Is Erythema Multiforme Contagious?

Erythema multiforme minor symptoms are mild and usually go away on their own within 2 weeks.

Erythema multiforme is a skin condition. It is a type of hypersensitivity reaction usually triggered by certain infections, medications, and other various triggers. Symptoms can range from mild to severe and the condition is not contagious. 

Erythema multiforme minor is the mild form of the condition, with localized skin lesions. The condition may be recurring in some patients. 

Erythema multiforme major is a severe and potentially life-threatening form of the disease. Erythema multiforme major occurs on the skin and in the mucous membranes (such as mouth, throat, digestive tract), and skin may blister and fall off in some cases. More than half of all erythema multiforme major cases are due to medications. The most severe types of erythema multiforme major are Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Symptoms of erythema multiforme minor include:

• Flu-like symptoms (fever, body aches, fatigue)
• Red, blotchy rash, usually starts on hands and feet, followed by rash on the face and trunk
• Red patches turn into round “target” lesions, which look like a bullseye
• Some lesions may blister 
• Itching
• Headache
• Joint pains

Symptoms of erythema multiforme major (as well as Stevens-Johnson syndrome and toxic epidermal necrolysis) include symptoms of erythema multiforme minor plus:

• Widespread progression of the rash to most skin surfaces
• Sores on mucus membranes (inside the mouth and nose, in the digestive tract)
• Swollen, crusted lips
• Eye redness and tearing
• Abdominal pain
• Rectal pain
• Blistering/peeling of skin 
• Sores on genitals which can result in pain with urination

About half of all cases of erythema multiforme have no known trigger. Certain factors are known causes, however, including:

• Medications, the most common include:
  • Sulfa drugs (about 30% of drug-related cases)
  • Antibiotics 
  • Anticonvulsants
  • Tuberculosis medications
  • Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • HIV medications
  • Blood pressure medications 
  • Hormone replacement therapies
  • Corticosteroids
  • Medicines to treat gout
• Vaccines
• Infections, commonly:
  • Bacteria such as Mycoplasma pneumoniae
  • Viruses such as herpes simplex
  • Fungi such as Histoplasma capsulatum
• Pregnancy
• Environmental triggers 
  • Chemical exposures
  • Seasonal allergens

Tests used to help confirm a diagnosis of erythema multiforme include:

• Physical exam finding of target lesion rash
• Cultures of blood, sputum, and mucosal lesions
• Blood tests
  • Complete blood count (CBC)
  • Electrolyte levels
  • Blood urea nitrogen (BUN) and creatinine tests
  • Sedimentation rate (ESR)
• Chest X-ray
• Skin biopsy

Treatment of erythema multiforme depends on identifying and treating the cause. 

• If the cause is determined to be due to medication, the medication may be stopped. Do not stop any medication without first consulting your doctor. 
• If the cause is due to infection, specific treatment for that particular infection is recommended such as antibiotics, antivirals, or antifungals. 

Treatment of erythema multiforme symptoms may include:

• Antihistamines
• Pain relievers
• Local skin care
• Soothing mouthwashes 
• Steroids – topical or oral

If the diagnosis is erythema multiforme major/Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), patients may require hospitalization to treat complications and may include:

• Fluid and electrolyte replenishment when there is severe mucous membrane involvement
• Medications for secondary infections
• Skin care/wound care 
  • The most severe cases should be managed in a burn unit

Erythema multiforme minor symptoms are mild and usually go away on their own within 2 weeks. The lesions may recur. 

Erythema multiforme major is more severe and has a mortality rate of up to 5%. The condition lasts longer and patients can take months to recover. Complications such as organ scarring can become chronic. 

In the most severe cases, Stevens-Johnson syndrome (SJS) has a mortality rate of about 10% while the mortality rate for toxic epidermal necrolysis (TEN) is more than 30%. Advanced age, organ involvement, kidney dysfunction, and previous bone marrow transplantation all lead to worse outcomes.

If a patient has a known trigger for erythema multiforme symptoms, that trigger (such as medications) should be avoided.