Erythema Multiforme Overview
Learn About Erythema Multiforme
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.
EM; Erythema multiforme minor; Erythema multiforme major; Erythema multiforme minor - erythema multiforme von Hebra; Acute bullous disorder - erythema multiforme; Herpes simplex - erythema multiforme
EM is a type of allergic reaction. In most cases, it occurs in response to an infection. In rare cases, it is caused by certain medicines or body-wide (systemic) illness.
Infections that may lead to EM include:
- Viruses, such as herpes simplex virus (HSV) that cause cold sores and genital herpes (most common)
- Bacteria, such as Mycoplasma pneumoniaethat cause lung infection
- Fungi, such as Histoplasma capsulatum, that cause histoplasmosis
Medicines that may cause EM include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Allopurinol (treats gout)
- Certain antibiotics, such as sulfonamides and aminopenicillins
- Anti-seizure medicines
Systemic illnesses that are associated with EM include:
- Inflammatory bowel disease, such as Crohn disease
- Systemic lupus erythematosus (SLE)
EM occurs mostly in adults 20 to 40 years old. People with EM may have family members who have had EM as well.
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)
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.
EM usually goes away on its own with or without treatment.
Your provider will have you stop taking any medicines that may be causing the problem. But, don't stop taking medicines on your own without talking to your provider first.
Treatment may include:
- Medicines, such as antihistamines, to control itching
- Moist compresses applied to the skin
- Pain medicines to reduce fever and discomfort
- Mouthwashes to ease discomfort of mouth sores that interferes with eating and drinking
- Antibiotics for skin infections
- Corticosteroids to control inflammation
- Medicines for eye symptoms
Good hygiene may help prevent secondary infections (infections that occur from treating the first infection).
Use of sunscreen, protective clothing, and avoiding excessive exposure to sun may prevent the recurrence of EM.
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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
Contact your provider right away if you have symptoms of EM.
Summary: This study is recruiting patients with chronic, treatment resistant erythema multiforme (EM), which is a disease that can affect the skin and mucous membranes (mucocutaneous). EM often impacts quality of life with pain, anorexia, hospitalization, and related long-term issues. While there are medications used to treat EM, no single therapeutic agent has been consistently effective for long-term man...
Summary: The goal of this study is to evaluate the effect of tofacitinib in patients with Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). The primary outcome of the study is the time to complete re-epithelialization. The secondary outcomes are to determine mortality, length of hospitalization, adverse events, the time to beginning of epithelization, the time to halting of progression o...
Published Date: October 13, 2024
Published By: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Hötzenecker W, Oschmann A, French LE. Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 5th ed. Philadelphia, PA: Elsevier; 2025:chap 20.
Lalor L, Shah KN. Urticaria and erythema multiforme. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 71.
Rubenstein JB, Kelly E. Infectious conjunctivitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2023:chap 4.6.