Erythema multiforme is a skin condition in which sudden red lesions occurs on face and extremities. It shows skin rash with limited mucosal involvement. 

Papules become target or iris lesions starting on extremities in 72 hours. Lesions stay in spot for 7 days before healing starts. 

It may recur frequently due to possible connection with recurrent HSV infections. Erythema multiforme major is a severe, life-threatening disorder with mucous membrane involvement and epidermal detachment possible. 

Erythema Multiforme minor is immune-mediated disorder from hypersensitivity to viral infections. Skin lesions on extremities, face, and minimal mucosal involvement. Self-limited disease usually resolves in weeks without complications. 

Symptoms of pemphigus vulgaris include blisters, erosions, and involvement of various body parts. 

Incidence of EM in United States is unknown, still up to 1% dermatologic outpatient visits for erythema multiforme.  

It has a global frequency of 1.2 to 6 cases per million. Female predominance of disease shifted to HIV epidemic among young males. 

Certain medical conditions increase susceptibility to disorder development. Persons with brain tumors have higher risk during treatments. 

Erythema multiforme’s pathophysiology is not fully understood but it involves an immunologically mediated hypersensitivity reaction triggered due to various stimuli. 

CD8 T lymphocytes and macrophages infiltrate the epidermis in the early stages of cell-mediated immunity. 

Immunologically active cells do not directly cause epithelial cell death, but release cytokines that mediate inflammation and apoptosis.
HLA-B12 increases risk of disorder development. Immune reaction occurs 9 to 14 days post drug exposure. 

Causes of EM are: 

• Herpes Simplex Virus 
• Mycoplasma pneumoniae 
• Vaccines 
• Autoimmune Conditions 
• Systemic Diseases 
• Radiation 

Erythema multiforme cases are self-limited. Lesions in minor type resolve in 2-3 weeks without scarring. 

EM major type has mortality under 5% correlates with total body surface area sloughed. 

Skin lesions heal with hyperpigmentation and hypopigmentation. Scarring rare unless infected. 

Old age, organ involvement, high urea, and prior transplant are considered as poor outcomes. 

To assess erythema multiforme information includes recent symptoms, history of herpes simplex infection and skin examination of patient. 

• Skin lesion assessment  
• Mucosal lesion assessment  

Acute symptoms are: 

• Fever, malaise, rash, and upper respiratory symptoms 

The treatment focuses on symptomatic relief with antihistamines, analgesics, skincare, and mouthwashes. 

Identify the cause of erythema multiforme, withdraw suspected drug promptly for treatment. 

Treatment for infections should follow culture or serologic tests. Liquid antiseptics are used to prevent superinfection.  

Topical treatments for genital infections include gauze or hydrocolloid dressings. 

Eye care involves lubricants, sweeping fornices, and remove adhesions for local support and treatment. 

Erythema multiforme mild cases treated with symptomatic methods in emergency department. 

Prehospital personnel may need to aggressively treat respiratory complications and fluid imbalances in severe erythema multiforme major. 

Aggressive fluid and electrolyte monitoring is essential. Provide respiratory support with suctioning and drainage. 

Dermatology, General

Maintain the environment cool and humidified to reduce discomfort.  

Patients should avoid direct sunlight because UV exposure aggravate skin lesions. 

Use a soft-bristled toothbrush and non-irritating toothpaste to maintain oral hygiene. 

Practice good cleaning hygiene to avoid contact with source of infection to reduce future episodes. 

Proper awareness about EM should be provided and its related causes with management strategies. 

Appointments with a dermatology and preventing recurrence of disorder is an ongoing life-long effort. 

Dermatology, General

Acyclovir: 

It reduces the duration of symptomatic erythema multiforme lesions.  

Patients may experience less pain and faster resolution of cutaneous lesions. 

Valacyclovir: 

It produces greater serum concentrations of acyclovir with smaller oral dose. 

Dermatology, General

Skin biopsy is the common procedure performed in patients with Erythema Multiforme. It is primarily done to confirm the diagnosis, when the clinical presentation. 

Dermatology, General

In the initial diagnosis phase, evaluation of medical history and clinical assessment of severity to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of antiviral agents. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the dermatologist are scheduled to check the improvement of patients along with treatment response.