Erythema Multiforme: A Review of Its Characteristics, Diagnostic Criteria, and Management

Erythema multiforme is a distinctive hypersensitivity syndrome characterized by skin and mucous membrane lesions and, in its more severe forms, mucosal lesions with constitutional symptoms and, at times, visceral involvement.1,2 It is usually considered acute and self-limiting, but recent observations indicate that it may also behave as a chronic recurrent disorder in many people.1,3,4 The disorder may occur at any age, with its highest incidence in young adults 20 to 40 years of age; as many as 20% of cases are seen in children and adolescents.2 PATHOGENESIS The pathogenesis of erythema multiforme remains unknown. It appears to represent the end result of a hypersensitivity reaction to a number of infectious and other agents: viral, bacterial, protozoal, fungal, or Mycoplasma pneumoniae (Eaton agent) infection; foods or drugs; immunizations; and a variety of other systemic diseases and physical agents. Whereas drug reactions and malignancies are important causes of erythema multiforme in older persons, infectious diseases are the most common precipitants in children and young adults. The most common cause of erythema multiforme appears to be the virus of herpes simplex; a history of cold sores precedes the development of other lesions by about 3 to 14 days. Recurrences are particularly common in this form of erythema multiforme.4,5