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Erythema Multiforme

Erythema Multiforme is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Erythema multiforme (EM) is an acute, self-limited mucocutaneous eruption characterized by distinct targetoid lesions on the skin.
  • Although classically defined by the presence of target lesions, at various stages of evolution, EM may appear as erythematous macules, papules, vesicles, or bullae.
  • EM is considered an immune-mediated reaction, usually to infectious triggers; numerous additional triggers have been reported in the literature.
  • Ranges from relatively mild cutaneous disease (EM minor) to severe forms with significant mucosal involvement (EM major)
  • Historically viewed as a spectrum of diseases, most authors now regard EM to be a separate entity from Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). SJS and TEN are distinguished from EM by differing patterns of mucocutaneous involvement, precipitating factors, and prognosis.

Epidemiology

  • Predominantly affects healthy young adults but can affect people of all ages, including young children
  • Possible seasonal variation with increased frequency in spring and summer. The more severe form has been reported to occur more frequently in winter.
  • Recurrences are common.

Etiology

  • ~90% of cases are caused by an infectious agent, most commonly herpes simplex virus (HSV) or Mycoplasma pneumoniae.
  • <10% of cases are secondary to drug exposure. Common culprits include NSAIDs, sulfonamides, antiepileptics, and antibiotics.
  • Reported causes are numerous. Rare precipitants include the following:
    • Chemical and physical exposures
    • Immunizations
    • Autoimmune disease
  • Often, the causative factor is not identified.
  • HSV is the major cause of recurrent EM.
  • M. pneumoniae is associated with a distinct phenotype in children, characterized by more severe mucosal involvement, particularly oral and ocular, with less severe cutaneous findings. The term Mycoplasma-induced rash and mucositis, (MIRM) has been proposed to describe this particular presentation.

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Citation

Cabana, Michael D., editor. "Erythema Multiforme." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/all/Erythema_Multiforme.
Erythema Multiforme. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/all/Erythema_Multiforme. Accessed April 21, 2019.
Erythema Multiforme. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/all/Erythema_Multiforme
Erythema Multiforme [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/all/Erythema_Multiforme.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Erythema Multiforme ID - 617665 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/all/Erythema_Multiforme PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -