Erythema exudative multiforme – symptoms and treatment

Proven content

Erythema multiforme is an expression of the body’s hypersensitivity to various factors, including: viral, bacterial, chemical and drugs. Among the latter, the most common are: ß-lactam antibiotics (e.g. penicillin), furosemide (a diuretic, i.e. a dehydrating drug), barbiturates, tetracyclines and propranolol.

What is erythema multiforme?

Erythema exudative multiforme is a condition that is often a sign of hypersensitivity of the body to chemical agents, medications or viral agents. Erythema can occur in virtually any age group, regardless of gender (although the most severe form usually occurs in women). However, half of the erythema cases are diagnosed mostly in young people under 20 years of age. The onset of the disease is quite rapid, the first symptoms appear immediately after taking medications or as a result of an infection. Erythema multiforme can occur in several forms, ranging from the mildest to the most severe. The most dangerous, however, is necrolysis of the epidermis, which can even result in death due to pulmonary embolism and gastrointestinal bleeding.

Factors causing exudative erythema multiforme

The causes of exudative erythema multiforme are not fully known, but it is suspected that they are related to an inadequate response of the immune system to certain factors.

The following factors affect the development of ailments:

1. a bacterial infection (streptococcus),
2. viral infection (erythema often occurs in the course of various infections, e.g. flu-like infections or upper respiratory tract infections),
3. Herpes simplex infection in the labia or genitalia – this is the factor causing erythema usually in young men
4. taking medications (antibiotics, anticonvulsants, antimalarial drugs, sulfa drugs, non-steroidal anti-inflammatory drugs, diuretics),
5. severe pneumonia
6. chemical.

General symptoms of exudative erythema multiforme

The symptoms of the disease vary depending on its form. In the course of the mild form of the disease, the symptoms are erythematous-edema changes of varying severity. They are symmetrical and have the shape of rings directed inwards. Sometimes vesicles and hemorrhagic changes appear additionally. It is worth mentioning that stress often intensifies the symptoms of erythema. Why is this happening? Long-term stress weakens the body, so herpes often appears, which leads to the rapid multiplication of the virus and the development of the body’s reaction characteristic of erythema.

Three forms of exudative erythema

Depending on the course, the erythema exudative multiforme may appear in three forms.

1. Normal (mild) form

Edema erythema clearly demarcated from the surrounding area appears on the skin. They are blue-red and may have bubbles on their surface. The lesions are usually bilateral and mainly affect the distal parts of the limbs (forearms, hands). Sometimes they take a ring-shaped shape.

2. Stevens-Johnson syndrome

The onset of Stevens-Johnson syndrome is sudden. The changes occur mainly on the mucous membranes of the mouth, conjunctiva and genitals. Initially, they are in the form of vesicles that burst over time, dry up or may turn into erosions or hemorrhagic crusts. The changes are short-lived and are usually accompanied by:

1. high fever,
2. joint pain.

3. Lyell’s toxic epidermal necrolysis (TEN)

This is the most dangerous form of erythema multiforme. The most common cause of its occurrence is the use of certain medications. The disease appears suddenly, shortly after taking the preparation – in the period from 3 days to 3 weeks, erythematous-bullous changes appear on the skin and mucous membranes of the mouth, conjunctiva and genitals. Soon there is a creeping of the entire epidermis covering the lesions (Nikolski’s symptom). At this stage, bacterial superinfection of the affected areas may occur. Dehydration and ion disturbances may also appear. Therefore, treatment of this form of erythema must be carried out in a hospital setting, where it is possible to rehydrate the body, compensate for abnormal electrolyte levels and possibly administer an antibiotic.

Erythema exudative multiforme – diagnosis and treatment

The diagnosis of the disease takes into account clinical symptoms and a detailed medical history with the patient. First of all, it is important to determine what preparations the patient was taking.

Mild exudative erythema multiforme requires only causal treatment. So if the reaction was caused by a specific drug – it should be discontinued, and if the infection – it should be cured. Among the drugs used in the course of the disease are:

1. painkillers,
2. antipyretic drugs,
3. antibiotics
4. disinfectants – in the form of an aerosol or a solution used when the epidermis has collapsed,
5. antihistamines – prescribed by a dermatologist,
6. glucocorticosteroids (in the form of topical creams),
7. antiviral preparations,
8. antifungal agents,
9. anti-burn dressings (when a large area of ​​the body has been affected).

In the course of epidermal necrolysis (the most severe form of erythema), the patient must be hospitalized in a unit specializing in the treatment of burns. The procedure is similar to that in the case of second degree burns, sterility and readiness for possible resuscitation is necessary. Patients are additionally given electrolytes and albumin.

Can erythema exudative multiforme lead to complications?

Yes, a complication of ailments may be superinfection of wounds formed on the skin and mucosa. For this reason, care is important; it is recommended to use mild disinfectants and antifungal agents. If there are scabs and erosions in the mouth and lips – it is necessary to eat food in a semi-liquid or liquid form (mildly seasoned!).

Another complication may be ophthalmic problems and adhesions in the genital area. Patients with genital lesions should not have sexual intercourse, because intimate contacts lead to mechanical damage to the lesions, and thus the spread of the disease.

The fatal complications relate only to Stevens-Johnson syndrome and Lyell’s syndrome, which most researchers consider a separate severe drug reaction, caused by, for example, anti-epileptic drugs or non-steroidal anti-inflammatory drugs.

How to prevent

To minimize the risk of erythema, take medications only under the supervision of a specialist. If a specific drug has not been prescribed by a doctor – do not use it! When an adverse reaction to a specific preparation occurs, remember its name and inform your doctor about it (each time).

Text: lek. med. Matylda Mazur