- 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.
- 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.
- ~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
- 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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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 MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/all/Erythema_Multiforme. Accessed June 5, 2023.
Erythema Multiforme. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/all/Erythema_Multiforme
Erythema Multiforme [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2023 June 05]. 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 -