Dermatologic Emergencies

dermatology-emergencieskapak-1-0-25

Erythema Multiforme Minor

İsmail Ufuk YILDIZ
Ankara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye

Yıldız İU. Erythema multiforme minor. In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.80-4.

ABSTRACT

Erythema multiforme (EM) is an acute, often self-limited skin condition that can present with isolated, recurrent, or persistent lesions. It has two forms: Erythema Minor, affecting only the skin, and Erythema Major, involving mucocutaneous involvement. Previously thought to be part of the same spectrum as Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis, EM is now recognized as a distinct disease. Epidemiology: EM has an incidence of less than 1% and is slightly more common in males, primarily affecting individuals aged 20-40. However, it can occur in all age groups, including children and the elderly. Etiology: EM is usually triggered by a cell-mediated immune response to infections, with over 90% of cases linked to such triggers. Herpes simplex virus (HSV) type 1 is the most common cause, but HSV-2 and Mycoplasma pneumoniae can also be involved. Drug-induced cases are less frequent, with common triggers including NSAIDs, antiepileptics, and antibiotics. Clinical Presentation: EM lesions begin as pink or red papules, potentially evolving into plaques. Classic “target” lesions have three concentric rings: a dark center, a paler ring, and an outer red ring. Lesions may also be atypical with only two zones. Lesions typically appear symmetrically on extremities and may affect the palms and soles. Diagnosis: Diagnosis is based on patient history, physical examination, and, if needed, biopsy. The presence of multiple typical or atypical target lesions smaller than 3 cm confirms the diagnosis. Treatment: Treatment varies based on severity and triggers. Mild cases may resolve spontaneously, managed with antihistamines, topical corticosteroids, and analgesics. Antiviral drugs like acyclovir are used in HSV-associated cases, and systemic corticosteroids are reserved for severe cases. Supportive care and follow-up are essential, especially for preventing complications.

Keywords: Erythema; erythema multiforme; Herpes simplex; urticaria; Stevens-Johnson syndrome

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