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This is an acute, self-limiting and often recurrent conditions affecting the skin and mucosal surfaces. There is evidence suggesting that curculating immune complexes are important in triggering the reaction in the skin, which occurs 10-14 days following, for example, recurrent herpes simplex infections.
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Children, adolescents and young adults are principally afected. It is associated with:
In half of cases, no precipitant is found.
Symmetrically distributed erythematous papules evolve into concentric rings of varying colour. These are commonly seen on the backs of the hands, palms and forearms, but may also be seen on the feet or toes. The lesions may show central pallor associated with oedema, bullae formation and peripheral oedema. Alternatively, pallor may be accompanied by central erythema or purpura. Frank bullae represent epidermal necrosis and the separtion of this layer. Lesions often spread proximally along the limbs or affect dependent parts in prorated patients.
Severe mucosal disease is seen with Mycoplasma pneumoniae infection for example, and peripheral lesions may be few in number and difficult to discern, so that erythema multiforme may not be easily diagnosed.
Eye changes include conjunctivitis, ulceration of the cormea, uveitis or panopthalmitis, so that the opinion of an opthalmologist should be sought in the early stages of the disease. These latter features are often the most serious of the complications associated with erythema multiforme.
The Stevens-Johnson syndrome describes a very severe erythema multiforme with widespread bullous disease assocaited with oral and gential ulceration and marked constitutional symptoms.
The disease is usually self-limitting, but death can occur with the Stevens-Johnson syndrome.Care of eye and mucosal ulceration are important and in severe cases, iv fluids and feeding may be required.
Kumar & Clarke p1006