Skip to main content
SpringerLink
Log in

Erythema Multiforme

  • Chapter
  • First Online:
Life-Threatening Rashes

Abstract

Erythema multiforme is an uncommon, acute or recurrent, widespread, immune-mediated, mucocutaneous hypersensitivity syndrome of varying severity. It is most commonly triggered by herpes simplex virus infection but may also be precipitated by a host of other conditions or exposures. The rash is characterized by polymorphous, acrally distributed lesions with a characteristic targetoid appearance. Erythema multiforme major is the rarer form and defined by oral, genital, or ocular mucosal erosions or bullae in addition to the classic lesions. This is likely a distinct entity from the clinically similar Stevens-Johnson syndrome. Erythema multiforme is generally self-limited and resolves in 3–6 weeks, and symptomatic therapy is all that is often required.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Bibliography

  1. Samim F, et al. Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment. Dent Clin N Am. 2013;57(4):583–96.

    Article  PubMed  Google Scholar 

  2. Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol. 2012;51(8):889–902.

    Article  PubMed  Google Scholar 

  3. Lamoreux MR, Sternbach MR, Hsu WT. Erythema multiforme. Am Fam Physician. 2006;74(11):1883–8.

    PubMed  Google Scholar 

  4. Tomasini C, et al. From erythema multiforme to toxic epidermal necrolysis. Same spectrum or different diseases? G Ital Dermatol Venereol. 2014;149(2):243–61.

    PubMed  CAS  Google Scholar 

  5. Schneider G, et al. A systematic review of validated methods for identifying erythema multiforme major/minor/not otherwise specified, Stevens-Johnson syndrome, or toxic epidermal necrolysis using administrative and claims data. Pharmacoepidemiol Drug Saf. 2012;21(Suppl 1):236–9.

    Article  PubMed  Google Scholar 

  6. Watanabe R, et al. Critical factors differentiating erythema multiforme majus from Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Eur J Dermatol. 2011;21(6):889–94.

    PubMed  Google Scholar 

  7. Williams PM, Conklin RJ. Erythema multiforme: a review and contrast from Stevens-Johnson syndrome/toxic epidermal necrolysis. Dent Clin N Am. 2005;49(1):67–76. viii

    Article  PubMed  Google Scholar 

  8. Kamala KA, Ashok L, Annigeri RG. Herpes associated erythema multiforme. Contemp Clin Dent. 2011;2(4):372–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Aurelian L, Ono F, Burnett J. Herpes simplex virus (HSV)-associated erythema multiforme (HAEM): a viral disease with an autoimmune component. Dermatol Online J. 2003;9(1):1.

    PubMed  CAS  Google Scholar 

  10. Singla R, Brodell RT. Erythema multiforme due to herpes simplex virus. Recurring target lesions are the clue to diagnosis. Postgrad Med. 1999;106(5):151–4.

    Article  PubMed  CAS  Google Scholar 

  11. Langley A, et al. Erythema multiforme in children and mycoplasma pneumoniae aetiology. J Cutan Med Surg. 2016;20(5):453–7.

    Article  PubMed  CAS  Google Scholar 

  12. Vargas-Hitos JA, Manzano-Gamero MV, Jimenez-Alonso J. Erythema multiforme associated with mycoplasma pneumoniae. Infection. 2014;42(4):797–8.

    Article  PubMed  CAS  Google Scholar 

  13. Schalock PC, Brennick JB, Dinulos JG. Mycoplasma pneumoniae infection associated with bullous erythema multiforme. J Am Acad Dermatol. 2005;52(4):705–6.

    Article  PubMed  Google Scholar 

  14. Petrosino MI, et al. Erythema multiforme syndrome associated with acute acquired cytomegalovirus infection. Arch Med Sci. 2016;12(3):684–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gallina L, et al. Erythema multiforme after orf virus infection. Epidemiol Infect. 2016;144(1):88–9.

    Article  PubMed  CAS  Google Scholar 

  16. Woolley IJ, Korman TM. Acute HIV infection presenting as erythema multiforme in a 45-year-old heterosexual man. Med J Aust. 2015;203(3):137.

    Article  PubMed  Google Scholar 

  17. Turnbull N, et al. Persistent erythema multiforme associated with Epstein-Barr virus infection. Clin Exp Dermatol. 2014;39(2):154–7.

    Article  PubMed  CAS  Google Scholar 

  18. Park IH, et al. A case of erythema multiforme followed by herpes zoster. Infection. 2014;42(4):799–800.

    Article  PubMed  CAS  Google Scholar 

  19. Lee YB, et al. Two cases of erythema multiforme associated with molluscum contagiosum. Int J Dermatol. 2009;48(6):659–60.

    Article  PubMed  Google Scholar 

  20. Olut AI, et al. Erythema multiforme associated with acute hepatitis B virus infection. Clin Exp Dermatol. 2006;31(1):137–8.

    Article  PubMed  CAS  Google Scholar 

  21. Gutierrez-Galhardo MC, et al. Erythema multiforme associated with sporotrichosis. J Eur Acad Dermatol Venereol. 2005;19(4):507–9.

    Article  PubMed  CAS  Google Scholar 

  22. Fuhrman L. Dermatological manifestations of hepatitis C. Dermatol Nurs. 2000;12(3):175–80. 184-6

    PubMed  CAS  Google Scholar 

  23. Vilas-Sueiro A, et al. Erythema multiforme associated with phenytoin and cranial radiation therapy (EMPACT syndrome) in a patient with lung Cancer. Actas Dermosifiliogr. 2016;107(2):169–70.

    Article  PubMed  CAS  Google Scholar 

  24. Sahraei Z, Mirabzadeh M, Eshraghi A. Erythema multiforme associated with misoprostol: a case report. Am J Ther. 2016;23(5):e1230–3.

    Article  PubMed  Google Scholar 

  25. Sawamura S, et al. Crizotinib-associated erythema multiforme in a lung cancer patient. Drug Discov Ther. 2015;9(2):142–3.

    Article  PubMed  CAS  Google Scholar 

  26. Massot A, Gimenez-Arnau A. Cutaneous adverse drug reaction type erythema multiforme major induced by eslicarbazepine. J Pharmacol Pharmacother. 2014;5(4):271–4.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Edwards D, et al. Erythema multiforme major following treatment with infliximab. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(2):e36–40.

    Article  PubMed  Google Scholar 

  28. Isik SR, et al. Multidrug-induced erythema multiforme. J Investig Allergol Clin Immunol. 2007;17(3):196–8.

    PubMed  CAS  Google Scholar 

  29. Layton D, et al. Serious skin reactions and selective COX-2 inhibitors: a case series from prescription-event monitoring in England. Drug Saf. 2006;29(8):687–96.

    Article  PubMed  CAS  Google Scholar 

  30. Moisidis C, Mobus V. Erythema multiforme major following docetaxel. Arch Gynecol Obstet. 2005;271(3):267–9.

    Article  PubMed  CAS  Google Scholar 

  31. Carrillo-Jimenez R, Zogby M, Treadwell TL. Erythema multiforme associated with bupropion use. Arch Intern Med. 2001;161(12):1556.

    Article  PubMed  CAS  Google Scholar 

  32. Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331(19):1272–85.

    Article  PubMed  CAS  Google Scholar 

  33. Schofield JK, et al. Recurrent erythema multiforme: tissue typing in a large series of patients. Br J Dermatol. 1994;131(4):532–5.

    Article  PubMed  CAS  Google Scholar 

  34. Khalil I, et al. HLA DQB1*0301 allele is involved in the susceptibility to erythema multiforme. J Invest Dermatol. 1991;97(4):697–700.

    Article  PubMed  CAS  Google Scholar 

  35. Grunnet KM, et al. Autoimmune progesterone dermatitis manifesting as mucosal erythema multiforme in the setting of HIV infection. JAAD Case Rep. 2017;3(1):22–4.

    Article  PubMed  Google Scholar 

  36. Torchia D, Romanelli P, Kerdel FA. Erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis associated with lupus erythematosus. J Am Acad Dermatol. 2012;67(3):417–21.

    Article  PubMed  Google Scholar 

  37. Doherty C, Ulitsky O, Petronic-Rosic V. Erythema multiforme-like presentation of chronic graft versus host disease. J Am Acad Dermatol. 2008;59(5 Suppl):S127–8.

    Article  PubMed  Google Scholar 

  38. Ghosh I, et al. Erythema multiforme associated with metastatic breast cancer. Indian J Dermatol. 2013;58(6):485–6.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ohtani T, Deguchi M, Aiba S. Erythema multiforme-like lesions associated with lesional infiltration of tumor cells occurring with adult T-cell lymphoma/leukemia. Int J Dermatol. 2008;47(4):390–2.

    Article  PubMed  Google Scholar 

  40. Tzovaras V, et al. Persistent erythema multiforme in a patient with extrahepatic cholangiocarcinoma. Oncology. 2007;73(1–2):127–9.

    Article  PubMed  Google Scholar 

  41. Davidson DM, Jegasothy BV. Atypical erythema multiforme--a marker of malignancy? Report of a case occurring with renal cell carcinoma. Cutis. 1980;26(3):276–8.

    PubMed  CAS  Google Scholar 

  42. Monastirli A, et al. Erythema multiforme following pneumococcal vaccination. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26(1):25–6.

    Google Scholar 

  43. Storie EB, Perry A. Erythema multiforme following smallpox vaccination. Mil Med. 2014;179(1):e113–5.

    Article  PubMed  Google Scholar 

  44. Wiwanitkit S, Wiwanitkit V. Erythema multiforme after rabies vaccination. Pediatr Dermatol. 2013;30(6):e299.

    Article  PubMed  Google Scholar 

  45. Samad I, Chong VH, Lim SS. Erythema multiforme secondary to H1N1 vaccine. South Med J. 2011;104(1):73–4.

    Article  PubMed  Google Scholar 

  46. Katoulis AC, et al. Erythema multiforme following vaccination for human papillomavirus. Dermatology. 2010;220(1):60–2.

    Article  PubMed  CAS  Google Scholar 

  47. Karincaoglu Y, et al. Erythema multiforme due to diphtheria-pertussis-tetanus vaccine. Pediatr Dermatol. 2007;24(3):334–5.

    Article  PubMed  Google Scholar 

  48. Studdiford J, et al. Erythema multiforme after meningitis vaccine: patient safety concerns with repeat immunization. Pharmacotherapy. 2006;26(11):1658–61.

    Article  PubMed  Google Scholar 

  49. Bernardini ML, et al. Erythema multiforme following live attenuated trivalent measles-mumps-rubella vaccine. Acta Derm Venereol. 2006;86(4):359–60.

    Article  PubMed  Google Scholar 

  50. Loche F, et al. Erythema multiforme associated with hepatitis B immunization. Clin Exp Dermatol. 2000;25(2):167–8.

    Article  PubMed  CAS  Google Scholar 

  51. Raghunath RS, Venables ZC, Millington GW. The menstrual cycle and the skin. Clin Exp Dermatol. 2015;40(2):111–5.

    Article  PubMed  CAS  Google Scholar 

  52. Koley S, et al. Erythema multiforme following application of hair dye. Indian J Dermatol. 2012;57(3):230–2.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kim H, et al. Erythema multiforme major due to occupational exposure to the herbicides alachlor and butachlor. Emerg Med Australas. 2011;23(1):103–5.

    Article  PubMed  Google Scholar 

  54. Nasabzadeh TJ, et al. Recurrent erythema multiforme triggered by progesterone sensitivity. J Cutan Pathol. 2010;37(11):1164–7.

    Article  PubMed  Google Scholar 

  55. Yoshitake T, et al. Erythema multiforme and Stevens-Johnson syndrome following radiotherapy. Radiat Med. 2007;25(1):27–30.

    Article  PubMed  Google Scholar 

  56. Techasatian L, et al. Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in children: 20 years study in a tertiary care hospital. World J Pediatr. 2017;13(3):255–60.

    Article  PubMed  CAS  Google Scholar 

  57. Abdulah R, et al. Incidence, causative drugs, and economic consequences of drug-induced SJS, TEN, and SJS-TEN overlap and potential drug-drug interactions during treatment: a retrospective analysis at an Indonesian referral hospital. Ther Clin Risk Manag. 2017;13:919–25.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Miliszewski MA, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: an analysis of triggers and implications for improving prevention. Am J Med. 2016;129(11):1221–5.

    Article  PubMed  Google Scholar 

  59. Hidajat C, LoicD. Drug-mediated rash: erythema multiforme versus Stevens-Johnson syndrome. BMJ Case Rep. 2014; 2014.

    Google Scholar 

  60. Weston WL. Herpes-associated erythema multiforme. J Invest Dermatol. 2005;124(6):xv–xvi.

    Article  PubMed  CAS  Google Scholar 

  61. Terraneo L, et al. Unusual eruptions associated with mycoplasma pneumoniae respiratory infections: review of the literature. Dermatology. 2015;231(2):152–7.

    Article  PubMed  Google Scholar 

  62. Ilkit M, Durdu M, Karakas M. Cutaneous id reactions: a comprehensive review of clinical manifestations, epidemiology, etiology, and management. Crit Rev Microbiol. 2012;38(3):191–202.

    Article  PubMed  CAS  Google Scholar 

  63. Chan HL, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol. 1990;126(1):43–7.

    Article  PubMed  CAS  Google Scholar 

  64. Siedner-Weintraub Y, et al. Paediatric erythema multiforme: epidemiological, clinical and laboratory characteristics. Acta Derm Venereol. 2017;97(4):489–92.

    Article  PubMed  Google Scholar 

  65. Moreau JF, et al. Epidemiology of ophthalmologic disease associated with erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis in hospitalized children in the United States. Pediatr Dermatol. 2014;31(2):163–8.

    Article  PubMed  Google Scholar 

  66. Kamaliah MD, et al. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in northeastern Malaysia. Int J Dermatol. 1998;37(7):520–3.

    Article  PubMed  CAS  Google Scholar 

  67. Pollack BP, Sapkota B, Haun PL. Activating transcription factor 3 (ATF3) expression is increased in erythema multiforme and is regulated by IFN-gamma in human keratinocytes. Exp Dermatol. 2010;19(8):e310–3.

    Article  PubMed  Google Scholar 

  68. Gober MD, et al. The herpes simplex virus gene Pol expressed in herpes-associated erythema multiforme lesions upregulates/activates SP1 and inflammatory cytokines. Dermatology. 2007;215(2):97–106.

    Article  PubMed  CAS  Google Scholar 

  69. Ono F, et al. CD34+ cells in the peripheral blood transport herpes simplex virus DNA fragments to the skin of patients with erythema multiforme (HAEM). J Invest Dermatol. 2005;124(6):1215–24.

    Article  PubMed  CAS  Google Scholar 

  70. Kokuba H, et al. Erythema multiforme lesions are associated with expression of a herpes simplex virus (HSV) gene and qualitative alterations in the HSV-specific T-cell response. Br J Dermatol. 1998;138(6):952–64.

    Article  PubMed  CAS  Google Scholar 

  71. Aurelian L, Kokuba H, Burnett JW. Understanding the pathogenesis of HSV-associated erythema multiforme. Dermatology. 1998;197(3):219–22.

    Article  PubMed  CAS  Google Scholar 

  72. Imafuku S, et al. Expression of herpes simplex virus DNA fragments located in epidermal keratinocytes and germinative cells is associated with the development of erythema multiforme lesions. J Invest Dermatol. 1997;109(4):550–6.

    Article  PubMed  CAS  Google Scholar 

  73. Kokuba H, Aurelian L, Burnett J. Herpes simplex virus associated erythema multiforme (HAEM) is mechanistically distinct from drug-induced erythema multiforme: interferon-gamma is expressed in HAEM lesions and tumor necrosis factor-alpha in drug-induced erythema multiforme lesions. J Invest Dermatol. 1999;113(5):808–15.

    Article  PubMed  CAS  Google Scholar 

  74. Said S, Golitz L. Vesiculobullous eruptions of the oral cavity. Otolaryngol Clin N Am. 2011;44(1):133–60. vi

    Article  Google Scholar 

  75. Scully C, Bagan J. Oral mucosal diseases: erythema multiforme. Br J Oral Maxillofac Surg. 2008;46(2):90–5.

    Article  PubMed  Google Scholar 

  76. Farthing P, Bagan JV, Scully C. Mucosal disease series. Number IV. Erythema multiforme. Oral Dis. 2005;11(5):261–7.

    Article  PubMed  CAS  Google Scholar 

  77. Ayangco L, Rogers RS 3rd. Oral manifestations of erythema multiforme. Dermatol Clin. 2003;21(1):195–205.

    Article  PubMed  Google Scholar 

  78. Dryankova MM, Popova CL. Erythema multiforme--oral manifestations. Folia Med (Plovdiv). 2001;43(1–2):57–63.

    CAS  Google Scholar 

  79. Mignogna MD, et al. Nikolsky’s sign on the gingival mucosa: a clinical tool for oral health practitioners. J Periodontol. 2008;79(12):2241–6.

    Article  PubMed  Google Scholar 

  80. Celentano A, et al. Oral erythema multiforme: trends and clinical findings of a large retrospective European case series. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(6):707–16.

    Article  PubMed  Google Scholar 

  81. Chang YS, et al. Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis: acute ocular manifestations, causes, and management. Cornea. 2007;26(2):123–9.

    Article  PubMed  Google Scholar 

  82. Schofield JK, Tatnall FM, Leigh IM. Recurrent erythema multiforme: clinical features and treatment in a large series of patients. Br J Dermatol. 1993;128(5):542–5.

    Article  PubMed  CAS  Google Scholar 

  83. Wetter DA, Davis MD. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. J Am Acad Dermatol. 2010;62(1):45–53.

    Article  PubMed  CAS  Google Scholar 

  84. Dumas V, et al. Recurrent erythema multiforme and chronic hepatitis C: efficacy of interferon alpha. Br J Dermatol. 2000;142(6):1248–9.

    Article  PubMed  CAS  Google Scholar 

  85. Cohen PR. Herpes simplex virus-induced recurrent erythema multiforme. J Gt Houst Dent Soc. 1995;66(9):17–8.

    PubMed  CAS  Google Scholar 

  86. Brice SL, et al. The herpes-specific immune response of individuals with herpes-associated erythema multiforme compared with that of individuals with recurrent herpes labialis. Arch Dermatol Res. 1993;285(4):193–6.

    Article  PubMed  CAS  Google Scholar 

  87. Wanner M, et al. Persistent erythema multiforme and CMV infection. J Drugs Dermatol. 2007;6(3):333–6.

    PubMed  Google Scholar 

  88. Ladizinski B, Lee KC. Oral ulcers and targetoid lesions on the palms. JAMA. 2014;311(11):1152–3.

    Article  PubMed  CAS  Google Scholar 

  89. Stollery N. Annular lesions. Practitioner. 2012;256(1752):30–1.

    PubMed  Google Scholar 

  90. Wolf R, Lipozencic J. Shape and configuration of skin lesions: targetoid lesions. Clin Dermatol. 2011;29(5):504–8.

    Article  PubMed  Google Scholar 

  91. Hughey LC. Approach to the hospitalized patient with targetoid lesions. Dermatol Ther. 2011;24(2):196–206.

    Article  PubMed  Google Scholar 

  92. Loh KY. A ‘target’ skin lesion. Aust Fam Physician. 2008;37(11):946.

    PubMed  Google Scholar 

  93. Keller N, et al. Nonbullous erythema multiforme in hospitalized children: a 10-year survey. Pediatr Dermatol. 2015;32(5):701–3.

    Article  PubMed  Google Scholar 

  94. Elfatoiki FZ, Chiheb S. Atypical erythema multiforme. Pan Afr Med J. 2015;20:436.

    PubMed  PubMed Central  Google Scholar 

  95. Katta R. Taking aim at erythema multiforme. How to spot target lesions and less typical presentations. Postgrad Med. 2000;107(1):87–90.

    Article  PubMed  CAS  Google Scholar 

  96. Gessesse B, Mulugeta E. Multiforme skin lesions in Yekatit 12 Hospital, 1976-1994. Ethiop Med J. 2000;38(1):43–7.

    PubMed  CAS  Google Scholar 

  97. Feller L, et al. Immunopathogenic oral diseases: an overview focusing on pemphigus vulgaris and mucous membrane pemphigoid. Oral Health Prev Dent. 2017;15(2):177–82.

    PubMed  Google Scholar 

  98. Caccavale S, Ruocco E. Acral manifestations of systemic diseases: drug-induced and infectious diseases. Clin Dermatol. 2017;35(1):55–63.

    Article  PubMed  Google Scholar 

  99. Yong AA, Tey HL. Paraneoplastic pemphigus. Australas J Dermatol. 2013;54(4):241–50.

    Article  PubMed  Google Scholar 

  100. Yachoui R, Cronin PM. Systemic lupus erythematosus associated with erythema multiforme-like lesions. Case Rep Rheumatol. 2013;2013:212145.

    PubMed  PubMed Central  Google Scholar 

  101. Rosenkrantz W. Immune-mediated dermatoses. Vet Clin North Am Equine Pract. 2013;29(3):607–13.

    Article  PubMed  Google Scholar 

  102. Mathur AN, Mathes EF. Urticaria mimickers in children. Dermatol Ther. 2013;26(6):467–75.

    Article  PubMed  Google Scholar 

  103. Lo Schiavo A, et al. Bullous pemphigoid: etiology, pathogenesis, and inducing factors: facts and controversies. Clin Dermatol. 2013;31(4):391–9.

    Article  PubMed  Google Scholar 

  104. Emer JJ, et al. Urticaria multiforme. J Clin Aesthet Dermatol. 2013;6(3):34–9.

    PubMed  PubMed Central  Google Scholar 

  105. Beer K, Beer MS, Appelbaum D. Granuloma annulare masquerading as erythema multiforme. J Drugs Dermatol. 2013;12(6):694–7.

    PubMed  Google Scholar 

  106. Kempton J, et al. Misdiagnosis of erythema multiforme: a literature review and case report. Pediatr Dent. 2012;34(4):337–42.

    PubMed  Google Scholar 

  107. Rochael MC, et al. Sweet’s syndrome: study of 73 cases, emphasizing histopathological findings. An Bras Dermatol. 2011;86(4):702–7.

    Article  PubMed  Google Scholar 

  108. Guerrier G, Daronat JM, Deltour R. Unusual presentation of acute annular urticaria: a case report. Case Rep Dermatol Med. 2011;2011:604390.

    PubMed  PubMed Central  Google Scholar 

  109. Ogilvie P, et al. Pemphigoid gestationis without blistersHautarzt. 2000;51(1):25–30.

    Article  PubMed  CAS  Google Scholar 

  110. Cretu A, et al. Erythema multiforme--etiopathogenic, clinical and therapeutic aspects. Rev Med Chir Soc Med Nat Iasi. 2015;119(1):55–61.

    PubMed  Google Scholar 

  111. Shabahang L. Characteristics of adult outpatients with erythema multiforme. Pak J Biol Sci. 2010;13(22):1106–9.

    Article  PubMed  Google Scholar 

  112. Leaute-Labreze C, et al. Diagnosis, classification, and management of erythema multiforme and Stevens-Johnson syndrome. Arch Dis Child. 2000;83(4):347–52.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  113. Fukiwake N, et al. Detection of autoantibodies to desmoplakin in a patient with oral erythema multiforme. Eur J Dermatol. 2007;17(3):238–41.

    PubMed  CAS  Google Scholar 

  114. Carrozzo M, Togliatto M, Gandolfo S. Erythema multiforme. A heterogeneous pathologic phenotype. Minerva Stomatol. 1999;48(5):217–26.

    PubMed  CAS  Google Scholar 

  115. Cote B, et al. Clinicopathologic correlation in erythema multiforme and Stevens-Johnson syndrome. Arch Dermatol. 1995;131(11):1268–72.

    Article  PubMed  CAS  Google Scholar 

  116. Howland WW, et al. Erythema multiforme: clinical, histopathologic, and immunologic study. J Am Acad Dermatol. 1984;10(3):438–46.

    Article  PubMed  CAS  Google Scholar 

  117. Tatnall FM, Schofield JK, Leigh IM. A double-blind, placebo-controlled trial of continuous acyclovir therapy in recurrent erythema multiforme. Br J Dermatol. 1995;132(2):267–70.

    Article  PubMed  CAS  Google Scholar 

  118. Sanchis JM, et al. Erythema multiforme: diagnosis, clinical manifestations and treatment in a retrospective study of 22 patients. J Oral Pathol Med. 2010;39(10):747–52.

    Article  PubMed  CAS  Google Scholar 

  119. AlFar MY, et al. The use of corticosteroids in management of herpes associated erythema multiforme. J Pak Med Assoc. 2015;65(12):1351–3.

    PubMed  Google Scholar 

  120. Staikuniene J, Staneviciute J. Long-term valacyclovir treatment and immune modulation for herpes-associated erythema multiforme. Cent Eur J Immunol. 2015;40(3):387–90.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Routt E, Levitt J. Famciclovir for recurrent herpes-associated erythema multiforme: a series of three cases. J Am Acad Dermatol. 2014;71(4):e146–7.

    Article  PubMed  Google Scholar 

  122. Inoue K, et al. Herpes virus-associated erythema multiforme following valacyclovir and systemic corticosteroid treatment. Eur J Dermatol. 2009;19(4):386–7.

    PubMed  Google Scholar 

  123. Kerob D, et al. Recurrent erythema multiforme unresponsive to acyclovir prophylaxis and responsive to valacyclovir continuous therapy. Arch Dermatol. 1998;134(7):876–7.

    Article  PubMed  CAS  Google Scholar 

  124. Davis MD, Rogers RS 3rd, Pittelkow MR. Recurrent erythema multiforme/Stevens-Johnson syndrome: response to mycophenolate mofetil. Arch Dermatol. 2002;138(12):1547–50.

    Article  PubMed  Google Scholar 

  125. Viard I, et al. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Science. 1998;282(5388):490–3.

    Article  PubMed  CAS  Google Scholar 

  126. Muller CS, Hinterberger LR, Vogt T. Successful treatment of Rowell syndrome using oral cyclosporine A. Int J Dermatol. 2011;50(8):1020–2.

    Article  PubMed  Google Scholar 

  127. Oak AS, Seminario-Vidal L, Sami N. Treatment of antiviral-resistant recurrent erythema multiforme with dapsone. Dermatol Ther. 2017;30(2).

    Google Scholar 

  128. Kieny A, Lipsker D. Efficacy of interferon in recurrent valaciclovir-refractory erythema multiforme in a patient not infected with hepatitis C virus. Clin Exp Dermatol. 2016;41(6):648–50.

    Article  PubMed  CAS  Google Scholar 

  129. Chen CW, et al. Persistent erythema multiforme treated with thalidomide. Am J Clin Dermatol. 2008;9(2):123–7.

    Article  PubMed  Google Scholar 

  130. Hoffman LD, Hoffman MD. Dapsone in the treatment of persistent erythema multiforme. J Drugs Dermatol. 2006;5(4):375–6.

    PubMed  Google Scholar 

  131. Geraminejad P, et al. Severe erythema multiforme responding to interferon alfa. J Am Acad Dermatol. 2006;54(2 Suppl):S18–21.

    Article  PubMed  Google Scholar 

  132. Bakis S, Zagarella S. Intermittent oral cyclosporin for recurrent herpes simplex-associated erythema multiforme. Australas J Dermatol. 2005;46(1):18–20.

    Article  PubMed  Google Scholar 

  133. Conejo-Mir JS, et al. Thalidomide as elective treatment in persistent erythema multiforme; report of two cases. J Drugs Dermatol. 2003;2(1):40–4.

    PubMed  Google Scholar 

  134. Mahendran R, Grant JW, Norris PG. Dapsone-responsive persistent erythema multiforme. Dermatology. 2000;200(3):281–2.

    Article  PubMed  CAS  Google Scholar 

  135. Kurkcuoglu N, Alli N. Cimetidine prevents recurrent erythema multiforme major resulting from herpes simplex virus infection. J Am Acad Dermatol. 1989;21(4 Pt 1):814–5.

    Article  PubMed  CAS  Google Scholar 

  136. Jones RR. Azathioprine therapy in the management of persistent erythema multiforme. Br J Dermatol. 1981;105(4):465–7.

    Article  PubMed  CAS  Google Scholar 

  137. Viarnaud A, et al. Severe sequelae of erythema multiforme: three cases. J Eur Acad Dermatol Venereol. 2017.

    Google Scholar 

  138. Sokumbi O, el-Azhary RA, Langman LJ. Therapeutic dose monitoring of mycophenolate mofetil in dermatologic diseases. J Am Acad Dermatol. 2013;68(1):36–40.

    Article  PubMed  CAS  Google Scholar 

  139. Dore J, Salisbury RE. Morbidity and mortality of mucocutaneous diseases in the pediatric population at a tertiary care center. J Burn Care Res. 2007;28(6):865–70.

    Article  PubMed  Google Scholar 

  140. Sen P, Chua SH. A case of recurrent erythema multiforme and its therapeutic complications. Ann Acad Med Singap. 2004;33(6):793–6.

    PubMed  CAS  Google Scholar 

  141. Carucci LR, Levine MS, Rubesin SE. Diffuse esophageal stricture caused by erythema multiforme major. AJR Am J Roentgenol. 2003;180(3):749–50.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Health Sciences Clinical Professor of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    David Burbulys & Kelly D. Young

  2. Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, CA, USA

    David Burbulys & Kelly D. Young

Authors
  1. David Burbulys
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelly D. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Burbulys .

Editor information

Editors and Affiliations

  1. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Emily Rose

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Burbulys, D., Young, K.D. (2018). Erythema Multiforme. In: Rose, E. (eds) Life-Threatening Rashes. Springer, Cham. https://doi.org/10.1007/978-3-319-75623-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-75623-3_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-75622-6

  • Online ISBN: 978-3-319-75623-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation