Erythema multiforme (EM) is an acute, immune-mediated disorder affecting the skin and/or mucous membranes, including the oral cavity. Target or iris lesions distributed symmetrically on the extremities and trunk characterize the condition. Infections are the most common cause of EM and the most frequently implicated infectious agent causing clinical disease is the herpes simplex virus. The diagnosis of EM is typically based on the patient’s history and clinical findings. Management involves controlling the underlying infection or causative agent, symptom control, and adequate hydration. The epidemiology, pathogenesis, clinical features, diagnosis, and treatment of EM are reviewed in this article.
Key points
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Erythema multiforme (EM) is a widespread hypersensitivity reaction that occurs with varying degrees of severity.
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Herpes simplex virus (HSV) infection is the most common precipitator of EM, and the possibility of HSV-induced disease should be considered in all patients.
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The history of lesion eruption and related clinical findings provides the most important information for the diagnosis of EM. Patients should be queried regarding prodromal symptoms as well as recent introduction of any new medications.
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The clinical course of EM is usually self-limiting, resolving within weeks without significant sequelae. However, in a minority of cases, the disease recurs frequently over the course of years.
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Most patients with EM can be managed with symptomatic therapy alone. However, patients with severe EM may require hospitalization for hydration, analgesia, antiviral therapy, and systemic steroids.
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