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Erythema Multiforme

July 08, 2025 | Black & Kletz Allergy

Erythema MultiformeErythema Multiforme is a type of a rash on the skin, usually triggered by an infection or an adverse effect of a medication.  The condition gets its name from the appearance of reddish skin lesions of various forms seen at the same time.

Erythema multiforme affects less than 1% of the population.  It is most common in young adults (aged 20 – 40 years) with a modest predominance in males.  Some people are genetically predisposed to develop erythema multiforme.

Causes:

Erythema multiforme is an immunological response to either an infection or a medication, manifested on the skin.  The most common causative factors are:
  • Infections – Herpes simplex virus (most common), mycoplasma, cytomegalovirus, Epstein-Barr virus, influenza virus, coronavirus, etc.
  • Medications – Antibiotics (e.g., sulfonamides, tetracyclines, erythromycin), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen), anti-seizure medications, and vaccines.
  • Systemic disorders – Inflammatory bowel disease, hepatitis, lymphoma, leukemia, and solid organ tumors.

Diagnosis:

  • After exposure to the trigger, there is usually a prodromal period when the individual may experience mild fever, cold like symptoms, sore throat, headache, fatigue, and/or achiness.
  • A few days later, the typical skin lesions will erupt.  These lesions may be in the form of red papules (i.e., small raised bumps), vesicles (i.e., blisters filled with clear fluid), ulcers (i.e., skin sores), etc.
  • Characteristic lesions are ‘bulls-eye’ target lesions with a central dusky area, surrounded by a pale edematous area and a peripheral reddish ring, demarcating it from the surrounding normal skin.
  • Atypical lesions are raised with poorly defined borders and/or fewer zones of color variation.
  • Several lesions in different developmental stages may be seen at the same time.
  • The skin lesions are usually symmetrical, begin at the periphery and spread centrally.  The skin lesions usually have a predilection to extensor surfaces (i.e., outer side of the limbs)
  • Skin lesions may be very itchy, painful, and/or swollen.
  • Confirmation of the diagnosis may require a skin biopsy.
  • Tests for infections, especially herpes simplex virus, are needed.

Types:

There are 2 types of erythema multiforme:
  1. Erythema multiforme minor – Mild form of the illness that only affects the skin and causes a rash.
  2. Erythema multiforme major – Most severe form of the condition which may be life-threatening because it causes large areas of the skin to blister and peel.  This type affects the mucus membranes in the mouth, eyes, and genitals.  Individuals usually have systemic symptoms such as fevers and/or joint pain.

Erythema multiforme is not contagious.  The lesions, blisters, or rash on the skin cannot spread from person to person.  The viruses and other agents that caused the infection, however, can spread from one person to another.

Treatment:

  • Most cases of erythema multiforme are mild and self-limiting and usually resolve spontaneously after a few days or weeks.
  • Antihistamines and topical corticosteroid medications are helpful in relieving the itching and discomfort associated with more severe skin lesions.
  • Antiseptic and local anesthetic mouthwashes may help relieve the pain and irritation associated with mucus membrane lesions inside the mouth.
  • Antihistamine or anti-inflammatory eye drops can treat redness, burning, and/or excessive tearing of the eyes.
  • Proper care of skin lesions such as avoidance of scratching will help prevent the spread of infections.
  • Most severe cases may need a course of systemic corticosteroids such as oral prednisone.
  • Recurrent cases are usually treated with 6 months or more of continuous oral antiviral medications such as acyclovir.

Prevention:

  • General hand and respiratory hygiene is important in order to reduce the risk of contracting viral and bacterial infections.
  • Avoiding medications that had previously caused adverse reactions in the past.
The board certified allergy specialists at Black & Kletz Allergy have 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean, VA offices are also Metro accessible.  The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  The allergists at Black & Kletz Allergy diagnose and treat both pediatric and adult patients.  To make an appointment, please call our office or you may click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy have been helping patients with allergic skin rashes, hives (i.e., urticaria), eczema (i.e., atopic dermatitis), as well as other causes of allergies including hay fever (i.e., allergic rhinitis), asthma, sinus disease, food allergies, medication allergies, insect sting allergies, and immunological disorders for more than 50 years.  If you suffer from an allergic skin rash or any other type of allergies it is our mission to improve your quality of life by minimizing or preventing your unwanted and annoying allergy symptoms.

McLean, VA Location

1420 SPRINGHILL ROAD, SUITE 350

MCLEAN, VA 22102

PHONE: (703) 790-9722

FAX: (703) 893-8666

Washington, D.C. Location

2021 K STREET, N.W., SUITE 524

WASHINGTON, D.C. 20006

PHONE: (202) 466-4100

FAX: (202) 296-6622

Manassas, VA Location

7818 DONEGAN DRIVE

MANASSAS, VA 20109

PHONE: (703) 361-6424

FAX: (703) 361-2472


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