An acute rash, symmetric on the back of both hands and elsewhere. In this patient, the cause was recent infection by sealpox.

ERYTHEMA MULTIFORME

Erythema multiforme (EM) is an allergic reaction pattern in the skin that is characterized by multiple target lesion (concentric rings of different shades of red). The center may be dusky, necrotic, or bullous. The lesions may prefer the photo exposed areas, e.g. dorsal hands, top of the ears. Bulla may form.

• A recent herpes infection, mycoplasma pneumonia, or a new drug (e.g., sulfa or penicillin) are most common causes, but implicated causes are legion.
• When EM is recurrent, inquire about herpes simplex virus infection as a trigger.
  
• PCR has shown HSV DNA in cutaneous lesions of EM triggered by herpes, but the lesions themselves are not contagious.

Treatment

• If herpes triggered it, treat the herpes if still present. Also, discuss the likelihood of recurrence if the herpes recurs. One may want to give refills on the prescription for prednisone. Can consider valacyclovir for individual outbreaks of herpes or as suppressive therapy.
• If a drug is the likely cause, stop it and put it on the allergy list.
• If the areas involved are sun-exposed, sun protection should be recommended.

For the typical case, Prednisone 1 mg/kg initially and tapered over 2 weeks is given.

Additional Pictures

The classic target lesions of erythema multiforme.

RegionalDerm

Who is Dr. White? | Privacy Policy | FAQs | Use of Images | Contact Dr. White