WHAT IS ERYTHEMA EXSUDATIVUM MULTIFORME?Erythema exsudativum multiforme(Erythema multiforme, EEM) is an acute skin rash with a distinctive appearance (ring-shaped lesions on the palms and body, chapped lips, and oral cavity). It is a type of allergic reaction to a viral or bacterial infection. A cold sore (herpes simplex virus infection) is usually the cause. Mycoplasma pneumonia , a small bacterium that can cause pneumonia, is also frequently implicated as a cause.
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| EEM, chapped lips |
EEM, palmar blisters |
EEM, shooting targets |
Classically, circular lesions develop on the palms that resemble " target lesions " (a red ring, within that a white ring, and a red or purplish-blue circle in the center). These target lesions are easy to recognize, but they are not always present. The rash can also take many other forms, hence its name erythema multiforme (erythema = red, multiforme = multiform).
Erythema exsudativum multiforme can be very extensive, involving the mucous membranes (lips, lining of the mouth, eyes). This extensive form was formerly called Stevens-Johnson syndrome. The extensive form with mucous membrane abnormalities is now called erythema multiforme major , and the milder form is called erythema multiforme minor .WHAT IS THE CAUSE OF ERYTHEMA EXSUDATIVUM MULTIFORME?As mentioned, the main causes are infections with the herpes simplex virus or Mycoplasma pneumonia. Cold sores (herpes simplex) are the most common, but the form of herpes transmitted through sexual contact (genital herpes) can also cause erythema multiforme. Mycoplasma is a bacterium that can cause infections of the lungs and respiratory tract. In addition, many other viral, bacterial, and fungal infections can cause erythema multiforme. In about half of the cases, no underlying cause can be found. The erythema multiforme may develop spontaneously, or there may have been an infection, such as a viral respiratory infection or a stomach flu, but the virus has already disappeared and can no longer be detected.WHAT ARE THE PHENOMENA?The rash may consist of spots, bumps, hives, so-called "target lesions," or a combination of these. These skin lesions are red and 1-3 cm in size. They are mainly found on the hands, wrists, feet, elbows, and knees. Target lesions are characteristic of erythema multiforme. These are round lesions with three zones: a dull red or purple center (possibly with a small blister within it), a surrounding area that is lighter in color and slightly raised, and a sharply defined red ring around that. For several days, new skin lesions appear in attacks, which disappear after 1 to 2 weeks. Erythema multiforme can occur at any age. Usually, the condition is not serious and the patient does not feel ill. It resolves on its own.
Sometimes there are only a few skin lesions (a minor form), and sometimes the rash is very extensive and also affects the mucous membranes (lips, inside the mouth, and sometimes also the eyes or genitals). With the extensive (major) form, patients can also be very ill. If the mouth is damaged, eating and drinking becomes difficult.
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| erythema multiforme |
EEM, shooting targets |
EEM, shooting targets |
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| EEM, shooting targets |
erythema multiforme |
EEM, chapped lips |
HOW IS THE DIAGNOSIS MADE?The diagnosis is usually made based on the clinical picture and its appearance. If there are characteristic target lesions or a history of a recent cold sore, it's easy to recognize. Other skin conditions can look very similar. One of these is a severe drug reaction called toxic epidermal necrolysis, which also causes chapped lips and lesions all over the body. A skin biopsy may be necessary for further examination. Sometimes blood tests or a culture are performed if there appear to be infections (herpes simplex, strep throat, pneumonia, etc.).HOW IS ERYTHEMA EXSUDATIVUM MULTIFORME TREATED?The mild form does not need to be treated as it goes away on its own. The severe forms with extensive skin lesions, broken lips and oral cavity often do require treatment. The treatment options are:
- Corticosteroid creams (anti-inflammatory creams), applied locally to the skin lesions
- Corticosteroid mouthwash
- Xylocaine anesthetic gel for the oral cavity
- Chlorhexidine bactericidal mouthwash
- Anti-inflammatory painkillers (ascal, diclofenac, ibuprofen)
- Prednisone tablets course
- Treatment of underlying infections (pneumonia, sore throat, etc.)
Sometimes an ophthalmologist needs to examine the eyes, sometimes an ENT specialist is asked to assess the oropharynx.
If erythema multiforme was caused by a herpes simplex virus, antiviral treatment will no longer be effective at that point (too late, the virus will have disappeared). However, if there are repeated cold sores, always followed by erythema multiforme, then maintenance treatment with an antiviral agent is useful.WHAT ARE THE OUTLOOK?Erythema multiforme usually disappears on its own after a few weeks and is a one-time condition that doesn't recur. However, when a herpes simplex virus infection is the cause, erythema multiforme can also recur with subsequent cold sore outbreaks. Some patients develop erythema multiforme with each cold sore. These patients are often prescribed preventative antiviral medication for a long period of time to curb the viral outbreak. A small amount of virus is enough to trigger an outbreak. Sometimes, no visible cold sore develops, but some virus is still released into the bloodstream, resulting in erythema multiforme.WHAT CAN YOU STILL DO YOURSELF?There's not much you can do about this. For recurring cold sores, a healthy and regular lifestyle can help reduce the number of herpes outbreaks per year. Exposure to bright sunlight can trigger cold sores, so that's something to avoid. |
