Pediatric emergency medicine trisk 1315 1315
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FIGURE 68.8 A, B: Classic target lesions seen in erythema multiforme with three distinct
zones. (A: Reproduced with permission from Roche Laboratories. Sauer GC, Hall JC. Manual
of Skin Diseases . 7th ed. Philadelphia, PA: Lippincott-Raven, 1996. B: Reprinted with
permission from Somolinos AL, Grant LM, Goldsmith LA, et al. VisualDx: Essential
Dermatology in Pigmented Skin . Philadelphia, PA: Lippincott Williams & Wilkins, 2011.)
EM is often confused for urticaria or SJS. EM can be distinguished from the
transient and pruritic lesions of urticaria because of the classic target appearance
of lesions that are fixed for several days. As discussed further below, SJS is a
severe drug eruption that has lesions that are often confused for the targetoid
lesions of EM, but they lack the characteristic three zones. Furthermore, in SJS,
two or more mucous membranes are typically involved with blisters, erosions,
and crusting.
EM is a self-limited reaction resolving within 2 to 3 weeks. Because of its
frequent association with herpes simplex virus, patients are often treated with
acyclovir. If a medication trigger is suspected, then stopping the medication will
help with resolution. Antihistamines can offer symptomatic relief.
