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    Erythema Multiforme

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

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    Basics

    Description

    • 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.

    Etiology

    • 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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    Citation

    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 -