Erythema multiformis is a hypersensitivity reaction in the skin that is often triggered by infection . Erythema multiformis is characterized by the appearance of a red rash on the skin . This condition is acute, non-infectious, and usually heals on its own without causing complications.
The exact cause of erythema multiformis is not known. However, this condition is generally triggered by viral infections, such as the herpes simplex and Epstein -Barr viruses . In some cases, erythema multiformis does not only occur on the skin, but can also occur in the mucous layers (mucous membranes), such as on the lips and eyes.
Although considered similar, erythema multiforme and Stevens-Johnson syndrome are different conditions. Stevens-Johnson syndrome is characterized by a more extensive, flat-surfaced rash. Meanwhile, erythema multiforme is characterized by a more prominent rash.
Stevens-Johnson syndrome is also more commonly caused by a hypersensitivity reaction to a drug, and results in a more serious condition.
Causes of Erythema Multiforme
Erythema multiformis is a type of hypersensitivity reaction . This reaction occurs when the body's immune system reacts incorrectly or excessively to exposure to certain substances or conditions.
The main cause of erythema multiformis is uncertain. Even so, this condition is generally triggered by infection, drugs, or exposure to certain chemicals. Types of infections that can trigger erythema multiformis include:
- Viruses, such as herpes simplex, Epstein-Barr , varicella zoster, parapoxvirus, adenovirus, hepatitis, Corona virus , HIV, or cytomegalovirus
- Bacteria, such as Mycoplasma pneumoniae , Neisseria meningitidis , Treponema pallidum , or Myocbacterium avium complex
- Fungi, such as Histoplasma capsulatum , Coccidioides, or Dermatophytes
- Parasites, such as Toxoplasma gondii or Trichomonas
In some cases, erythema multiformis is triggered by the use of certain drugs, such as:
- Sulfonamide class antibiotic drugs , penicillin, or nitrofurantion
- Barbiturate drug
- Nonsteroidal anti-inflammatory drugs ( NSAIDs ), such as ibuprofen
- Anticonvulsant or anticonvulsant medications, such as phenytoin or carbamazepine
- Phenothiazine class of drugs
- Certain vaccines, such as BCG , polio, tetanus , or diphtheria
A risk factor for erythema multiforme
Although it can happen to anyone, there are several factors that can increase a person's risk of developing erythema multiformis, namely:
- 20–40 years old
- Have a history of herpes
- Using certain drugs, such as corticosteroids
- Suffer from an immune system disorder, such as HIV/AIDS
- Undergoing a bone marrow transplant
- Suffering from cancer
Symptoms Erythema Multiforme
In the condition of erythema multiformis, a hypersensitivity reaction is characterized by the appearance of a rash on the skin. The rash that appears often feels itchy and hot like burning.
Erythema multiformis mild (minor) is usually only characterized by a rash on the skin and is not accompanied by other symptoms. The following are some of the characteristics of skin rashes in erythema multiforme:
- Reddish which then stands out compared to the surrounding skin (papules)
- Has a core in the middle
- Sometimes blisters and crusts may appear in the center of the papule
- Itches or burns
- Symmetrically appear on the body, face, and neck
- It generally appears first on the back of the hands or feet, then spreads down the legs until it reaches the body
- Usually appears less than 10% of the skin area on the body
Mild erythema multiformis is rare on the mucous membranes. However, in severe (major) erythema multiformis, the lesions may also appear on the mucous membranes, especially on the lips, mouth, or eyes.
In addition, in severe erythema multiforme, the following symptoms may accompany skin lesions:
- Fever
- Shivering
- Joint pain
- Red and sore eyes
- Blurry vision and more sensitivity to light
- Mouth and throat pain making it difficult to eat and drink
When to see a doctor
Check with your doctor if you experience the symptoms of erythema multiformis as mentioned above. The rash that appears in this condition can be similar to other diseases. Therefore, a doctor's examination is very important to confirm the diagnosis.
Go to the emergency room immediately if you experience:
- A rash that spreads and is accompanied by peeling skin
- The rash in the mouth is getting more and more
- There is a feeling of pain or burning that is getting worse
- Spots appear around the eyes or the whites of the eyes look red
- It's getting harder to breathe, eat, or drink
Diagnosis Erythema multiforme
The doctor will conduct a debriefing with the patient regarding the complaints and symptoms experienced, medical history, including a history of infectious diseases and drug use. Next, the doctor will do a skin examination. The doctor will observe the color, shape, size, and distribution of the rash.
Erythema multiformis can generally be diagnosed by questioning and examination of the skin. However, to find out the causes or conditions that may trigger erythema multiformis, the doctor will perform further tests, such as:
- Skin biopsy , to find out the exact cause of erythema multiformis by taking a skin sample which will then be examined under a microscope
- Blood test , to identify the presence of antigens and antibodies to ensure the presence of viruses or bacteria that trigger erythema multiformis
Treatment of erythema multiforme
Treatment of erythema multiformis aims to overcome trigger factors and relieve symptoms that arise. The method of treatment depends on the patient's age, symptoms, severity, and triggers of erythema multiformis.
In most cases of mild erythema multiformis, the rash clears up on its own within a few weeks without needing medical treatment. However, if the condition is severe enough, several treatment methods can be used.
Especially in patients with severe (major) erythema multiformis, patients can undergo inpatient treatment at the hospital to prevent or treat complications. Some of the actions that doctors can give are:
- Administration of antiviral drugs , to treat viral infections that trigger erythema multiforme
- Giving antibiotics , to treat secondary infections that occur in the skin if erythema multiformis is triggered by a bacterial infection
- Drug discontinuation or replacement if the erythema multiforme is caused by the use of certain drugs
To relieve the symptoms of erythema multiformis, patients can be given drugs in the form of:
- Antihistamines and topical corticosteroids, to treat itching
- Mouthwash containing antiseptic, to reduce discomfort in the mouth and throat, and prevent secondary infections in the oral cavity
- Oral corticosteroids , to relieve inflammation in severe erythema multiforme, but these drugs should be considered for use
Mild erythema multiformis generally heals on its own without leaving scars. The healing period for this condition is around 2–3 weeks. However, for cases of severe erythema multiformis, the healing period can last up to 6 weeks.
Complicated erythema multiforme
If the erythema multiformis experienced by the patient is severe enough, several complications can occur in the form of:
- Permanent skin damage
- Skin infections, such as cellulitis
- Inflammation in internal organs, such as the liver and lungs
- Dehydration and malnutrition
- Permanent eye damage
- Bacteremia
- Sepsis
Prevention of erythema multiforme
Because the cause is unknown, the prevention of erythema multiforme can be done by avoiding things that can trigger the occurrence of erythema multiformis. Some of the ways this can be done are:
- Maintain personal health and hygiene with clean and healthy living behaviors ( PHBS ) to avoid viral, bacterial, fungal or parasitic infections, which can trigger erythema multiformis.
- Avoid using drugs that can cause erythema multiforme if you have previously suffered from the condition.
- Check with your doctor if you have an infection.
- Avoid indiscriminate consumption and use of drugs.