Erythema multiforme is an acute dermatological condition, usually post-infectious, with very characteristic lesions. Update on symptoms, locations and treatments with Dr Saskia Oro, dermatologist at Henri Mondor hospital.
Erythema multiforme is a inflammatory skin disease, and sometimes mucous membranes, which is characterized by the occurrence of cockade lesions on the skin, that is to say rounded, annular, with three concentric rings. These small red rashes sometimes have a bullous appearance and usually appear on the hands, forearms, knees, elbows, soles and palms, sometimes more diffuse. The disease usually resolves spontaneously within a few weeks. Recurrences are however frequent, requiring a basic treatment to try to limit the occurrence of relapses.
Erythema multiforme is said to be bullous when a small blister develops within the lesions.
Cases of erythema multiforme have been described after vaccination against smallpox. More recently, two cases of erythema multiforme have been reported following inoculation of Moderna vaccine against Covid, according to the ANSM. “However, causality is very difficult to say and it should be remembered that erythema multiforme is essentially a post-infectious inflammatory disease, the main cause of which (more than half of cases) is the herpes virus”, nuance Dr Saskia ORO.
Erythema multiforme usually affects ends (hands, feet, ankles, elbows, forearms) and thrusts are not very disabling. In rarer cases, the disease can be much more severe with the appearance of extensive lesions, damage to the mucous membranes which can lead to difficulty eating, and ocular involvement, requiring hospitalization.
Erythema multiforme is usually induced by an infectious agent, most often herpes, sometimes by a bacteria called mycoplasma. Sometimes no cause is found. “It is a disease which is not strictly speaking infectious, it corresponds to a hypersensitivity, a abnormal reaction of the body to these infectious agents which leads to the appearance of lesions of the skin and mucous membranes. We have known for thirty years that erythema multiforme is not an allergy to drugs. For a long time, this dermatological disease has been mistaken for some form of allergy drugs called syndrome de Stevens-Johnson. But several French and international studies have proven that erythema multiforme is essentially a post-infectious disease, which is not triggered by a drug in the vast majority of cases “, details the dermatologist.
Erythema multiforme is not contagious at all.
“The diagnosis is clinical, it is confirmed by the presence of cockades on the skin. In case of doubt, a biopsy (small sample of the skin) can be performed”, indicates the dermatologist. There are two forms of erythema multiforme:
► erythema multiforme minor : there is no involvement of the mucous membranes or this involvement is very limited.
► erythema multiforme major is characterized by involvement of two or more mucous membranes. “Some patients present with lesions in the mucous membranes (eyes, mouth, genital mucosa, nose). This can be painful, debilitating, and require hospitalization”, specifies the specialist.
During the acute phase of the disease, that is to say at the time of flare-ups, symptomatic treatments are administered to relieve pain and try to accelerate healing in the mouth. Of the cortisone can also be prescribed for a few days. “In case of frequent recurrences, long-term antiviral treatment can be beneficial in preventing herpes outbreaks, which in the vast majority of cases cause outbreaks of erythema multiforme. When this does not work, or it is not postherpetic erythema multiforme, various immunomodulatory treatments can be considered. These treatments are the subject of a therapeutic discussion by teams specializing in the management of erythema multiforme “, informs Dr Saskia ORO.
“Erythema multiforme can be debilitating and painful, but it is a disease with a very good prognosis. In the vast majority of cases, there are no complications, however mucosal sequelae (especially ocular) may exceptionally be observed in the most severe cases “, reassures our interlocutor.
Thanks to Dr Saskia ORO, dermatologist at Henri Mondor hospital.
Source: Pharmacovigilance survey of the COVID-19 VACCINE MODERNA vaccine. Report n ° 14: period from May 28, 2021 to July 01, 2021 CRPV de Lille, CRPV de Besançon. ANSM
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