What does the rash look like?
A typical element is called target-shaped: it is a round spot with a diameter of usually up to three centimeters, in which three zones are distinguishable - a dark or bubbly center, a lighter edematous ring around it and a red rim along the edge. The rash appears symmetrically, starting from the back of the hands, forearms, feet and legs, then spreading to the torso. The elements appear in waves over several days, so patches of varying degrees of maturity are visible at the same time - hence the name "multiform". After one to three weeks they fade, leaving temporary dark spots without scarring.
- Target-shaped spots with three color zones
- Symmetrical arrangement
- Start with the hands and feet, move towards the torso
- Elements of different degrees of maturity at the same time
- Possible bubbles in the center of the spots
- Healing without scars, temporary pigmentation
Reasons
The vast majority of cases are associated with the herpes simplex virus: rashes appear one to two weeks after an exacerbation of herpes on the lips, sometimes so subtle that the person does not remember it. The second most common cause, especially in children and adolescents, is mycoplasma infection of the respiratory tract, which most often affects the mucous membranes. Less commonly provoked by other viral and fungal infections. Drugs rarely cause erythema multiforme, but it is the drug connection that makes you wary, since a severe reaction, Stevens-Johnson syndrome, can begin in a similar way.
- Herpes simplex virus is the most common cause
- Mycoplasma infection, especially in children
- Other viral and fungal infections
- Less commonly - medications
- Sometimes the cause cannot be determined
- Relapses are usually associated with repeated exacerbations of herpes
Symptoms and damage to mucous membranes
Skin rashes are accompanied by a slight burning or itching; pain is not typical for them. A few days before the rash, you may feel unwell, have a slight fever, or have a sore throat. In about half of the patients, the mucous membranes are involved: blisters appear in the mouth, which quickly open, forming painful erosions on the lips, cheeks and tongue, the lips become covered with bloody crusts. It becomes difficult to eat and drink. Eye damage is manifested by redness, pain and photophobia and requires urgent examination by an ophthalmologist, as it can leave scars on the conjunctiva.
- Mild burning or itching in the area of the rash
- Malaise and slight fever before the rash
- Erosions in the mouth and bloody crusts on the lips
- Difficulty eating and drinking
- Redness and pain in the eyes
- Damage to the genital organs in severe cases
Diagnostics
The diagnosis is made primarily clinically: typical target-like elements on the hands and feet are very characteristic. The doctor asks in detail about recent infections, herpes flare-ups, and, most importantly, about any medications started in recent weeks. If the picture is unclear, a skin biopsy is performed. Tests for the herpes simplex virus help confirm the cause, especially in recurrent cases. A complete blood count and inflammation indicators are needed to assess severity. The main task is to exclude Stevens-Johnson syndrome and other severe drug reactions.
- Examination by a dermatologist with assessment of typical elements
- Detailed questions about medications and infections
- Tests for herpes simplex virus
- Complete blood count and inflammation indicators
- Skin biopsy in unclear cases
- Urgent examination by an ophthalmologist for eye damage
Treatment and prevention of relapses
In mild cases, treatment is symptomatic: rest, skin care, painkillers and antiseptic rinses for mouth lesions, soft foods and sufficient fluids. If the connection with herpes is obvious, an antiviral drug is prescribed, but it is effective only at the very beginning. Antihistamines reduce itching, but do not affect the course. The question of hormonal drugs is decided by the doctor individually. In the recurrent form, when the rashes return several times a year, long-term antiviral prophylaxis is used, which usually stops relapses. Any drug suspected as a cause is discontinued in consultation with the doctor.
- Skin and oral care, pain relief
- Soft, non-irritating foods and sufficient fluids
- Antiviral drugs for herpetic nature
- Long-term prophylaxis for recurrent course
- Stopping a suspected medication only with a doctor
- Protecting your lips from the sun as a way to prevent exacerbations of herpes