Erythema multiforme

Alternative names:

Lyell's syndrome; Stevens-Johnson syndrome; toxic epidermal necrolysis

Symptoms:

• skin lesion
  • multiple
  • with sudden onset, may recur
  • may spread
  • may appear as nodule, papule, or macule
  • central lesion surrounded by concentric rings of pallor and redness ("target", "iris", "bull's eye" shape)
  • may have vesicles and bullae (blisters of various sizes)
  • located on the legs, arms, palms, hands, or feet
  • may involve the face and/or lips
  • trunk is usually not involved
  • usually symmetrical

• itching of the skin may be present
• fever
• general ill feeling (malaise)
• joint aches

Additional symptoms that may be associated with this disease:

• vision abnormalities
• tearing, decreased
• mouth sores
• eyes, bloodshot
• eye pain
• eye burning, itching and discharge

Signs and tests:

• positive Nikolsky's sign

The diagnosis is primarily based on the classic skin lesion appearance and typical symmetrical distribution, especially if there is a history of risk factors or associated diseases.

A skin lesion biopsy and microscopic examination may be helpful to differentiate erythema multiforme from other disorders. Erythema multiforme may show keratinocyte necrosis (tissue death) and other changes. Microscopic examination of the tissue may also show deposits of immune complexes (antibody deposits).