensitivity, or it may be caused by herpes simplex infection; the eruption, although usually self-limited (for example, multiforme minor), may be recurrent or may run a severe course, sometimes with fatal termination (for example, multiforme major or Stevens-Johnson syndrome).

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.
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Erythema multiforme

er·y·the·ma mul·ti·for·me

(er'i-thē'mă mŭl-ti-fōr'mē)
An acute eruption of macules, papules, or subdermal vesicles presenting a multiform appearance, the characteristic lesion being the target or iris form of lesion over the dorsal aspect of the hands and forearms; its origin may be allergic, seasonal, or from drug sensitivity, and the eruption, although usually self limited, may be recurrent or may run a severe course, sometimes with fatal termination (Stevens-Johnson syndrome).
Synonym(s): herpes iris (2) .
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erythema multiforme

Abbreviation: EM
A rash usually caused by an immune response to drugs or to an infection, esp. herpes simplex virus. It may express itself on the skin in multiform ways, including macules, papules, blisters, hives, and, characteristically, iris or target lesions. It may involve the palms and soles, the mucous membranes, the face, and the extremities. The disease is usually self-limited. The most severe (and occasionally fatal) variant of the illness, in which the eyes, mouth, and internal organs are involved, is called Stevens-Johnson syndrome, or toxic epidermal necrolysis. Synonym: Hebra disease (1.) See: illustration
See also: erythema

erythema multiforme

A hypersensitivity disorder featuring red, raised skin eruptions of various sizes and shapes (‘multiforme’) occurring symmetrically on the face, neck, forearms, backs of the hands, and legs. It is associated with drug and other allergies, many infections and pregnancy.


Ferdinand von, Austrian dermatologist, 1816-1880.
Hebra disease - an acute eruption of macules, papules, or subdermal vesicles presenting a multiform appearance. Synonym(s): erythema multiforme; familial nonhemolytic jaundice
Hebra prurigo - a severe form of chronic dermatitis with secondary infection. Synonym(s): prurigo agria; prurigo ferox

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.
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Erythema multiforme (EM).

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.


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.
References in periodicals archive ?
Erythema multiforme associated with prophylactic use of phenytoin during cranial radiation therapy.
Ayangco L, Rogers RS 3rd: Oral manifestations of erythema multiforme.
In the largest review of this issue in the medical literature (12) only one case of a severe form of erythema multiforme was found in a series of 289 patients treated with radiotherapy and using anti-epileptic drugs (AEDs) prophylaxis.
Erythema multiforme is a skin condition that is likely the result of a T-cell mediated immune reaction after an antecedent herpes simplex infection or drug exposure (antibiotics, barbiturates).
1% of patients on etravirine, including Stevens-Johnson syndrome, hypersensitivity reactions, and erythema multiforme.
Erythema multiforme (EM) may appear as symmetric erythematous target or irislike papules and vesicobullous eruptions that present on the extremities and palmoplantar surfaces within days of starting drug therapy (Photo 1, page 104).
Imatinib rarely may cause bullous dermatologic reactions, including erythema multiforme and Stephens-Johnson syndrome.
Key Words: Mycoplasma pneumoniae, Stevens Johnson syndrome, atypical pneumonia, erythema multiforme
The target lesions that form in pemphigoid gestationis look just like the target lesions of erythema multiforme.
In a group of 933 children and adolescents exposed to the drug during trials, there were 12 cases that could have been definite erythema multiforme (EM) or SJS, early prodromal EM or SJS, or suggestive of prodromal EM or SJS--a rate of 1.