Erythema Multiforme

What is erythema multiforme?

Erythema multiforme is a skin reaction usually due to an infection or a medication. Erythema multiforme gets its name because it takes different forms on your skin, such as a rash, raised bumps or blisters. These lesions can come and go unexpectedly and can affect different parts of your body, including your eyes, mouth and genitals.

What are the types of erythema multiforme?

There are two types of erythema multiforme:

• Minor: Erythema multiforme minor is a mild form of the condition that only affects your skin and causes a rash. It’s unlikely to have involvement of your mucous membranes (mouth, eyes, genitals), as well as unlikely to have systemic symptoms such as fevers or chills.
• Major: Erythema multiforme major is the most severe form of the condition. It can be life-threatening because it causes large areas of your skin to blister and peel. This type affects the mucus membranes in your mouth (oral), eyes and genitals. People usually have systemic symptoms such as fevers or joint pain.

Who does erythema multiforme affect?

Erythema multiforme is a rare condition that can affect anyone, but it’s most common among children, young adults and people under the age of 40.

How does erythema multiforme affect my body?

Erythema multiforme usually causes a painful or uncomfortable rash on your skin. This rash can start small but can increase in size over time. It can be itchy and cause raised bumps on your skin. Severe forms of erythema multiforme can affect your mouth and eyes, with symptoms that make it difficult for you to eat, drink and see. Depending on the severity, you may need to be treated in the hospital. Treatment helps alleviate symptoms to get you feeling better.

What are the symptoms of erythema multiforme?

Symptoms that affect your skin could include:

• A red to purple rash that causes your skin to puff up (swell) and be painful to the touch.
• Pimple-like blisters on your skin or inside of your mouth.
• Round mark on your skin that looks like a bulls-eye on a target, with a dark center and a pale ring around it.
• Itchy skin.

Symptoms that affect your skin usually go away after two to four weeks.

Other symptoms include:

• Headache.
• Feeling tired (fatigue).
• Fever.
• Joint pain and soreness.
• Eye sensitivity, blurred vision, sore eyes and red eyes.

Depending on where a rash forms on your body, you could have additional symptoms like pain when urinating or pain when eating or drinking.

Where on my body will I experience symptoms?

The most common places on your body where you’ll experience symptoms of erythema multiforme include:

• On your skin.
• In your mouth.
• On or near your genitals.
• In and around your eyes.

What causes erythema multiforme?

The exact cause of erythema multiforme is unknown, but studies show that erythema multiforme can be triggered by:

• An infection (mycoplasma pneumoniae or herpes simplex virus).
• A medication.

A reaction to medication is a less common cause of erythema multiforme. Medications that trigger the condition vary for each person, but include:

• Antiseizure medications
• Antibiotics.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).

Is erythema multiforme contagious?

No, erythema multiforme isn’t contagious. Your symptoms, especially the lesions, blisters or rash on your skin, can’t spread from person to person. If a virus or bacteria caused your symptoms, the virus or bacteria can spread to other people, but another person might not experience symptoms of erythema multiforme.

How is erythema multiforme diagnosed?

Your provider will diagnose erythema multiforme after learning more about your symptoms and medical history, as well as doing a physical exam. Your provider will also diagnose erythema multiforme based on characteristics of your lesions that include:

• Size.
• Shape.
• Color.
• Distance between each lesion (distribution).
• Involvement of your eyes, mouth or genitals.

Your provider may need to perform a skin biopsy to diagnose erythema multiforme.

How is erythema multiforme treated?

Treatment for erythema multiforme isn’t always necessary, as symptoms can resolve on their own. If you need treatment, it could include:

• Using topical corticosteroids or oral antihistamines for itching.
• Using eye drops if symptoms affect your eyes.
• Applying topical anesthetics or oral numbing medicine for pain.
• Eating a soft or liquid diet if lesions in your mouth make eating difficult.
• Rinsing your mouth with a warm saltwater solution.
• Taking antibiotics or antiviral medications if you have an infection.
• Stopping a medication that causes erythema multiforme.

What medications treat erythema multiforme?

Medications can help treat recurring symptoms of erythema multiforme, especially if symptoms arise after a herpes flare. Common medicines to treat erythema multiforme include:

• Acyclovir.
• Valacyclovir.
• Famciclovir.

How to take care of myself/manage symptoms?

Follow your provider’s treatment plan to reduce your symptoms. Try not to scratch your skin because your fingernails can scratch the lesions and break them open, which could cause an infection. To prevent itching, use a topical cream or ointment to soothe your skin.

While it may be painful to eat or drink, make sure you eat and drink regularly to prevent malnutrition or dehydration. Change your diet to include liquids and/or soft foods. Avoid foods that are hot in temperature, acidic or spicy to prevent irritation. If you have trouble eating, contact your provider.

How can I prevent erythema multiforme?

You can’t prevent all cases of erythema multiforme, but you can reduce your risk of a flare by:

• Avoiding medicines like NSAIDs or antibiotics if they cause your flares.
• Washing your hands regularly with soap and water to prevent fungal or bacterial viruses.
• Cleaning and caring for wounds to prevent infections.
• Practicing safe sex to protect yourself and others from the herpes simplex virus.

Talk to your healthcare provider about steps you can take to reduce your risk of an erythema multiforme flare.

What can I expect if I have erythema multiforme?

Erythema multiforme can cause symptoms that make you uncomfortable, especially when lesions form on your skin and become itchy. Your provider will recommend treatment to alleviate or lessen your symptoms, and they should go away within a few weeks.

Work closely with your provider to understand what causes your flares. Be honest with your provider during an exam to help them learn more about your medical history to help you feel better.

How long does erythema multiforme last?

Erythema multiforme normally clears up between two and four weeks. In some people, the condition is recurring, which means it can come and go over and over again. If you have frequent flare-ups, talk to your provider about ways to reduce the frequency of your flares.

When should I see my healthcare provider?

Visit your healthcare provider if you experience symptoms of erythema multiforme that don’t clear up with treatment after four weeks or if you have frequent flares that affect your quality of life.

Visit the emergency room if your symptoms affect a large area of your skin, eyes, mouth or the area on or around your genitals. Or if you have systemic symptoms such as fevers, nausea or joint pain.

What questions should I ask my doctor?

• What causes erythema multiforme flares?
• Is it safe for me to take NSAIDs?
• What types of topical creams or ointments should I use to prevent itching?

Does COVID-19 cause erythema multiforme?

COVID-19 will rarely cause an erythema multiforme flare. Some people diagnosed with both COVID-19 and erythema multiforme have a skin reaction to the treatment for COVID-19 instead of a reaction to the virus itself.

A note from Cleveland Clinic

Symptoms of erythema multiforme are usually mild but can range in severity for each person diagnosed with the condition. Your provider will work closely with you during your diagnosis to find out what’s causing your flares and to treat your skin when a flare does happen. In severe cases of erythema multiforme, you may need to be hospitalized. Talk to your provider about your symptoms, especially if they happen frequently and prevent you from participating in activities in your day-to-day life so they can help you feel better.