Erythema Multiforme is a hypersensitivity reaction to the skin that is often triggered by infection, especially viral infections such as the Herpes simplex virus (HSV). Erythema Multiforme is characterized by the appearance of reddish skin lesions and is acute.
This condition is generally mild and will recover within a few weeks. However, there are more rare and severe types of Erythema multiforme that can be life threatening. This major Erythema multiforme usually affects the mouth, genitals, and eyes.
To note, Erythema has two types, namely Erythema multiforme minor and Erythema multiforme major. The resulting skin reactions also vary, from mild, with a limited rash (E. multiforme minor) to life-threatening known as Erythema multiforme major.
Symptoms of Erythema Multiforme
In people with Erythema multiforme, the most important symptom is skin lesions. However, in major Erythema multiforme, before the appearance of the lesion can be preceded by several symptoms such as:
- Joint pain.
- Feeling unwell.
- Pubic pain and pain when urinating.
- Red and painful eyes.
- Vision is blurred and more sensitive to light.
- Pain in the mouth and throat area
The mild form of Erythema multiforme is usually slightly itchy, pink-red patches, symmetrical regularly and begins in the extremities (limbs). The classic shape is the ‘target lesion’ appearance with a pink-red circle around the center.
Individuals with persistent (chronic) Erythema multiforme will often have the form of lesions in the injured area, for example on areas of skin that are scratched or eroded within a week. Irritation or even pressure from clothing will cause Erythema to continue to develop within a few weeks to months.
Classification of Erythema Multiforme:
- Minor-typical Erythema multiforme, distributed edema papules located in the acral (end of the body).
- Major-typical target Erythema multiforme, edema papules distributed acral with the involvement of one or more mucous membranes (mucosa); Epidermal detachment involves less than 10% of the total surface area of the body.
- SJS and TEN are reactions that involve the skin and mucosa (mucous membranes) are heavy and life-threatening characterized by the release of the epidermis, water-filled nodules and erosion/peeling of mucous membranes. The difference between SJS and TEN is that in SJS the area of skin damage reaches 10% of the total surface area of the body, while in TEN the skin damage/exfoliation> 30% of the total surface area of the body.
Causes of Multiform Erythema
Until now, the main cause of Erythema multiforme has not been clearly established. However, some studies suggest that there is involvement of genetic factors that cause a person affected by Erythema multiforme. New Erythema multiforme can appear in a person if triggered by external factors, such as:
- Infection: bacteria vaccination, Streptococcus hemolytic, leprosy, Neisseria meningitidis, Mycobacterium, Pneumococcus, Salmonella species, Staphylococcus species).
- Parasites (Trichomonas species),
- Viral (especially Herpes simplex)
- Drug reactions: antibiotics (including, sulfonamides, penicillin), anticonvulsants ( barbiturates), aspirin, anti-tuberculosis, and many others.
- Physical factors: radiotherapy, cold air, sunlight
- Other: collagen disease, non-Hodgkin’s lymphoma, leukemia, multiple myeloma, myeloid metaplasia, polycythemia
Treatment of Erythema Multiforme
Treatment is carried out to control the underlying disease, prevent infection, and treat the symptoms. Your doctor may ask you to stop drugs that are suspected of causing symptoms. Consult with your doctor about the right dosage for you.
Treatment for mild-stage Erythema multiforme includes:
- Nonprescription pain relievers such as paracetamol to relieve fever and pain.
- Local anesthetics (especially for mouth ulcers) to relieve pain that may appear when eating or drinking.
- Antihistamine prescription to reduce itching.
- Cold compresses on problematic skin.
- Prescribe antiviral medication if the cause is herpes simplex.
Meanwhile, if the known cause of Erythema multiforme is a virus, then patients can be given antivirals, such as oral acyclovir or injections, especially those caused by the Herpes simplex virus.
If the cause of Erythema multiforme is bacterial, then the patient can be given antibiotics to treat the bacterial infection that triggers Erythema multiforme. If the cause of Erythema multiforme is certain drugs, the patient must immediately stop taking the drug.
The following are some of the treatments that can be given:
- Mouthwash that contains anti-pain as well as antiseptics to reduce pain and prevent secondary infections in the oral cavity.
- Oral corticosteroids. This drug can be given in the early stages of treatment for major Erythema multiforme.
- Antihistamines and topical corticosteroids to treat itching.
In general, Erythema multiforme can heal on its own without leaving a scar. The recovery period also varies, some heal faster but some others take longer.
If you experience symptoms as described above, see your doctor immediately to get treatment quickly because this condition can result in something fatal.