Erythema multiforme

Erythema multiforme
ICD-10	L51
DiseasesDB	4450
MedlinePlus	000851
eMedicine	derm/137

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2] Kiran Singh, M.D. [3]

Overview

Erythema multiforme is a skin condition of unknown etiology, but some authors suggest that the disease is mediated by deposition of immune complex (mostly IgM) in the superficial microvasculature of the skin and oral mucous membrane. It can occur due to drug exposure,as well in association with some types of infections. It varies from a mild, self-limited rash (E. multiforme minor) to a severe, life-threatening form (E. multiforme major, or Stevens-Johnson syndrome) that also involves mucous membranes.

Common Causes

E. multiforme may also be caused by drug reactions, most commonly sulfa drugs, Hydrochlorothiazide, phenytoin, barbiturates, penicillin, and allopurinol, Ethynodiol diacetate and ethinyl estradiol, or a host of internal ailments. The most common predisposing infection for E. multiforme is Herpes simplex, but bacterial infections (commonly Mycoplasma) and fungal diseases are also implicated.

Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Amifostine, Amoxicillin, Atovaquone and proguanil hydrochloride, Aztreonam, Cefaclor, Cefadroxil, Cefotaxime sodium, Ceftazidime, Dactinomycin, Desogestrel and Ethinyl Estradiol, Indinavir, Isotretinoin, Lincomycin Hydrochloride, Meropenem, Oxaprozin, Piperacillin, Piperacillin/tazobactam, Sulfasalazine, Rifampin, Valdecoxib,
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Amoxicillin
• Aztreonam
• Cefadroxil
• Ceftazidime
• Desogestrel and Ethinyl Estradiol
• Indinavir
• Isotretinoin
• Oxaprozin

Diagnosis

History and Symptoms

The skin form of E. multiforme, far more common than the severe form, usually presents with mildly itchy, 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 7-10 days is the norm.

Erythema multiforme target lesions

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  Erythema Multiforme Major

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  Erythema Multiforme reaction to an antibiotic

Physical Examination

Skin

Extremities

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

Trunk

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

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  .:Erythema multiforme Adapted from Dermatology Atlas.

Neck

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  .:Erythema multiforme Adapted from Dermatology Atlas.

Face

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  .:Erythema multiforme Adapted from Dermatology Atlas.

Image:Erythema multiforme24.jpg|.:Erythema multiforme Adapted from Dermatology Atlas.</gallery> </gallery>

Laboratory Findings

Laboratory findings are non-specific and can include an elevated erythrocyte sedimentation rate (ESR), elevated white blood cell count (WBC), and elevated liver enzymes.