Dermatological emergencies- Erythema multiforme

Erythema multiforme (EM) has two streams: erythema multiforme minor and erythema multiforme major.

Erythema multiforme minor mostly affects men than women. About 50% of affected patients are under age of 20. The condition refers to the eruption of regular lesions which is supported by mild fever and malaise. It lasts from one to three weeks.

Erythema multiforme minor is usually caused due to certain infections like herpes simplex, viral infections, or as side effects from vaccination (e.g. smallpox, tetanus, and diphtheria). Drugs are the most rare causes of EM minor.

Erythema multiforme major is rare among average patients; however, those who suffer from human immunodeficiency virus infection are affected the most. It usually appears as mucosal eruption of erosions and blisters on lips, conjunctivae, oropharynx and/or genitalia, which is also supported by fever and prostration. The target lesions and/or acral bullae can also be present.

Erythema multiforme major is a result of drug eruption. The most common drugs that cause erythema multiforme major are antibiotics, allopurinol, anticonvulsants, and sulphonamides. Infections are the most rare causes of erythema multiforme major, but can erupt in those infected with Mycoplasma pneumoniae.

The underlying causes and complications associated with erythema multiforme are investigated through collecting skin swabs for herpes simplex and bacterial culture; full blood count, and viral titres, especially the mycoplasma.

Erythema multiforme minor can resolve within 10 days. The symptomatic treatment can include the prescription of oral antihistamines or topical corticosteroids. The bullae usually gets incised and drained.

Erythema multiforme major is more serious and challenging to treat; it requires hospitalization for supportive care. This includes mouth care which requires frequent antiseptic and analgesic mouth washes. The intravenous fluid replacement can also be done. Oral corticosteroids should be avoided.

Due to COVID-19 eruption, Centre for Medical and Surgical Dermatology offers Teledermatology appointments from Mondays to Fridays.

For more information on Teledermatology, visit the following link:

Teledermatology

For more information on drug eruptions, visit the following link:

Dermatological emergencies- Drug eruptions