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Erythema Multiforme, Causes, Diagnosis, Treatment, Prevention, Complications
erythema multiforme is a hypersensitivity reaction in the skin that is often triggered by infection. erythema multiforme 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 multiforme 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 multiforme 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 broader, flatter 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 multiforme 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 multiforme is uncertain. Even so, this condition is generally triggered by infection, drugs, or exposure to certain chemicals. Types of infections that can trigger erythema multiforme include:
- Viruses, such as herpes simplex, Epstein-Barr, varicella zoster, parapoxvirus, adenovirus, hepatitis, coronavirus, 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 multiforme is triggered by the use of certain drugs, such as:
- Sulfonamide class antibiotics, penicillins, or nitrofurantion
- Barbiturate drug
- Non-steroidal 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
Risk factors for erythema multiforme
Although it can happen to anyone, there are several factors that can increase a person's risk of developing erythema multiforme, 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 of erythema multiforme
In the condition of erythema multiforme, 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.
Mild (minor) erythema multiforme is usually only marked 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
- Feel itchy or burning
- Appears symmetrically on the trunk, 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 multiforme is rare on the mucous membranes. However, in severe (major) erythema multiforme, 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 the skin lesions:
- Fever
- shivers
- Joint pain
- Red and sore eyes
- Blurred vision and more sensitive 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 multiforme 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 gets wider and is accompanied by peeling skin
- More and more rashes in the mouth
- 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 of 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 multiforme can generally be diagnosed by debriefing and examining the skin. However, to find out the causes or conditions that might trigger erythema multiforme, the doctor will carry out further tests, such as:
- Skin biopsy, to find out the exact cause of erythema multiforme 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 multiforme
Treatment of erythema multiforme
Treatment of erythema multiforme 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 multiforme.
In most cases of mild erythema multiforme, 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 multiforme, patients can undergo inpatient treatment at the hospital to prevent or treat complications. Some of the actions that doctors can give are:
- Giving antiviral drugs, to treat viral infections that trigger erythema multiforme
- Giving antibiotics, to treat secondary infections that occur in the skin if erythema multiforme is triggered by a bacterial infection
- Discontinuation or replacement of drugs if erythema multiforme is caused by the use of certain drugs
To relieve the symptoms of erythema multiforme, patients can be given drugs in the form of:
- Topical antihistamines and 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 need to be considered
Mild erythema multiforme 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 multiforme, the healing period can last up to 6 weeks.
Complications of erythema multiforme
If the erythema multiforme 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, prevention of erythema multiforme can be done by avoiding things that can trigger erythema multiforme. Some ways that 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 multiforme.
- Avoid using drugs that can cause erythema multiforme if you have previously suffered from this condition.
- Check with your doctor if you have an infection.
- Avoid consumption and use of drugs carelessly.
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