Erythema multiforme

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Erythema multiforme, circular lesions - hands	Erythema multiforme, target lesions on the palm	Erythema multiforme on the hand	Erythema multiforme on the hands
Erythema multiforme on the leg	Exfoliation following erythroderma

Lyell's syndrome; Stevens-Johnson syndrome; Toxic epidermal necrolysis

Treatment goals include control of the underlying causes or illnesses, treatment of the symptoms, and prevention of infection. Suspected medications should be discontinued.

Treatment of mild symptoms may include:

• Moist compresses applied to skin lesions
• Medications such as antihistamines to control itching
• Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort
• Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking

Treatment of severe symptoms may include:

• Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
• Systemic corticosteroids to control inflammation
• Intravenous immunoglobulins (IVIG) to stop the process
• Antibiotics to control secondary skin infections

Good hygiene and isolation from others may be required to prevent secondary infections.

Extensive skin involvement may cause the loss of large quantities of body fluids, causing shock in addition to the risk of infection. Intensive care with support of body systems may be required.

Skin grafting may be helpful in cases in which large areas of the body are affected.

In cases that are caused by the herpes virus, daily antiviral medications may be prescribed to prevent recurrences of erythema multiforme.

Mild forms of erythema multiforme usually resolve without difficulty in 2 - 6 weeks, but they may recur. More severe forms may be difficult to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis are associated with high death rates.

• Permanent skin damage and scarring
• Occasionally, lesions on internal organs causing:
  • Pneumonitis (lung inflammation)
  • Myocarditis (heart inflammation)
  • Nephritis (kidney inflammation)
  • Hepatitis (liver inflammation)
• Secondary skin infection (cellulitis)
• Systemic infection, sepsis
• Loss of body fluids, shock

Go to the emergency room or call the local emergency number (such as 911) if symptoms indicate erythema multiforme. Involvement of a large area of the body is an emergency situation.

Review Date: 10/16/2006
Reviewed By: Michael S. Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.