ERYTHEMA MULTIFORME

Classification:

1. erythema multiforme minor: mild cutaneous syndrome

2. erythema multiforme major (Stevens-Johnson): marked mucosal damage with hemorrhagic oral mucosal and conjunctival lesions.

3. Toxic epidermal necrolysis: widespread desquamation.

Clinical manifestations:

1. Prodromal sxs: fever, headache, malaise, cough, prostration, sore throat; usually 1 week before cutaneous eruption. Only occur in 1/3 of cases, more common w/ major.

2. “Target” or “Iris” lesions w/ central pallor. Macule(papule(vesicle/bulla. Classically involves extensor surfaces of extremities symmetrically.

3. Major: mucous membrane, genital involvement, hemorrhagic crusting of lips in major.

4. Complications: visceral organ damage to larynx, bronchi and esophagus, inflammatory renal lesions.

Etiology:

1. Three most common causes:

a. HSV- 2/3 of cases, occurs 10 days after initial infxn

b. mycoplasma- 1 to 3 wks after respiratory infxn

c. drug rxn- most commonly PCN, sulfonamides, MTX, DPT and HepB vaccines, phenytoin, many others. More frequently progresses to toxic epidermal necrolysis.

2. Other causes: collagen vascular disease, protozoan infxn, mycotic infxn, vaccination, skin allergens, underlying carcinoma, lymphoma, leukemia.

Treatment:

1. D/C nonessential drugs

2. supportive care (fluids, mouthcare, etc.)

3. ?antihistamines, steroids, prophylactic abx

American Family Physician, 46(4): 1171-6, Oct 1992