Erythema Multiforme (Child)

Erythema multiforme is a skin rash. It's caused by a hypersensitivity reaction. The reaction can be caused by many things. These include viruses, bacteria, fungi, medicines, vaccines, or food. A severe form of erythema multiforme called Stevens-Johnson syndrome (erythema multiforme major) is most often caused by medicines. This is a very rare form of erythema multiforme.

At first, the skin may have round red bumps, fluid-filled blisters, or pimples. Most of these turn into a round circle with a small dark center. The entire area of the skin may be surrounded by a white ring. The sores may cause pain, burning, or itching. They occur most often on the forearms, legs, and back of hands and feet. In more severe cases, they may happen in the mouth or on the genitals. They are not contagious.

Treatment includes finding and treating or removing the cause. If a medicine may be the cause, you will be told to stop giving it to your child. The sores will likely go away in about 2 to 6 weeks. It may take longer in severe cases. The sores may come back. Medicine to reduce pain and inflammation may be given. Depending on the cause, your child may be given antiviral or antibiotic medicines.

Your child's doctor may prescribe medicines for swelling, pain, and itching. Follow all instructions for giving these to your child.

• Let your child rest as needed.
• Clean the sores as advised by the doctor.
• Ask your child's doctor if you can use colloidal oatmeal baths, wet compresses, or unscented lotion to ease your child's discomfort. You can use a clean, damp washcloth as a wet compress.
• Wash your hands with soap and clean running water before and after caring for your child. This is to prevent infecting the sores.
• You can give your child acetaminophen or ibuprofen to ease fever or pain. Don't give aspirin or products with aspirin to children under 19 years of age. It can cause a serious illness called Reye syndrome, which may cause brain or liver damage.

Follow up with your child's doctor or as advised.

The sores are usually not dangerous, but watch for warning signs mentioned below. Your child is not contagious. Make sure to tell family, friends, and caregivers that contact with your child is safe.

Contact your child's doctor or seek medical care right away if any of these occur:

• Shortness of breath or trouble breathing (call 911)
• Lack of interest in feeding or drinking in a baby or young child
• The rash spreads to the eyes, mouth, or genitals.
• Large areas of redness or skin peeling appear
• Fever (see Fever and children, below)
• Sores that don't go away after 6 weeks
• Vomiting or diarrhea
• Redness or swelling that gets worse
• Pain that gets worse
• Foul-smelling fluid leaking from the sores
• Sores that come back after going away

Use a digital thermometer to check your child's temperature. Don't use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.
• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The doctor may want to confirm with a rectal temperature.
• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.
• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The doctor may want to confirm with a rectal temperature.
• Mouth (oral). Don't use a thermometer in your child's mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker's directions for correct use. Insert it gently. Label it and make sure it's not used in the mouth. It may pass on germs from the stool. If you don't feel okay using a rectal thermometer, ask the doctor what type to use instead. When you talk with any doctor about your child's fever, tell them which type you used.

Below are guidelines to know if your young child has a fever. Your child's doctor may give you different numbers for your child. Follow your doctor's specific instructions.

Fever readings for a baby under 3 months old:

• First, ask your child's doctor how you should take the temperature.
• Rectal or forehead: 100.4°F (38°C) or higher
• Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

• Rectal, forehead, or ear: 102°F (38.9°C) or higher
• Armpit: 101°F (38.3°C) or higher

Contact the doctor in these cases:

• Repeated temperature of 104°F (40°C) or higher in a child of any age
• Fever of 100.4° F (38° C) or higher in baby younger than 3 months
• Fever that lasts more than 24 hours in a child under age 2
• Fever that lasts for 3 days in a child age 2 or older