Erythema exsudativum multiforme

Erythema multiforme is an acute vesicular disease of the skin and mucous membranes with a varied clinical picture and a tendency for seasonal recurrences (spring, autumn). The cause is unknown and there is no consensus on it. Apparently it is an immunological response to various infectious stimuli, often arising after angina or a herpes simplex infection (especially HSV-1). Children and adolescents in particular are affected the most.

Clinical picture
It starts with a fever and joint pain (clinically it looks the same as drug allergies). Brick-red, circular spots or papules the size of a lentil appear on the skin, and spread to the surrounding area with a red raised border. The center depresses (erythema annulare) and a blister usually spreads from the center - resembling an iris ("herpes iris"). The content of the blister is clear to hemorrhagic. Manifestations arise suddenly and they heal ad integrum within a month. Areas with higher predilection include: hands, forearms, insteps, lower legs, face and neck – this form is called erythema exsudativum minus. When the lips, mucous membranes of the mouth, genitals, anus, and conjunctiva are affected, it is called erythema exsudativum majus or Stevens-Johnson syndrome, which often has a severe course with general symptoms, severe painful erosions, and pain is accompanying the opening of mouth. If cutaneous symptoms are absent, it is necessary to differentiate it from the the mucosal pemphigus.

Treatment
Discontinuation of drugs suspected to contribute to the reaction. Corticosteroids or antibiotics.

Related articles

 * Lyell's syndrome
 * Stevens-Johnson syndrome