Erythema multiformis is a hypersensitivity reaction of the skin that is often triggered by infection. Multifocal erythemareg characterized by the appearance of reddish skin lesions. This condition is acute, non-infectious, and usually goes away on its own without complications.
The exact cause of erythema multiformis is not known. However, this condition is generally triggered by viral infections, such as the Herpes simplex virus and Epstein-Barr virus. In some cases, erythema multiforme does not only occur on the skin, but can also occur in the mucous layers, such as the lips and eyes.
Causes of Erythema Multiformis
Erythema multiformis is a type of hypersensitivity reaction. A hypersensitivity reaction occurs when the immune system (the immune system) reacts incorrectly or excessively to exposure to certain substances or conditions. The main cause has not been ascertained.
Although the cause is unknown, erythema multiforme is generally triggered by infection, drugs, or exposure to certain chemicals. Some types of infections that can trigger erythema multiforme are:
- Viruses, such as herpes simplex, Epstein-Barr, varicella zoster, parapoxvirus, adenovirus, hepatitis, HIV, or cytomegalovirus
- Bacteria, such as Mycoplasma pneumoniae, Neisseria meningitidis, Treponema pallidum, or Myocbacterium avium complex
- Mushrooms, like Histoplasma capsulatum, Coccidioides, or ddermatophytes
- Parasites, such as Toxoplasma gondii or Trichomonas
In some cases, erythema multiformis triggered by the use of certain drugs, such as:
- Barbiturate drugs
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Anticonvulsant or anticonvulsant drugs, such as phenytoin
- Phenothiazine class of drugs
- Sulfonamides, penicillin or nitrofurantion antibiotics
- Certain vaccines, such as BCG, polio, tetanus, or diphtheria
Risk factors for erythema multiforme
Although it can occur in all age groups, erythema multiforme is often found at the age of 20-40 years. In addition, someone who has a history of herpes disease, uses certain medications, suffers from immune system disorders, cancer, also has a risk of developing erythema multiforme.
Symptoms of Erythema Multiform
In the condition of erythema multiformis, the hypersensitivity reaction that occurs will be characterized by the appearance of lesions (changes or abnormalities) on the skin. Often the lesions that appear are itchy and like burning.
Erythema multiformis mild (minor) is usually only characterized by lesions on the skin and is not accompanied by other symptoms. The following are some of the characteristics of skin lesions that occur in erythema multiforme:
- Redness that develops into a papule (a skin lesion that protrudes and is higher than the surrounding skin area)
- Has a core in the middle
- Sometimes blisters and crusts may appear in the center of the papule
- Feeling itchy or burning
- Arises on the body, face, and neck symmetrically, generally the lesions first appear on the back of the hands or feet, then spread to the legs until they reach the body.
- Generally, lesions that occur in less than 10% of the skin area on the body
Mild erythema multiforme generally rarely affects the mucosal layer. However, in severe (major) erythema multiforme, the lesions may also appear on the mucosal lining, particularly on the lips, mouth, or eyes.
In addition, in severe erythema multiforme, the following symptoms may accompany skin lesions, namely fever, chills, joint pain, red eyes, pain, blurred vision and sensitivity to light, and pain in the mouth and throat area, making it difficult eat and drink.
When to go to the doctor
Check with your doctor if you experience symptoms of erythema multiforme, as mentioned above. Lesions that appear in the condition of erythema multiforme can be similar to other diseases. Therefore, an examination to the doctor is very important to confirm the diagnosis.
Go to the ER immediately if you experience:
- The lesions on the skin are getting wider and accompanied by peeling skin
- More and more lesions in the mouth
- Pain or burning sensation that gets 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 Multiformis
The doctor will ask for complaints and symptoms experienced, medical history, including a history of infectious diseases and previous drug use. Next, the doctor will perform a skin examination. The doctor will observe the color, shape, size, and distribution of the lesions.
Erythema multiformis is generally diagnosed through questioning and examination of the skin. However, to find out the causes or conditions that may trigger the erythema multiforme, the doctor will perform further tests, such as:
- Skin biopsy, to determine the exact cause of erythema multiforme by taking a skin sample which will then be examined under a microscope
- Blood tests, to identify the presence of antigens and antibodies to confirm the presence of viruses or bacteria that trigger erythema multiforme
Erythema Multiformis Treatment
In most cases of mild erythema multiforme, the lesions resolve on their own within a few weeks without the need for medical treatment. However, if the condition experienced is severe enough, several methods of treatment can be used.
Treatment of erythema multiforme aims to overcome the triggering factors and relieve complaints and symptoms that arise. Treatment will be based on age, symptoms, severity, and triggers for erythema multiforme.
Especially in patients with severe (major) erythema multiforme, patients can undergo inpatient treatment in a hospital to prevent and treat complications. Some types of treatment that may be given by the doctor are:
- Administration of antiviral drugs to treat viral infections that trigger erythema multiforme
- Administration of antibiotics if the erythema multiforme is triggered by a bacterial infection or to treat secondary infections that occur in the skin
- Stopping and changing drug choices if caused by the use of certain drugs
To relieve symptoms and complaints 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 to prevent secondary infections of the oral cavity
- Oral corticosteroids may be considered, to relieve inflammation that occurs in severe erythema multiforme
Erythema multiformis will generally heal on its own without leaving a scar with a healing period of about 2–3 weeks. However, for severe cases of erythema multiforme, the healing period can last up to 6 weeks.
Complications of Erythema Multiformis
If the erythema multiforme experienced by the patient is severe enough, several complications can occur, such as:
- Permanent skin damage
- Skin infections, such as cellulitis
- Dehydration and malnutrition
- Permanent eye damage
- Blood poisoning
- Inflammation in organs, such as the liver and lungs
- Sepsis
Prevention of Erythema Multiformis
Because the cause is not known, prevention can be done by avoiding things that can trigger the occurrence of erythema multiformis. Some of the ways this can be done are:
- Take care of your health and personal hygiene to avoid viral, bacterial, fungal, or parasitic infections, which can trigger erythema multiforme.
- If you have experienced erythema multiforme due to the use of drugs, then avoid using these drugs in the future.
- Always check with a doctor if you have an infectious disease.
- Avoid indiscriminate consumption and use of drugs.