Erythema multiforme

    Article Contributors: 
    Sean Klepper M.D.
    Artur Zembowicz M.D....

    Clinical Features:

    • Most common in children and young adults, with a slight male predominance
    • Seasonal variation, with a peak in the spring and summer
    • Self-limiting, but commonly recurs
    • Presents as multiple, symmetrically distributed maculopapules with a predilection for the extensor surfaces of the extremities
    • As the lesions progress, their centers become ischemic and bluish, resulting in the classic target lesions, and blisters sometimes form.
    • Oral lesions are also frequently present.
    • The lesions often heal leaving postinflammatory hyperpigmentation.
    • Frequent recurrent episodes of erythema multiforme are associated with herpes simplex infection, which is the most common etiologic agent of the disease.
    • Many other infectious agents, especially Mycoplasma, drugs and malignancies have also been implicated.
    • An additional association, known as Rowell syndrome, is with discoid or systemic lupus erythematosus.

    Histologic Features:

    • Basal cell hydropic degeneration, which may be severe enough to result in the formation of subepidermal clefts or vesicles
    • Apoptosis of keratinocytes, ranging from focal to diffuse epidermal involvement
    • Marked superficial dermal lymphohistiocytic inflammation with lymphocytic exocytosis and satellite cell necrosis
    • Intra- and intercellular epidermal edema, sometimes resulting in spongiotic vesicles
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    Cases associated with this book:

  • Erythema multiforme
    Author: Artur Zembowicz M.D. Ph.D.

    Conference: Teaching Collection