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Erythema Multiforme

Erythema Multiforme is a topic covered in the 5-Minute Emergency Consult.

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  • A rash caused by a hypersensitivity reaction:
    • May occur in response to various medications, infections, or other illness
  • Erythema multiforme (EM) minor:
    • Typical target lesions
    • Edematous papules
    • Usually distributed peripherally
    • Benign, self-limited rash generally not associated with acute, serious illness
  • EM major
    • Also called bullous EM
    • Target lesions
    • Edematous papules
    • Also with peripheral distribution
    • Involves 1 or more mucous membranes
    • <10% total body surface area of epidermal detachment
  • Differentiate from:
    • Stevens–Johnson syndrome (SJS):
      • Also <10% TBSA epidermal detachment
      • Often widespread blisters over trunk and face
      • Mucosal involvement
    • Toxic epidermal necrolysis (TEN)
      • >30% TBSA epidermal detachment
    • EM is now considered a different entity from SJS and EM
  • Most often affects children and young adults (>50% younger than 20 yr)
  • Males are affected more often than females.


  • Hypersensitivity reaction, probably transient autoimmune defect
  • Herpes simplex virus (HSV) is the most common precipitant (>70%).
  • Other causes include:
    • Idiopathic
    • Medications
      • Penicillin
      • Sulfur based
      • Phenytoin
      • Barbiturates
      • NSAIDs
    • Vaccines
      • Diphtheria—tetanus
      • Hepatitis B
      • Smallpox
    • Malignancy
    • Infection
      • HIV
      • CMV
      • Hepatitis C
      • Mycoplasma infections

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Rosen, Peter, et al., editors. "Erythema Multiforme." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307319/all/Erythema_Multiforme.
Erythema Multiforme. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307319/all/Erythema_Multiforme. Accessed April 26, 2019.
Erythema Multiforme. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307319/all/Erythema_Multiforme
Erythema Multiforme [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307319/all/Erythema_Multiforme.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Erythema Multiforme ID - 307319 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307319/all/Erythema_Multiforme PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -