Medical knowledge, Patient Education
Erythema Multiforme
Erythema Multiforme
Erythema multiforme is a skin rash that can also affect the lips and the inside of the mouth. Usually, the rash is mild and goes away on its own after 3–5 weeks. In some cases, the rash may come back after it has gone away. This condition most often affects young adults and children.
What are the causes?
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The cause of this condition is often unknown. It may be caused by the body’s disease-fighting system (immune system) overreacting to certain substances, which are called triggers. Some common triggers include:
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Reactions to medicines, such as NSAIDS, seizure medicines, and antibiotics.
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Infections caused by:
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The cold sore virus (herpes simplex virus, HSV).
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Bacteria.
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Fungus.
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Radiation or chemotherapy.
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Less common triggers include trauma, cold, menstruation, cancer, inflammatory bowel disease, and vaccines.
What increases the risk?
This condition is more likely to develop in:
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Males.
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People who are 20–40 years old.
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Children.
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People who inherit certain genes from their parents.
What are the signs or symptoms?
The main symptom of this condition is a skin rash. The rash:
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Develops suddenly, a few days after exposure to a trigger.
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May start as small, red, round or oval-shaped marks. Over 24–48 hours, the rash may change to bumps or raised welts that look like a target or “bull’s eye.” The bumps or welts can spread, and they may be up to about 1 inch (2.5 cm) in size.
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Usually appears first on the hands. It may spread to the forearms, trunk, face, lips, and the lining of the mouth.
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May cause skin itchiness and a burning feeling.
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Goes away after 3–5 weeks. In some cases, it may come back.
Other symptoms may be present, including:
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Pain or swelling in the joints.
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Weakness or fatigue.
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Fever.
How is this diagnosed?
This condition may be diagnosed based on:
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Your symptoms and medical history.
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A physical exam.
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Blood tests.
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Results of a skin biopsy. A skin sample is removed and tested by a specialist.
How is this treated?
Most episodes of erythema multiforme heal on their own without medical treatment.
Your health care provider will recommend removing or avoiding your triggers, if possible.
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If your trigger is an infection or other illness, you may be treated for that infection or illness.
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If your trigger is a medicine that you are taking, you and your health care provider will discuss how you can avoid taking that medicine.
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If you have lesions around your eyes, you will need to see a doctor who treats eye problems (ophthalmologist).
Your health care provider may also prescribe some medicines, such as:
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Topical steroid or topical antihistamine cream for itching.
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Oral antihistamines.
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Anesthetic and antiseptic solutions to treat mouth lesions.
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Oral steroids, such as prednisone.
Follow these instructions at home:
Skin care
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Avoid scratching your rash.
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To help relieve itchiness:
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Take cool or lukewarm baths.
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Avoid taking hot baths or showers. Hot water can make itchiness worse.
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Add dry oatmeal to your baths. You may take oatmeal baths 2–3 times a day, as needed.
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Make a paste with dry oatmeal and warm water, then put the paste on itchy areas. Let the paste dry, remove it, and then apply a moisturizer. You may do this 2–3 times a day, or as needed.
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General instructions
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If possible, avoid your triggers.
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If your trigger is a herpes virus infection, use sunscreen lotion and lip balm that contains sunscreen. Use those products every day. Doing that helps to prevent sunlight-triggered outbreaks of herpes virus.
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Take over-the-counter and prescription medicines only as told by your health care provider.
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If you have sores in your mouth or on your lips, try eating soft, bland foods or liquid foods until you feel better.
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Keep all follow-up visits. This is important.
Contact a health care provider if:
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Your rash comes back.
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You have a fever.
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You develop redness, swelling, or a burning feeling on your lips or in your mouth.
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You develop blisters on your skin or open sores on your mouth, lips, vagina, penis, or anus.
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You have blood in your urine.
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You have pain when you urinate.
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You are unable to eat or drink.
Get help right away if:
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You have changes in your vision, or you have eye symptoms, such as:
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Eye pain.
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Redness or lesions around your eye.
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Fluid draining from your eye.
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You have difficulty swallowing.
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You start drooling.
Summary
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Erythema multiforme is a skin rash. It can also affect the lips and the inside of the mouth.
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This condition usually appears first on the hands. It may spread to the forearms, trunk, face, lips, and the lining of the mouth.
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The rash goes away after 3–5 weeks. In some cases, it may come back.
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Get help right away if you have any eye pain, new lesions around your eye, or changes in your vision.
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
