Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. Since this is an infection, erythema multiforme in children is most often coupled with other symptoms such as fever, body weakness, sore throat, muscle pain and joint pain. Erythema multiforme minor typically affects only one mucosa and can be associated with symmetrical target skin lesions on the extremities. It is not one single entity but rather a spectrum of diseases. Erythema multiforme is an uncommon acute inflammatory disorder caused by exposure to microbes or drugs. Erythema multiforme em is a rare skin disorder that mainly affects children.
Mild cases of erythema multiforme do not require treatment. Erythema multiforme johns hopkins all childrens hospital. In kids, a germ that causes lung infections also can trigger erythema multiforme. Erythema multiforme em is an acute mucocutaneous hypersensitivity reaction with a variety of etiologies. Erythema multiforme nord national organization for rare.
Erythema multiforme mainly affects adults under 40. Em without mucous membrane involvement em minor and em with mucous membrane involvement em major. Erythema multiforme em is an acute skin reaction that comes from an infection or another trigger. Fox published may 5, 2017 updated july 30, 2017 parents pay a lot of attention to the skin of their child and, certainly, the skin exam is a valuable tool for the vigilant clinician ex, cap refill, petechiae below nipple line, leukemia, rmsf. Erythema multiforme presents over a period of 12 to 24 h. Erythema multiforme in children europe pmc article. Final diagnosis of herpes associated erythema multiforme was given. This reaction causes red, targetshaped or bullseye patches or sores on the skin. There is much controversy about the proper classification of the various clinical presentations, although for simplicity, it will be described in three categories, em minor, em major, and toxic epidermal. In half of the cases, the triggering agents appear to be medications, including anticonvulsants. In more severe cases called erythema multiforme major, it can affect the lips and the inside of the mouth.
The exact prevalence of this disorder is not known. Mucous membrane lesions without cutaneous involvement em is usually called minor when mucous membranes are spared or minimally affected, for example, lips, and majus or major when at. Erythema multiforme em is a selflimiting, immunemediated reaction, which manifests with a typical mucocutaneous eruption. It is characterized by skin eruptions, with or without oral or other mucus membrane lesions. These lesions are often accompanied by erosions or bullae involving the oral, genital, andor ocular mucosae picture 2ac. Diagnosis, classification, and management of erythema. For most people, a herpes simplex virus infection causes erythema multiforme, such as an infection of the lip i. Erythema multiforme is a rare disorder that affects slightly more males than females. Methods a retrospective analysis of 77 paediatric cases of em or sjs admitted to the childrens hospital in. Drugs adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1% 14. Usually, the diagnosis can be made on the basis of the size, shape, color and distribution of the target lesions. This is the less severe and most common form of erythema multiform. This study revises the em minor characteristics according to the most important publications found in literature.
Erythema multiforme em is a skin condition of unknown cause. Erythema multiforme em minor is a bullseye rash with alternating rings of red erythema and flaky skin desquamation. Use of steroids for erythema multiforme in children. Erythema multiforme is a distinct dermatologic hypersensitivity pathology characterized by cutaneous or mucous lesions and eventually it can also involve both. Erythema multiforme is a skin condition considered to be a hypersensitivity reaction to infections or drugs. When seen in adults, it usually occurs between the ages of 20 and 40, although it can happen to people of any age. Erythema multiforme pictures, treatment, causes, symptom. Erythema multiforme em is an acute, immunemediated condition characterized by the appearance of distinctive targetlike lesions on the skin picture 1ah.
Erythema multiforme for parents nemours kidshealth. This is highly associated with a herpes simplex infection. Erythema multiforme em is an immunemediated, mucocutaneous condition characterized by target lesions. Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening. Erythema multiforme types, symptoms, causes, diagnosis. Erythema multiforme major is the term used to describe em with severe mucosal involvement and. In most cases, it occurs in response to an infection. Herpes associated erythema multiformea diagnostic dilemma. Erythema multiforme is a hypersensitivity reaction to an infection or, in some cases, a medicine. In em minor emm, only one mucous membrane is affected and symmetrical target cutaneous lesions on the extremities are seen. Erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Erythema multiforme em is an inflammatory mucocutaneous skin disorder. It is usually circular, less than 3 centimeters in size, and similar to a bullseye in appearance. A revision article pdf available in american journal of infectious diseases 44 april 2008 with 1,352 reads how we measure reads.
The most common trigger is the germ that causes cold sores. Erythema multiforme is a rare, acute, selflimiting, immunemediated hypersensitivity reaction in children and it is exceptional in newborns. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Most cases of erythema multiforme happen because the body has an allergic reaction to an infection or a medicine. In rare cases, it is caused by certain medicines or bodywide. However, the disease is supposed to account for at least 1% of all dermatological outpatient visits. Answer erythema multiforme is relatively common in children. Erythema multiforme syndrome associated with acute. In 1950, the terms erythema multiforme major and erythema multiforme minor were coined by thomas to describe this skin ailment. Background in adults, erythema multiforme em is thought to be mainly related to herpes infection and stevensjohnson syndrome sjs to drug reactions. The characteristic skin lesion of em is the target lesion, which measures multiforme. Recently, erythema multiforme has been classified as minor, major, stevensjohnson syndrome or toxic epidermal necrolysis, where erythema multiforme minor is the mildest type of lesion and toxic epidermal necrolysis the most severe2,3 table 1.
Mucosal changes, if present, consist initially of redness of the lips and inside the cheek. Erythema multiforme an overview sciencedirect topics. It is an uncommon disorder, with peak incidence in the second and third decades of life. Erythema multiforme em is an acute, selflimited, inflammatory cutaneous disorder caused by infection or drugs that is characterized by bulls eye lesions, blisters, and erythematous plaques on the skin fitzpatrick and bernhard 1987. Management involves treating the existing infectious agent or. The erythematous vesicular lesions gradually improved. Erythema multiforme induced by alendronate sodium in a. Erythema multiforme in children the college of family. Erythema multiforme minor presents as a bulging, rashlike lesion that is red, pink, purple, or brown. Erythema multiforme em is an acute, selflimited illness characterized by the presentation and distinctive distribution of fixed red papules. In erythema multiforme minor, mucous membrane involvement is absent or mild. The rash usually starts off looking like pink or red blotches that develop over a few days into round shapes that look like targets with red, pink, and pale rings. The disease usually occurs in patients in their 3rd and 4th decade of life, but can also.
To better distinguish the clinical features of this condition from the features of erythema multiforme and serumsicknesslike reaction, and to increase awareness of this diagnosis, pediatric dermatologists at a large childrens hospital characterized the disease in a case series of 18 children. Erythema multiforme is an uncommon, selflimited symmetrical skin rash with target lesions that begins abruptly and heals in 7 to 14 days. Sometimes, a person may also get the rash after taking medicine. This means it usually resolves on its own without treatment. Clinical features, diagnosis, and treatment of erythema. Erythema multiforme is associated with an acute onset. Erythema multiforme is divided into major and minor forms and is now regarded as distinct from stevensjohnson syndrome sjs and toxic epidermal. Erythema multiforme in children pediatric em morsels.
Current recommendations suggest not to treat current recommendations suggest not to treat em minor with systemic steroids and that topical steroids might be of benefit. In erythema multiforme major, one or more mucous membranes are typically affected, most often the oral. A few people may get the rash after taking certain medications, such as seizure medicines, anesthesia medicines, nonsteroidal antiinflammatory medicines e. The term erythema multiforme em includes a wide and controversial variety of clinical expressions at the present time. In em minor, lesions often present as papules, which might enlarge and eventually form the typical target. Sometimes blisters develop and quickly break to form erosions and ulcers. It may begin at any age, but is most common in children and young adults.
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