Erythema multiforme

Synonym(s)

Erythema exudativum; erythema polymorphe

Hebra's disease;

Erythema Exudativum
Erythema multiforme. Target-like papules on the palm

Definition

Acute inflammatory disorder related to numerous factors, characterized by distinctive clinical eruption, with hallmark of iris or target lesion

Pathogenesis

Unclear; herpes-associated disease appears to represent the result of a cell-mediated immune reaction associated with herpes simplex virus (HSV) antigen becoming violaceous and forming concentric target lesion; lesions appear predominantly on the extensor surfaces of acral extremities and spread centripetally; mild erosions of one mucosal surface; palms, neck, and face frequently involved Erythema multiforme major variant: prodrome of moderate fever, general discomfort, cough, sore throat, vomiting, chest pain, and diarrhea, usually for 1-14 days preceding the eruption; skin lesions same as with erythema multiforme minor; severe erosions of at least 2 mucosal surfaces; generalized lymphadenopathy

Differential diagnosis

Stevens-Johnson syndrome; toxic epidermal necrolysis; Henoch-Schonlein purpura; urticaria; viral exanthem; Kawasaki disease; figurate erythema; fixed drug eruption; lupus erythematosus; primary her-petic gingivostomatitis; Behcet's disease; aphthous stomatitis

Therapy

Antihistamines, first generation; pred-nisone; herpes simplex virus prophylaxis with valacyclovir, if more than 4-5 episodes per year

References

Salman SM, Kibbi AG (2002) Vascular reactions in children. Clinics in Dermatology 2o(1):11-15

Clinical manifestation

Most commonly associated with herpes simplex virus infection; also associated with other infections, drug ingestion, rheumatic diseases, vasculitides, non-Hodgkin's lymphoma, leukemia, multiple myeloma, myeloid metaplasia, polycythemia Erythema multiforme minor variant: occasional mild flu-like prodrome; initial lesion dull red macule or urticarial plaque in the center, with small papule, vesicle, or bulla sometimes developing; raised, pale ring with edematous; periphery gradually

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