Triggers, clinical manifestations, and management of pediatric erythema multiforme: A systematic review
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Updated: Jan 21, 2026
Minimal Erythema Dose MED Testing
Published on: May 28, 2013
Samer Zoghaib1, Elio Kechichian1, Karim Souaid1
1Department of Dermatology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
Insights
Pediatric erythema multiforme (EM) is rare, often triggered by infections like herpes simplex virus (HSV) or Mycoplasma pneumoniae. Management focuses on supportive care, with vaccines being a specific trigger in infants.
Area of Science:
- Pediatric Dermatology
- Immunology
- Infectious Diseases
Background:
- Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition.
- EM is infrequently documented in pediatric and infant populations.
Purpose of the Study:
- To comprehensively review the triggers, clinical presentations, and therapeutic strategies for pediatric EM.
- To analyze the specific characteristics of EM in infants and identify risk factors for recurrence.
Main Methods:
- Systematic literature review of published pediatric EM cases.
- Inclusion of 113 articles encompassing 580 pediatric patients.
Main Results:
- Infections, particularly herpes simplex virus (HSV) and Mycoplasma pneumoniae, were the primary triggers.
- Drug-related triggers accounted for 24.1% of cases, and vaccines for 3.2%.
- EM major occurred in 39.5% of patients; supportive care was the most common treatment.
Conclusions:
- Pediatric EM is predominantly infection-triggered, affecting mucosal surfaces, especially the oral mucosa.
- Vaccines are a notable trigger in infants, while HSV is linked to recurrence in older children.
- Awareness among dermatologists and pediatricians is crucial for managing this potentially severe and recurrent condition.
Background:
Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants.
Objective:
To investigate the triggers, clinical manifestations, and treatment of pediatric EM.
Methods:
Systematic literature review of pediatric EM.
Results:
After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children.
Limitations:
Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias.
Conclusion:
Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition.
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