Materiały źródłowe

• #1 Erythema Multiforme: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0715/p82.html

  Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Classically described as target-like, the erythema multiforme lesions can be isolated, recurrent, or persistent. Most commonly, the lesions of erythema multiforme present symmetrically on the extremities (especially on extensor surfaces) and spread centripetally. Erythema multiforme is an acute, typically self-limited skin condition with lesions that can be isolated, recurrent, or persistent. Erythema minor affects only the skin and erythema major includes mucocutaneous involvement. Erythema multiforme lesions typically begin as pink or red papules, which can then become plaques. These lesions can cause burning or itching. Over the next three to five days, the lesions transform into a variety of appearances. The classic lesion of erythema multiforme is called the target or iris lesion. It is a round lesion of three concentric segments: a dark center, surrounded by a lighter pink ring, both of which are surrounded by a red ring. Lesions are initially found symmetrically on the extremities, especially on extensor surfaces. The lesions usually spread centripetally but tend to be fewer on patients’ trunks. Mucosal lesions are present in 25% to 60% of patients with erythema multiforme. Prodromal weakness, fever, and malaise are common symptoms in patients with mucosal involvement. When these associated symptoms are present, they usually occur at least one week before skin lesions occur. Mucosal lesions usually begin as edematous, erythematous lesions that may develop into shallow erosions with pseudomembranes. Isolated episodes of erythema multiforme most commonly follow HSV infections by an interval of 10 days and usually resolve within two weeks. However, some episodes of erythema multiforme have been documented to persist for up to five weeks. Patients may experience recurrent erythema multiforme with multiple episodes. A study of 48 patients with recurrent erythema multiforme reported an average of six episodes per year. The mean disease duration was from six to 10 years. Recurrent erythema multiforme may occur because of the reactivation of HSV, even if there are no symptoms of an active HSV outbreak. Persistent erythema multiforme is a rare condition. It has been associated with inflammatory bowel disease, malignancies, and infections, such as HSV, Epstein-Barr virus, cytomegalovirus, hepatitis C, and influenza.

• #2 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Erythema multiforme is an immune-mediated, typically self-limiting, mucocutaneous condition characterised by target lesions. Significant mucosal involvement distinguishes erythema multiforme major from multiforme minor. Episodes can be isolated, recurrent, or persistent. […] Many patients report prodromal symptoms including fatigue, malaise, myalgia, or fever. These likely represent the course of precipitating illness rather than true prodrome. […] Symptoms are expected to self-resolve within 4 weeks from onset (or up to 6 weeks in severe disease). […] Erythema multiforme is self-limiting with little to no ongoing complication in most patients. Recurrent or persistent disease comes with additional treatment challenges, but remission can be achieved.

• #3 Erythema Multiforme Symptoms, Doctors, Treatments, Advances & More | MediFind

  https://www.medifind.com/conditions/erythema-multiforme/1878

  Erythema multiforme (EM) is an acute skin reaction that comes from an infection or another trigger. EM is a self-limiting condition. This means it usually resolves on its own without treatment. […] Symptoms of EM include: Low-grade fever, Headache, Sore throat, Cough, Runny nose, General ill feeling, Itchy skin, Joint aches, Many skin lesions (sores or abnormal areas). […] The skin rash may: Start quickly, Come back, Spread, Be raised or discolored, Look like hives, Have a central sore surrounded by pale red rings, also called a target, iris, or bulls-eye, Have liquid-filled bumps or blisters of various sizes, Be located on the upper body, legs, arms, palms, hands, or feet, Include the face or lips, Appear evenly on both sides of the body (symmetrical). […] There are two forms of EM: EM minor usually involves the skin and sometimes mouth sores. EM major often starts with a fever and joint aches. Besides the skin sores and mouth sores, there may be sores in the eyes, genitals, lung airways, or gut. […] Mild forms of EM usually get better in 2 to 6 weeks, but the problem may return.

• #4 Erythema Multiforme: Treatment, Symptoms, and Causes

  https://www.webmd.com/skin-problems-and-treatments/erythema-multiforme

  Symptoms of erythema multiforme appear suddenly, without notice. Signs include: Red spots, wheals, or blisters on your hands, arms, face, neck, legs, or trunk […] Symptoms last two to four weeks. They may go away and come back a few months later. […] The rash starts as itchy round, raised spots. Some may have a ring around them. They may also blister. The rash can be red, pink, purple, or even darker than your skin. […] The rash often begins on your hands and feet. Over the next couple of days, it can spread to your stomach, torso, or face. It may even form painful blisters inside your mouth, on your lips, or in your eyes, butt or private parts.

• #5 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, medications, and various other triggers. It has a wide spectrum of severity and occurs in both minor and major forms. […] EM minor represents a localized eruption of the skin with minimal or no mucosal involvement. The papules evolve into pathognomonic target or iris lesions that appear within a 72-hour period and begin on the extremities. Lesions remain in a fixed location for at least 7 days and then begin to heal. […] EM major is a more severe and potentially life-threatening disorder. One or more mucous membranes are involved, and as much as 10% of body area may have epidermal detachment. More than 50% of all cases are attributed to medications.

• #6 Erythema multiforme: Pathogenesis, clinical features, and diagnosis – UpToDate

  https://www.uptodate.com/contents/erythema-multiforme-pathogenesis-clinical-features-and-diagnosis

  Erythema multiforme (EM) is an acute, immune-mediated condition characterized by the appearance of distinctive target-like lesions on the skin. These lesions are often accompanied by erosions or bullae involving the oral, genital, and/or ocular mucosae. „Erythema multiforme major” is the term used to describe EM with severe mucosal involvement (and may have associated systemic symptoms, such as fever and arthralgias). Erythema multiforme minor refers to EM without (or with only mild) mucosal disease (and without associated systemic symptoms). […] The clinical course of EM is usually self-limited, resolving within weeks without significant sequelae. However, in a minority of cases, the disease recurs frequently over the course of years.

• #7 Erythema Multiforme: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24475-erythema-multiforme

  Erythema multiforme usually causes a painful or uncomfortable rash on your skin. This rash can start small but can increase in size over time. It can be itchy and cause raised bumps on your skin. Severe forms of erythema multiforme can affect your mouth and eyes, with symptoms that make it difficult for you to eat, drink and see. Depending on the severity, you may need to be treated in the hospital. Treatment helps alleviate symptoms to get you feeling better. […] Symptoms that affect your skin could include: A red to purple rash that causes your skin to puff up (swell) and be painful to the touch. Pimple-like blisters on your skin or inside of your mouth. Round mark on your skin that looks like a bulls-eye on a target, with a dark center and a pale ring around it. Itchy skin. […] Symptoms that affect your skin usually go away after two to four weeks. […] Erythema multiforme normally clears up between two and four weeks. In some people, the condition is recurring, which means it can come and go over and over again. If you have frequent flare-ups, talk to your provider about ways to reduce the frequency of your flares.

• #8 Erythema multiforme

  https://www.nhs.uk/conditions/erythema-multiforme/

  Erythema multiforme is a skin condition that can be caused by an infection or some medicines. It usually gets better on its own in 2 to 4 weeks. […] The main symptom of erythema multiforme is a rash. The rash usually appears on your hands and feet, and spreads to your tummy, chest, back or face. It might feel itchy or like it’s burning. […] The rash usually starts as round, slightly raised spots. Some spots develop rings around them and can turn into blisters. […] Sometimes you can get the rash inside your mouth or on your lips, eyes, anus or genitals. This can be painful. […] You may also have other symptoms such as a high temperature, headache, body aches and pains, feeling generally unwell. […] You think you have erythema multiforme and the rash is painful. […] Erythema multiforme usually gets better on its own in 2 to 4 weeks.

• #9 Erythema multiforme – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/erythema-multiforme/

  Erythema multiforme (EM) is a hypersensitivity reaction (when the immune system mistakenly identifies a harmless substance as harmful) which tends to develop suddenly. […] EM often starts with the development of multiple red spots on the affected area. The spots usually begin on the feet and hands and spread upwards towards the trunk. The face is often affected. Over time, these spots change to plaques (raised patches) that look like targets (concentric circles). […] If your EM is more severe (EM major), you may have a fever and a headache, and feel unwell for a few days before the rash appears. Blisters on your skin may burst and leave painful areas. […] In erythema multiforme minor: The spots usually develop over the course of 3 – 4 days, starting on the hands and feet, and then spreading up the limbs to the trunk and face.

• #10 Erythema Multiforme: Symptoms and Treatment | Doctor

  https://patient.info/doctor/erythema-multiforme-pro

  Erythema multiforme (EM) is a skin condition due to an immune-mediated hypersensitivity reaction to infections or drugs. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur – hence the name. It is usually an acute, self-limiting disease that affects the skin. Mucosal lesions are present in 25% to 60% of patients with erythema multiforme. […] The rash starts abruptly, usually within three days. It starts on the extremities, being symmetrical and spreading centrally. […] There may be some mild burning or itching sensation but the skin is not tender. […] The iris or target lesion is the classical feature of the disease. Initially, there is a dull red macule or urticarial plaque that enlarges slightly up to 2 cm over 24-48 hours. In the middle, a small papule, vesicle or bulla develops, flattens, and then may clear. The intermediate ring forms and becomes raised, pale and oedematous. The periphery slowly becomes violaceous and forms a typical concentric target lesion.

• #11 Erythema Multiforme | Dayton Children’s Hospital

  https://www.childrensdayton.org/kidshealth/a/erythema-multiforme

  Erythema multiforme (air-uh-THEE-muh mul-teh-FOR-mee) starts with pink or red blotches. They grow over a few days into round spots that look like targets with red, pink, and pale rings. […] Often, the rash starts on the arms, hands, legs, and feet, then appears on the face, neck, diaper area, and body. […] The rash is most often on both sides of the body. It might not bother kids, but it can itch or burn. […] When spots are also on the lips or mouth, it is called erythema multiforme major. These rashes should be checked by your doctor. […] As the rash goes away, the skin where the spots were can look dark for a few months, but won’t leave a scar. […] The rash might be the only sign, but sometimes kids with erythema multiforme also: feel tired, have a mild fever, have sore muscles and joints, have puffy hands or feet. […] The erythema multiforme rash often goes away in 1 to 2 weeks, but can last as long as 4 weeks. It doesn’t cause a scar, but in some kids might leave darker spots on the skin for a few months.

• #12 Erythema multiforme – Skin Deep

  https://dftbskindeep.com/all-diagnoses/erythema-multiforme/

  Erythema multiforme is an acute and often relapsing mucocutaneous syndrome that is self-limiting. It is usually mild and related to an acute infection (in 90% of cases), commonly a recurrent herpes simplex virus (HSV) infection. EM can occur in patients of any age but is most common in adolescents and young adults. Cutaneous EM lesions arise abruptly and usually in a symmetric, acral distribution on extensor surfaces of extremities (hands, feet, elbows, knees), face and neck. They often appear peripherally (acrally) then spread centripetally. The lesion periphery is usually erythematous and oedematous while the centre becomes violaceous and dark, i.e. a target lesion. Mucosal lesions are present in up to 70% of patients, favouring oral mucosa. Eye involvement (pain, bilateral conjunctivitis) and urogenital lesions may also occur. Prodromal symptoms are uncommon (one-third cases) in most cases however can present as mild upper respiratory tract infection (e.g. cough, rhinitis, fever). Clinically, a link with herpes (HSV-1 usually, but also HSV-2) can be found in one-half of cases. EM lesions begin on average 7 days after a recurrence of symptomatic or asymptomatic herpes. M.pneumoniae is the next most common cause of EM, especially in paediatric cases. These cases may present with clinical signs (cough, tachypnoea, hypoxia) and radiology of atypical pneumonia. […] General management involves symptomatic treatment with topical steroids, antihistamines and treating the underlying cause. Recurrent EM associated with HSV should be treated with prophylactic antiviral therapy.

• #13 Erythema Multiforme: Treatment and Symptoms

  https://www.healthline.com/health/erythema-multiforme

  The EM rash can consist of dozens of target-shaped (bulls-eye pattern) lesions that develop over a 24-hour period. These lesions can start on the backs of hands and tops of feet before spreading to the trunk. They may also develop on the face and neck. The arms may be more affected than the legs. These lesions can be concentrated on the elbows and knees. […] In minor cases of EM, there are lesions covering the affected area. The rash will affect both sides of the body. For example, if its on one leg, it will also affect the other leg. […] If you have EM minor, you may have no symptoms other than feeling like the rash is itching or burning and perhaps a low fever. […] In cases of EM major, there can be additional symptoms, such as fatigue, joint ache, and a brownish color to the rash once it fades.

• #14 Erythema multiforme as first sign of incomplete Kawasaki disease | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/1824-7288-39-11

  Erythema multiforme is an acute, self-limiting condition considered to be a hypersensitivity reaction commonly associated with various infections or medications. […] Even if the typical findings of cutaneous changes are multiple symmetrical erythematous eruptions on the extensor surfaces of the extremities developing after 35 days of fever, Kawasaki disease may rarely present as erythema multiforme. […] Annular cutaneous manifestations evolved to multiple target-like erythematous lesions compatible with erythema multiforme. […] Erythema multiforme was more appreciable at the extremities, including palms and soles, with relative unusual sparing of the trunk. […] Erythema multiforme is an acute, self-limited, sometimes recurring, skin condition considered to be a hypersensitivity reaction associated with certain infections, particularly herpes simplex virus and mycoplasma pneumoniae, and with medications such as penicillins and non steroidal anti-inflammatory drugs, commonly used in children.

• #15 Erythema Multiforme | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1201/p1883.html

  Erythema multiforme is a skin condition considered to be a hypersensitivity reaction to infections or drugs. It consists of a polymorphous eruption of macules, papules, and characteristic target lesions that are symmetrically distributed with a propensity for the distal extremities. There is minimal mucosal involvement. […] Erythema multiforme is an acute, self-limited, and sometimes recurring skin condition considered to be a hypersensitivity reaction associated with certain infections and medications. […] The individual lesions begin acutely as numerous sharply demarcated red or pink macules that then become papular. The papules may enlarge gradually into plaques several centimeters in diameter. The central portion of the papules or plaques gradually becomes darker red, brown, dusky, or purpuric. Crusting or blistering sometimes occurs in the center of the lesions. The characteristic target or iris lesion has a regular round shape and three concentric zones: a central dusky or darker red area, a paler pink or edematous zone, and a peripheral red ring.

• #16 Erythema Multiforme – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-multiforme

  Erythema multiforme manifests as the sudden onset of asymptomatic, erythematous macules, papules, wheals, vesicles, bullae, or a combination on the distal extremities (often including palms and soles) and face. The classic lesion is annular with a violaceous center and pink halo separated by a pale ring (target or iris lesion). Distribution is symmetric and centripetal, sometimes spreading to the trunk. Some patients have itching. […] Erythema multiforme is characterized by target or iris lesions, which are annular lesions with a violaceous center and pink halo separated by a pale ring. […] Oral lesions may include target lesions on the lips and vesicles and erosions on the palate and gingivae.

• #17 Erythema multiforme

  https://www2.hse.ie/conditions/erythema-multiforme/

  Most people with erythema multiforme will just have a rash, but there can be other symptoms too. […] The rash starts suddenly and develops over a few days. It often starts on the hands or feet, and spreads to the limbs, upper body and face. […] In more severe cases, the patches may join together to form large, red areas that may be raw and painful. […] Additional symptoms of erythema multiforme can include: a high temperature, a headache, feeling generally unwell, raw sores inside your mouth, making it hard to eat and drink, swollen lips covered in crusts, sores on the genitals, making it painful to pee, sore, red eyes, sensitivity to light and blurred vision, aching joints. […] These symptoms are more common in erythema multiforme major or a similar condition called Stevens-Johnson syndrome.

• #18 Erythema multiforme | nidirect

  https://www.nidirect.gov.uk/conditions/erythema-multiforme

  Erythema multiforme is usually a mild skin reaction triggered by an infection, or medication, ending in a few weeks. Erythema multiforme mainly affects adults under 40 years old. Most people with erythema multiforme will just have a rash, but other symptoms can also sometimes occur. The rash comes on suddenly and develops over a few days. It tends to start on the hands or feet, before spreading to the limbs, upper body and face. The rash starts as small red spots, which may become raised patches a few centimetres in size […] often has patches that look like a target or „bulls-eye”, with a dark red centre that may have a blister or crust, surrounded by a pale pink ring and a darker outermost ring […] may be slightly itchy or uncomfortable […] usually fades over two to four weeks. In more severe cases, the patches may join together to form large, red areas that may be raw and painful. Additional symptoms of erythema multiforme can include: a high temperature (fever) of 38C (100.4F) or more, a headache, feeling generally unwell, raw sores inside your mouth, making it hard to eat and drink, swollen lips covered in crusts, sores on the genitals, making it painful to pee, sore, red eyes, sensitivity to light and blurred vision, aching joints. These symptoms are more common in erythema multiforme major or a similar condition called Stevens-Johnson syndrome. Most people with erythema multiforme make a full recovery within a few weeks. There aren’t usually any further problems and the skin normally heals without scarring. But there is a risk the condition could come back at some point, especially if it was caused by the herpes simplex virus.

• #19 Erythema Multiforme Treatment Bakersfield Dermatologist

  https://www.bakersfielddermatology.com/medical-dermatology/erythema-multiforme/

  Erythema multiforme is a skin condition that can cause red, circular patches on the skin, sometimes with blisters or ulcers. It can be triggered by infections, medications, or other factors. It’s usually mild and goes away in a few weeks, but there’s also a rare, severe form that can affect the mouth, genitals and eyes and can be life-threatening. […] Some of the signs and symptoms of erythema multiforme are: A red to purple rash that causes your skin to puff up (swell) and be painful to the touch. Pimple-like blisters on your skin or inside of your mouth. Round mark on your skin that looks like a bulls-eye on a target, with a dark center that may have a blister or crust, surrounded by a pale pink ring and a darker outermost ring. This is also called a target lesion. Itchy skin. Headache, fever, feeling unwell, joint pain, eye sensitivity, blurred vision, sore eyes and red eyes. These symptoms are more common in the severe form of erythema multiforme. […] Erythema multiforme usually lasts for two to four weeks, but it may recur in some people who have recurrent infections or exposure to medications.

• #20 Erythema multiforme: Pictures, causes, treatment, and more

  https://www.medicalnewstoday.com/articles/323801

  Erythema multiforme is an immune-mediated reaction that causes a raised, red, target-like rash on the skin or mucous membranes. […] Erythema multiforme minor is usually a mild condition that causes a rash on the skin. Erythema multiforme major can be severe, affecting the mucous membranes, and typically requires more extensive treatment. […] A person with erythema multiforme may also experience the following symptoms: itching and burning rash, which is the most common symptom; fever or body temperature of 100.4F (38C) or higher; headache; general feeling of being unwell, sometimes before the rash appears; joint pain and swelling; sores in the mouth; sores and redness in the eyes; sensitivity to light; joint pain. […] Most erythema multiforme lesions are not painful, although some people may experience a burning sensation. Lesions involving mucous membranes, such as those on the mouth, throat, genitals, or eyes, can be painful.

• #21

  https://111.wales.nhs.uk/erythemamultiforme/

  Erythema multiforme is a skin condition that can be caused by an infection or some medicines. It usually gets better on its own in 2 to 4 weeks. […] The main symptom of erythema multiforme is a rash. The rash usually appears on your hands and feet, and spreads to your tummy, chest, back or face. It might feel itchy or like it’s burning. […] The rash usually starts as round, slightly raised spot. Some spots develop rings around them and can turn into blisters. […] Depending on your skin tone, the rash may be red, pink or purple, or it may be darker than surrounding skin. […] Sometimes you can get the rash inside your mouth or on your lips, eyes, anus or genitals. This can be painful. […] You may also have other symptoms such as a high temperature, headache, body aches and pains, feeling generally unwell. […] Erythema multiforme usually gets better on its own in 2 to 4 weeks.

• #22 Erythema Multiforme Clinical Presentation: History, Physical Examination, Complications

  https://emedicine.medscape.com/article/1122915-clinical

  Prodromal symptoms are usually absent or mild in persons with EM minor, consisting of a mild, nonspecific upper respiratory tract infection. The abrupt onset of a rash usually occurs within 3 days, starting on the extremities symmetrically, with centripetal spreading. Pruritus is generally absent. […] In EM major, 50% of patients have prodromes similar to an influenzalike prodrome, including moderate fever, general discomfort, cough, sore throat, vomiting, chest pain, and diarrhea (secondary to gastrointestinal [GI] tract ulceration). These symptoms have a classic time course of development and are usually present for 1-14 days before the cutaneous eruption occurs. The lesions begin on the acral areas and spread similarly to the distribution of EM minor (ie, they are usually symmetrical and extend from the face and torso to the trunk and proximal extremities).

• #23 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470259/

  The eruptions start with blisters, eroding to show a white overlying pseudo-membrane. […] Thick hemorrhagic crusts may cover the labial lesions, and a fibrin-whitish coating may line the mucosal erosions of the cheeks, palate, and genitalia. […] While skin lesions are nonpainful, mucosal lesions are frequently painful. […] The prognosis of erythema multiforme is mainly related to the body surface area affected; however, most cases are self-limited, and the lesions eventually subside within 2 to 3 weeks without scarring. […] In contrast, resolving erythema multiforme major takes 4 to 6 weeks. […] The mortality rate in erythema multiforme major is less than 5% and is directly proportional to the extent of sloughed epithelium. […] The mucosal lesions always take longer to heal. […] Recurrences are seen in less than 5% of cases, mainly in forms due to herpes infection.

• #24 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470259/

  The mucous membranes are involved in 2% to 10% of individuals. […] Management of acute erythema multiforme focuses on improving symptoms, managing pain, and supporting recovery, which usually happens within 2 weeks. […] In patients with erythema multiforme minor, prodromal symptoms are usually nonspecific, absent, or mild. […] Patients may report fatigue, malaise, or upper respiratory tract infection. […] The onset of a rash usually occurs within 3 days, with centripetal spreading. […] In erythema multiforme major, patients have more marked symptoms, such as moderate fever, generalized aches, cough, sore throat, chest pain, vomiting, and diarrhea. […] These symptoms may classically persist for 2 weeks before the cutaneous lesions appear. […] Mucosal lesions are common, mainly in the mouth, and less frequently in the urogenital and ocular mucous membranes.

• #25 Erythema Multiforme Clinical Presentation: History, Physical Examination, Complications

  https://emedicine.medscape.com/article/1122915-clinical

  Prominent mucosal involvement may also occur in EM major. Erosions of the oral mucosa may result in difficulty in eating, drinking, or opening the mouth. Conjunctival involvement may cause lacrimation, photophobia, burning eyes, or visual impairment. Genital lesions are painful and may result in urinary retention; painful micturition due to genitourinary (GU) tract ulceration may also occur. Shortness of breath or difficulty in breathing may occur due to tracheobronchial epithelial involvement.

• #26 Erythema Multiforme – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/erythema-multiforme/

  Erythema multiforme (EM) is an acute inflammatory disorder, usually self-limiting and often recurrent. […] The episodes of EM are usually acute, self-limited and recurring, and often preceded by systemic symptoms such as malaise, fever, headache. The classic skin lesion of EM is the “target” or “iris” lesion, which consist of concentric erythematous rings separated by skin of near-normal appearance; the tissue in the centre of the target may be erythematous or tan. […] In EM major, skin lesions usually follow mucosal lesions; they may resemble classical target skin lesions, but are often characterized by bullae and erosions which can cause epidermal loss. […] Early oral EM presents erythematous spots which progress to blisters that quickly break, resulting in erosion and/or ulcers. Oral involvement varies from a few aphthous-like lesions to multiple, superficial, widespread erosions.

• #27 Erythema Multiforme in Mouth: Symptoms, Causes, and More

  https://www.healthline.com/health/erythema-multiforme-in-mouth

  Erythema multiforme is an immune-mediated skin condition that may develop inside the mouth. Oral symptoms can include lesions on the lips and blisters and erosions on the gums and palate. […] Symptoms of erythema multiforme in the mouth can include: target-shaped lesions on the lips, vesicles, or blisters, on the palate and gums (gingivae), erosions on the palate and gums. […] A rash may also develop on the skin, usually on the hands and feet. It can also affect the stomach, chest, back, face, eyes, genitals, anus. […] Other symptoms can include: headache, high temperature, body aches, generally feeling unwell (malaise). […] Erythema multiforme in the mouth, or oral erythema multiforme, can cause symptoms such as target-shaped lesions on the lips and blisters and erosions on the palate and gums. It can also affect the skin and other parts of the body. […] The condition usually resolves on its own without medical treatment within about 4 to 6 weeks. Oral washes containing antiseptic or local anesthetic can also help, and you may require treatment for an underlying infection.

• #28 Clinical features, diagnosis, and treatment of erythema multiforme

  https://ostrowonline.usc.edu/clinical-features-diagnosis-and-treatment-of-erythema-multiforme/

  Erythema multiforme (EM): First described in 1866 by Ferdinand von Hebra as an acute, self-limited cutaneous disease characterized by multiform skin lesions, now called EM minor. In addition to the mucosal involvement, a key difference between these two subtypes is systemic symptoms such as fever and arthralgia preceding and/or accompanying EM major. The clinical course of EM varies depending on the cause. EM caused by infection is usually self-limited, resolving within a few weeks. In a minority of cases, the disease recurs over the years. Studies show that recurrent EM is mainly associated with recurrent HSV infections, which might happen two to three weeks before the EM clinical symptoms appear. Regardless of the cause, EM lesions erupt within a few weeks from the infection or taking the offending medication. Skin and oral lesions appear rapidly over a few days and begin as red macules that become papular in the skin, starting primarily in the hands and moving centripetally toward the trunk in a symmetrical distribution. This acute onset of the mucocutaneous lesions is one of the hallmarks of considering EM in the differential diagnosis. In EM Major, it is not uncommon to have a prodrome of fever, arthralgias, malaise, headache proceeding or accompany the mucocutaneous lesions. The intraoral lesion is mainly seen in EM major, not minor. The lesions range from mild erythema and erosion to large painful ulcerations covered by a yellow-white fibrinous exudate. Lip inflammation, ulceration, and crusting are very common in patients with EM major. EM Minor always presents with skin lesions similar to the major subtype described above but without epidermal detachment and without or only mild mucosal disease. Although not included in the Bastuji-Garin classification, oral health providers must realize that sometimes EM cases present with oral mucous membrane involvement only. Interestingly, skin lesions are mostly asymptomatic; however, some patients will complain of itching or burning sensation.

• #29 Erythema Multiforme — Advanced Dermatology

  https://www.advanced-dermatology.com.au/erythema-multiforme

  Symptoms of erythema multiforme can be mild to severe. Symptoms include fever, chills, fatigue, bloodshot eyes, eye pain, mouth sores, dry eyes, vision problems, general ill feeling, weakness and painful joints. Skin lesions will appear on the skin, a few to hundreds could erupt. They typically develop over 2 to 3 days, and will look different on various places of the body. They will appear equally on both sides of the body. They are usually first seen on the backs of the hands, the top of the feet, and then spread on the limbs to the trunk. Upper limbs are effected more than the lower limbs. Mild itching or burning could take place. The skin lesions will appear to be red/pink and round at first, and then become raised, enlarging to form plaques that can be several cm in diameter. The center of the skin lesion will be dusky or dark red, which looks like a blister or has crusted over. The next ring is a paler pink that is raised due to fluid swelling. The outer ring will be a bright red.

• #30 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. EM can be confused with other more serious conditions like Stevens-Johnson syndrome (SJS); however, clinical research has provided significant evidence to classify EM and SJS as separate disorders. Prodromal symptoms usually do not accompany EM; however, in cases where there is mucocutaneous involvement, prodromal symptoms have been observed. Lesions usually erupt over a 72-hour period, and in some cases, produce a mild pruritus or burning sensation. There can be occasional mucosal involvement in EM, which is what splits the condition into its two broad categories: EM minor (a form with no mucosal involvement) and EM major (a form that includes mucosal membrane involvement). The most common mucous membranes that are involved include the lips, tongue, and the buccal oral mucosa. Genital or ocular mucosal lesions have also been observed, as well as any combination of the mucosal sites listed. While acute disease is usually self-limiting, some patients experience recurrent disease. Identifying the etiology of EM is crucial in developing a successful treatment modality. Most acute cases of EM have been reported to stem from infections caused by HSV and Mycoplasma pneumoniae. A rarer type of EM is known as persistent EM, which is defined by the continuous appearance of EM lesions with marked resistance to therapy. Lesions are typically widespread and are, by definition, uninterrupted. Treatment for acute or isolated cases of EM typically do not need intervention, but in cases where patients are experiencing uncomfortable symptoms, topical steroids, antiseptics, and oral antihistamines are recommended. In recurrent EM, treatment focuses on addressing the etiology through systemic antiviral prophylactic therapy. Recurrent EM is the most difficult type of EM to treat due to its refractory nature. In both HSV-associated EM and idiopathic EM, the first-line treatment is antiviral prophylaxis. Current recommendations include acyclovir, 400 mg, twice daily, valacyclovir, 500 mg, twice daily, or famciclovir, 250 mg, twice daily. The goal of treatment is to reduce the number of recurrences and to induce remission, which is difficult to maintain. Recurrence is frequent once antiviral therapy is stopped.

• #31 Erythema multiforme – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/erythema-multiforme/

  Erythema multiforme is a rare, acute hypersensitivity reaction most commonly triggered by the herpes simplex virus (HSV). Erythema multiforme typically occurs in adults between 20-40 years of age and manifests as a polymorphic rash that begins as macules and papules and develops into characteristic target lesions. The rash initially appears on the dorsal aspect of the hands and feet and extends proximally. In patients with moderate to severe mucosal involvement with or without systemic symptoms, the condition is defined as erythema multiforme major. Erythema multiforme is usually self-limited and resolves spontaneously within a month; symptomatic treatment with antihistamines, and topical steroids is usually sufficient. Patients with erythema multiforme major may require systemic glucocorticoids and, in severe cases, IV fluid therapy and specialized nutritional support.

• #32 Erythema Multiforme – UF Health

  https://ufhealth.org/conditions-and-treatments/erythema-multiforme

  Symptoms of EM include: Low-grade fever, Headache, Sore throat, Cough, Runny nose, General ill feeling, Itchy skin, Joint aches, Many skin lesions (sores or abnormal areas) […] Skin sores may: Start quickly, Come back, Spread, Be raised or discolored, Look like hives, Have a central sore surrounded by pale red rings, also called a target, iris, or bulls-eye, Have liquid-filled bumps or blisters of various sizes, Be located on the upper body, legs, arms, palms, hands, or feet, Include the face or lips, Appear evenly on both sides of the body (symmetrical) […] Other symptoms may include: Bloodshot eyes, Dry eyes, Eye burning, itching, and discharge, Eye pain, Mouth sores, Vision problems […] There are two forms of EM: EM minor usually involves the skin and sometimes mouth sores. EM major often starts with a fever and joint aches. Besides the skin sores and mouth sores, there may be sores in the eyes, genitals, lung airways, or gut. […] Mild forms of EM usually get better in 2 to 6 weeks, but the problem may return.

• #33 Erythema Multiforme: Symptoms, Causes, Diagnosis, Treatment

  https://www.verywellhealth.com/erythema-multiforme-7092731

  The most common symptom of EM is a rash that starts suddenly then develops over a few days. This rash: […] Typically lasts about two to four weeks […] In more severe cases, it can cause sores in the mouth, on the genitals, and other areas such as the eyes or lung airways. […] Other symptoms of EM (more common with EM major) may include: Fever, Joint and/or muscle aches, Headache, Fatigue, Feeling generally unwell, Swollen, crusted lips, Cold sores, Puffy hands or feet, Vision problems, such as sensitivity to light and/or blurred vision, Red, bloodshot, sore, burning, itching, and/or dry eyes (may have discharge), Painful urination (if there are sores on the genitals), Sore throat, Cough, Runny nose. […] EM typically resolves on its own in two to four weeks, but medications such as antihistamines, pain medications, or steroids may be used if necessary. EM is usually minor but can be serious or life-threatening. See a healthcare provider if you have symptoms of EM.

• #34 Erythema multiforme | Clear Chemist

  https://www.clearchemist.co.uk/az-health/erythema-multiforme

  This rare form of the disease is much more severe, and can be life-threatening. It’s usually caused by a reaction to mycoplasma bacteria or certain medications. […] The rash is made up of bigger spots, which may fuse to produce large red areas. They may blister to reveal raw, painful sores. You might also have: a fever and headache, and feel unwell; bloodshot or dry eyes that may burn, itch and weep; sensitivity to light and blurred vision; raw sores inside your mouth, making it hard to eat and drink; swollen lips covered in crusts; itchy skin; achy joints; corneal ulcers; septicaemia; myocarditis; hepatitis; haematuria; acute tubular necrosis.

• #35 Is Erythema Multiforme Contagious? Symptoms & Treatment

  https://www.emedicinehealth.com/is_erythema_multiforme_contagious/article_em.htm

  Erythema multiforme minor symptoms are mild and usually go away on their own within 2 weeks. […] Symptoms can range from mild to severe and the condition is not contagious. […] Symptoms of erythema multiforme minor include: Flu-like symptoms (fever, body aches, fatigue), Red, blotchy rash, usually starts on hands and feet, followed by rash on the face and trunk, Red patches turn into round target lesions, which look like a bullseye, Some lesions may blister, Itching, Headache, Joint pains. […] Symptoms of erythema multiforme major (as well as Stevens-Johnson syndrome and toxic epidermal necrolysis) include symptoms of erythema multiforme minor plus: Widespread progression of the rash to most skin surfaces, Sores on mucus membranes (inside the mouth and nose, in the digestive tract), Swollen, crusted lips, Eye redness and tearing, Abdominal pain, Rectal pain, Blistering/peeling of skin, Sores on genitals which can result in pain with urination.

• #36 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  Most cases of EM are self-limited. In EM minor, the lesions evolve over 1-2 weeks and ultimately subside within 2-3 weeks without scarring. However, recurrence of EM minor is common, developing in as many as one third of cases, and is mostly preceded by apparent or subclinical HSV infection. […] EM major has a mortality of less than 5%, which is directly proportional to the TBSA of sloughed epithelium. It usually has a more protracted course than EM minor, and clearing may require 3-6 weeks. Skin lesions usually heal with hyperpigmentation, hypopigmentation, or both. Scarring is usually absent, except after secondary infection. Sepsis secondary to loss of the cutaneous barrier is the principal cause of death. […] Two additional rare clinical forms of EM have been reported: continuous EM and persistent EM. Continuous EM manifests as a prolonged course with overlapping attacks and may be associated with systemic administration of glucocorticoids. Persistent EM has a protracted clinical course over months, is commonly associated with atypical skin lesions, and is commonly resistant to conventional treatment.

• #37 Erythema multiforme: Pictures, causes, treatment, and more

  https://www.medicalnewstoday.com/articles/323801

  In its minor form, erythema multiforme usually improves in 2 to 3 weeks and typically does not cause scarring. Erythema multiforme major typically resolves in 4 to 6 weeks as mucosal lesions, such as mouth ulcers, take longer to heal. Scarring usually does not occur, but skin discoloration might persist.

• #38 Erythema Multiforme | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1201/p1883.html

  The skin lesions of erythema multiforme usually appear symmetrically on the distal extremities and progress proximally. Lesions on the dorsal surfaces of the hands and extensor aspects of the extremities are most characteristic. […] Erythema multiforme resolves spontaneously in three to five weeks without sequelae, but it may recur. […] In a study involving 65 patients with recurrent erythema multiforme, the mean number of attacks per year was six, with a range of two to 24; the mean duration of the disease was 9.5 years.

• #39 Erythema Multiforme

  https://fpnotebook.com/ENT/Derm/ErythmMltfrm.htm

  Lesion onset typically 3 to 5 days after initial exposure. […] Onset up to 1 to 3 weeks after medication exposure. […] Mild prodrome for 7-10 days may be present (more common with mucosal lesions, Erythema Multiforme Major). […] Rash develops 3-5 days after prodrome. […] Lesions persist up to 1 to 2 weeks. […] Rash may burn or itch. […] Progresses: Central necrosis. […] Some lesions may coalesce into annular Plaques. […] Most lesions heal without complication. […] Scarring or Postinflammatory Hyperpigmentation may occur. […] New lesions occur over 3-5 days. […] Lesions persist for 1-2 weeks (non-migratory). […] Resolves spontaneously in 3-5 weeks. […] HSV related lesions typically resolve by 2 weeks.

• #40 Erythema Multiforme – Skin Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-multiforme

  Painful blisters or sores often form on the lips and lining of the mouth and rarely in the eyes. […] Attacks of erythema multiforme may last 2 to 4 weeks. Some people have only one attack, but some have multiple recurrences. Recurrences are common, especially when the cause is herpes simplex virus. The frequency of recurrence usually decreases with time.

• #41 Erythema multiforme – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/erythema-multiforme/

  In erythema multiforme major: You may feel ill and have a high temperature. The spots are usually larger and run into each other. […] Most patients with EM recover completely; however, there can be a risk of further attacks, particularly following cold sores. […] Mild rashes will clear up in a few weeks spontaneously. […] Severe rashes: Patients may need to be nursed in hospital as the skin may need regular dressings, pain relief and fluid and salt replacement. […] If a medication was suspected to be the cause, it is vital that this is avoided in the future.

• #42 Pulsenotes | Erythema multiforme

  https://app.pulsenotes.com/medicine/dermatology/notes/erythema-multiforme

  Erythema multiforme is an immune-mediated reaction that results in characteristic target lesions on the skin. EM is characterised by the presence of target lesions that are usually 3 cm in size. EM may cause characteristic target lesions on both cutaneous and mucosal surfaces. There are two broad forms of EM known as minor and major: Erythema multiforme minor: the presence of EM with no (or minor) mucosal involvement and absence of systemic symptoms […] Erythema multiforme major: the presence of EM with severe mucosal involvement and often with systemic symptoms (e.g. fever, arthralgia). Systemic features may be seen in severe cases of EM, but are usually absent in mild cases. EM is characterised by the presence of target lesions that are usually 3 cm in size. These lesions are usually present in a symmetrical distribution on the extensor surfaces of acral extremities. Lesions may then progress more centrally and involve other parts of the body such as the face, neck, palms, soles, and trunk. The lesions themselves are usually asymptomatic although mild itching (pruritus) may occur. Mucosal lesions commonly involve the oral mucosa and can lead to erythema, erosions, and/or bullae. These may be painful and can involve many other mucosal surfaces including the ocular and genital mucosa. EM typically develops over 3-5 days and improves over 2 weeks. Some patients may get persistent or recurrent episodes.

• #43 Erythema multiforme – Wikipedia

  https://en.wikipedia.org/wiki/Erythema_multiforme

  Erythema multiforme (EM) is an immune-mediated inflammatory skin condition associated with several viral infections, that appears with red patches evolving into target lesions, typically on both hands. […] The condition varies from a mild, self-limited rash (E. multiforme minor) to a severe, life-threatening form known as erythema multiforme major (or erythema multiforme majus) that also involves mucous membranes. […] The mild form usually presents with mildly itchy (but itching can be very severe), 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 710 days is the norm. […] Individuals with persistent (chronic) erythema multiforme will often have a lesion form at an injury site, e.g. a minor scratch or abrasion, within a week.

• #44 Erythema Multiforme – Kidshealth | Akron Children’s

  https://www.akronchildrens.org/kidshealth/en/parents/erythema-multiforme.html

  Erythema multiforme (air-uh-THEE-muh mul-teh-FOR-mee) starts with pink or red blotches. They grow over a few days into round spots that look like targets with red, pink, and pale rings. […] Often, the rash starts on the arms, hands, legs, and feet, then appears on the face, neck, diaper area, and body. […] The rash is most often on both sides of the body. It might not bother kids, but it can itch or burn. […] When spots are also on the lips or mouth, it is called erythema multiforme major. These rashes should be checked by your doctor. […] As the rash goes away, the skin where the spots were can look dark for a few months, but won’t leave a scar. […] The rash might be the only sign, but sometimes kids with erythema multiforme also feel tired, have a mild fever, have sore muscles and joints, or have puffy hands or feet. […] The erythema multiforme rash often goes away in 1 to 2 weeks, but can last as long as 4 weeks. It doesn’t cause a scar, but in some kids might leave darker spots on the skin for a few months.

• #45 Erythema multiforme as first sign of incomplete Kawasaki disease | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/1824-7288-39-11

  The skin eruption of Kawasaki disease has been described as an erythematous rash usually appearing within 5 days of the onset of fever. The most common is a non specific, diffuse maculopapular eruption. […] In our case the rash erupted the first day of fever as annular, slightly itchy cutaneous manifestations that evolved to multiple target-like erythematous lesions compatible with erythema multiforme in 4th day of fever. […] The case we reported is particularly interesting for the unusual presentation of incomplete Kawasaki disease. Indeed, erythema multiforme was reported as a cutaneous manifestation of classic Kawasaki disease in only 2 young children. […] The paper indicates erythema multiforme as a possible early cutaneous manifestation of Kawasaki disease, particularly in the case of the incomplete form.

• #46 Erythema Multiforme – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/erythema-multiforme/

  The mucosal involvement in EM major and TEN, is early and constant, affecting the oral cavity (95-100% of the cases), eyes (70-75%), genitalia (60-65%) and occasionally pharynx, larynx, oesophagus and respiratory tract. […] Symptoms range from mild discomfort to severe pain that can leave patients unable to open the mouth, to speak or to eat. […] In cases of oral EM, EM minor and moderate SJS, appropriate therapy generally gives a complete resolution within 10-15 days.

• #47 Erythema Multiforme: Treatment and Symptoms

  https://www.healthline.com/health/erythema-multiforme

  EM major lesions can also seriously affect any of the bodys mucous membranes, most often the lips and interior of the cheeks. It can also affect the bottom of the mouth, palate, and gums, eyes, genitals and anus, trachea (breathing tube), and digestive tract. […] Lesions in these areas may cause swelling and redness with blisters. The blisters also break, leaving painful, large, irregularly shaped ulcers covered with a whitish membrane. When the lips are affected, theyre swollen and covered with a bleeding crust. There can be difficulty speaking and swallowing because of pain.

• #48 Is Erythema Multiforme Contagious? Symptoms & Treatment

  https://www.emedicinehealth.com/is_erythema_multiforme_contagious/article_em.htm

  Erythema multiforme major is more severe and has a mortality rate of up to 5%. The condition lasts longer and patients can take months to recover. Complications such as organ scarring can become chronic. […] In the most severe cases, Stevens-Johnson syndrome (SJS) has a mortality rate of about 10% while the mortality rate for toxic epidermal necrolysis (TEN) is more than 30%. Advanced age, organ involvement, kidney dysfunction, and previous bone marrow transplantation all lead to worse outcomes.

• #49 FloridaHealthFinder | Erythema multiforme | Health Encyclopedia | FloridaHealthFinder

  https://quality.dev.healthfinder.fl.gov/health-encyclopedia/HIE/1/000851

  Erythema multiforme (EM) is an acute skin reaction that comes from an infection or another trigger. EM occurs mostly in adults 20 to 40 years old. Symptoms of EM include: Low-grade fever, Headache, Sore throat, Cough, Runny nose, General ill feeling, Itchy skin, Joint aches, Many skin lesions (sores or abnormal areas). Skin sores may: Start quickly, Come back, Spread, Be raised or discolored, Look like hives, Have a central sore surrounded by pale red rings, also called a target, iris, or bulls-eye, Have liquid-filled bumps or blisters of various sizes, Be located on the upper body, legs, arms, palms, hands, or feet, Include the face or lips, Appear evenly on both sides of the body (symmetrical). Other symptoms may include: Bloodshot eyes, Dry eyes, Eye burning, itching, and discharge, Eye pain, Mouth sores, Vision problems. There are two forms of EM: EM minor usually involves the skin and sometimes mouth sores. EM major often starts with a fever and joint aches. Besides the skin sores and mouth sores, there may be sores in the eyes, genitals, lung airways, or gut. Mild forms of EM usually get better in 2 to 6 weeks, but the problem may return. […] Complications of EM may include: Patchy skin color, Return of EM, especially with HSV infection.

• #50 Erythema multiforme | Northwell Health

  https://www.northwell.edu/dental-medicine/conditions/erythema-multiforme

  Erythema multiforme minor is not very serious and usually clears up with medication to control infection or inflammation. However, if a person develops a more severe form of erythema multiforme (erythema multiforme major), the condition can become fatal. Erythema multiforme major is also known as Stevens-Johnson syndrome, and is usually caused by a medication reaction rather than an infection.

• #51 Erythema multiforme: Management – UpToDate

  https://www.uptodate.com/contents/erythema-multiforme-management

  Erythema multiforme (EM) is an acute, immune-mediated condition characterized by the appearance of distinctive, target-like lesions on the skin. These lesions are often accompanied by erosions or bullae involving the oral, genital, and/or ocular mucosae. „Erythema multiforme major” is the term used to describe EM with mucosal involvement (and may have associated systemic symptoms, such as fever and arthralgias). „Erythema multiforme minor” refers to EM without (or with only mild) mucosal disease and without associated systemic symptoms. […] EM is most commonly induced by infection, with herpes simplex virus (HSV) being the most frequent precipitator. The clinical course of EM is usually self-limited, resolving within a few weeks without significant sequelae. In a minority of cases, the disease recurs frequently over the course of years.

• #52 Erythema multiforme: Management – UpToDate

  https://www.uptodate.com/contents/erythema-multiforme-management

  The management of EM is divided into interventions for acute episodes and interventions for suppression of recurrent disease. Treatments for acute episodes primarily aim to improve symptoms (eg, pain) and support resolution because acute episodes typically spontaneously resolve within two weeks. Involvement of the ocular mucosa is an exception; prompt intervention and close monitoring is advised to minimize risk for long-term complications.

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