Erythema multiforme is an acute, recurrent skin condition characterized by target-shaped lesions that commonly appear on the extremities and face. It is caused by herpes simplex virus or Mycoplasma pneumoniae infections triggering an immune response in genetically predisposed individuals. The condition ranges from isolated skin involvement to more severe cases affecting the mucous membranes. Treatment focuses on managing underlying infections, reducing symptoms with corticosteroids, and preventing recurrences with antivirals.

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ERYTHEMA MULTIFORME
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2. INTRODUCTION
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 Erythema – Redness ; Multiforme – Polymorphic
 First Classified by Bastuji – Garin et al to separate
from SJS / TEN in 1922
 described by Hebra in 1866 as Erythema
exudativum Multiforme
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3. DEFINITION
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 Acute, Recurrent, self-limiting Cutaneous and/or
Mucocutaneous eruptions characterised by target –
shaped plaques commonly over extremities and
face.
 Assoc with HSV / Mycoplasma pneumonia infections
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4. EPIDEMIOLOGY
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 Male : Female = 3:2
 Occurs in the young / adoloscents
 Recurrent in 30 %
 Familial clustering s/o Infective Etiology
 Assoc with HLA – DQB1 * 0301 Allele
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5. AETIOLOGY
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6. CLASSIFICATION
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 EM Minor : Cutaneous without Mucous inv
 EM Major (EMM) : Cutaneous + Mucous inv
 Mucosal EM : Fuch’s Ectodermosis Pluriorificialis
 HAEM
 MPAEM
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7. CLINICAL FEATURES
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Prodromal Features
Prev Attack (30%)
Preceding Infection
Fever (T>103.1 deg C)
Cutaneous Lesions
Mucous Lesions
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8. CUTANEOUS LESIONS
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 Symmetrical, Acral, Centripetal Rash
 Extensor aspect : Extremities > Face > Neck > Trunk
 Predilection to Sun-Exposed Areas / Koebnerization
 Well-defined, circular, blanching papule / plaque that
persists for 01 week – Self-limiting in 04 weeks –
Persistent / Continuous EM
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9. CUTANEOUS LESIONS
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 Typical Target Lesion :-
1. Dusky Central Disk / Bulla
(later Violaceous / Purpuric)
2. Infiltrated Pale Ring
3. Erythematous edematous halo
Larger lesions show Central
Bulla and Marginal ring of vesicles - Herpes Iris of Bateman
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10. TARGET LESIONS
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11. CUTANEOUS LESIONS
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 Raised Atypical Target lesions / Targetoid lesions
 SJS-TEN lesions – mostly Macular
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12. MUCOSAL LESIONS
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 70% Cases
 Lips – Cutaneous
Target Lesions
Serous Crusting
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13. MUCOSAL LESIONS
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 LIPS – Mucosal (Erosions / Vesicles / Bullae)
 GINGIVAL / Ventral Tongue
 Hard Palate – Spared
 Pharynx / Larynx / Trachea / Bronchi
 Conjunctivitis B/L with Vesicles / Erosions
 Nasal / Urethral / Anal Mucosae
 2/3 Mucosal Sites sans Cutaneous inv
– FUCH’s SYNDROME
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 aa
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16. DDx
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ss
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18. TREATMENT
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 Treating underlying Etiology
 Reducing morbidity – Oral CS
 Anti-Virals ?
 Macrolides / Quinolones for MPAEM
 Oral EM – Topical CS / Anesthetics / Antacids
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19. RECURRENT EM
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 Anti-Virals
 Topical Acyclovir ?
 Azathioprine
 Thalidomide
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THANK YOU
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