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. 



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. 



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