clinical features

Last reviewed 03/2021

A patient may present with mild or no prodromal symptoms. Itching and burning might be experienced by the patients at the site of the eruption (1).

Distribution of lesions:

  • symmetrically distributed lesions
  • common sites are the back of the hands, palms, forearms, feet, toes - genital and oral lesions may be seen in Stevens-Johnson syndrome
  • there is often a proximal spread of the lesions along an affected limb (1)
  • the scalp is characteristically avoided

appearance of lesions:

  • the appearance of lesions is very variable - the lesions may have central pallor with peripheral erythema or central erythema with peripheral pallor. Frank bullae may be present and represent epidermal necrosis
  • the lesions begins as numerous, sharply demarcated erythematous macules which then become papular.
  • these papules gradually evolve into plaques
  • there may be crusting or blistering at the central portion of the lesion
  • the characteristic target or iris lesions are regular round shaped lesions with 3 concentric zones:
    • a central dusky or darker red area
    • a paler pink or edematous zone
    • a peripheral red ring
    • some target lesion may contain only 2 zones - the dusky or darker red center and a pink or lighter red border .

Target lesions may become noticeable several days after the disease onset. These target lesions together with lesions of various clinical morphology accounts for the name erythema "multiforme" (1).

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