How I Manage Viral-Induced Erythema Multiforme

Picture of a Dove chocolate wrapper with the words "You've got this!" written on the inside.

Hell, yes! I’ve got this!

As I type this post, I’m on day six of an erythema multiforme flare.

I first learned about this condition in 2001 when I found myself struggling to eat or talk clearly when several blisters popped up in my mouth one day. I was terrified and went to the doctor.

After visits to four different clinics, I was put on steroids and told to rest and heal.

I didn’t actually have a diagnosis for what I’d eventually learn in 2008 — during another flare-up —  is a rare skin condition known as viral-induced erythema multiforme.

Since a major episode in 2008 (that progressed into a more serious condition called Steven Johnson Syndrome), I’ve been managing my erythema multiforme with daily antiviral medication, relaxation techniques and dietary changes. If you’ve recently been diagnosed with this condition, or suspect you may have it, read on. I’m happy to share my experiences from a patient perspective.

I’m a health and wellness writer, not a doctor, so please consider this information as a source of talking points to bring up with your health care provider.

Disclosure: This blog is reader-supported, which means this post contains affiliate links and advertisements. I earn a small commission if you shop through them, which helps fund this website so I can continue to bring you amazing content. Thank you! ~Angela

What is Viral Induced Erythema Multiforme?

Erythema multiforme can be triggered by medications (over-the-counter or prescription) or viral infections. I fall into the latter category, with the herpes simplex (cold sore) virus (HSV) being at the root cause of my EM flares.

According to American Family Physician Magazine, additional viruses that can trigger erythema multiforme include cytomegalovirus, hepatitis C, human immunodeficiency virus and varicella zoster virus.

I should also note, that when I get a cold sore from HSV, I don’t always get an EM flare. And likewise, when my EM is flaring (like now), I don’t always get a cold sore. The two conditions can present independently of one another.

What Does Erythema Multiforme Look Like?

Do a quick Google image search for erythema multiforme and you’ll get a good idea of how this skin condition can vary in appearance and location on the body.

My current flare-up started with little red dots on my legs. They reminded me of measles. A girlfriend said she thought they looked like poison ivy. The red dots then grow in size, and some turn into blisters filled with clear liquid. When the blisters pop, they leave behind a small ulcer-like sore, that caves in. Over time, the ulcers widen and sometimes grow into each other, creating a larger lesion. Eventually, the sores dry out and heal, often leaving behind scaring.

The large EM flare I referenced earlier from 2008 left several discolored spots on my lips. I don’t notice any scarring on my hands or knees from previous EM lesions.

Update: In 2022, I do notice scarring on my lower legs from a severe 2020 EM flare.

What Does Erythema Multiforme Feel Like?

Viral-induced erythema mutiforme is uncomfortable! First off, for me, the skin condition is combined with cold or flu-like symptoms. I often have a stuffy nose, runny nose, heaviness in my chest, coughing and general fatigue.

When it comes to the EM sores themselves, they are very tender. The initial red spots are itchy. Then they begin to blister and are sore to the touch. When the blisters pop and the fluid drains, the area stings. If I brush against an open lesion, it zings, often making sleeping or wearing loose clothes over the affected area uncomfortable.

I currently have two lesions (which actually merged into one this morning) on my left cheek. Each time my fingers graze over the area, I feel mild discomfort. If I accidentally scratch the area, it hurts.

What Can I Do to Ease the Pain from Erythema Multiforme?

During my current flare, my doctor has put me on oral steroids daily. I’m also using a topical steroid cream on the lesions. I have a high pain tolerance, so I just use naproxen or ibuprofen to offset the discomfort to my skin.

In the past, when the erythema multiforme erupted on my tongue, gums and lips, my pain levels were nearly unmanageable. I was given pain medication through an IV at the emergency room of my local hospital. I later managed with a prescription-level liquid pain medication I could swallow. I also took over-the-counter pain pills, as advised by my doctor.

I also like to soak in a warm bath with Epsom salts. I use products from WestLab and Dr. Teal’s. Yes, the water and salt burns a bit on the open lesions, but eventually feels soothing and seems to help my skin heal. When it comes to oral lesions, I like to place a warm, moist washcloth over my mouth the keep the sores from drying out and cracking, which causes more pain.

Rest is a huge aspect of healing from EM, and when you’re sleeping, you also feel less pain. I like to diffuse essential oils, read and use meditation to get drowsy and nap when managing an EM flare.

How Long Does Erythema Multiforme Last?

This varies per person. My major flare-up in 2008 lasted 36 days. That count is based on when I stopped being able to eat (due to excessive mouth lesions) and when I took my first bite of soft food again. It took me about three months in total to revive my energy and fully heal my skin.

I’m a week into my current flare, and I’m guessing it will be another week or two before it simmers down and I feel like I’m back at a healthy baseline, pre-flare.

Can You Suggest Further Reading about Erythema Multiforme?

Of course! Viral-induced erythema multiforme is quite rare overall, and there’s not a lot of research out there specifically on this category of EM. That’s in part why I wanted to share my first-hand experience. I hope this insight helps you understand what you or someone you care about is experiencing, and serves as background for informed conversations with your medical providers.

In the meantime, feel free to browse these online resources to learn more:

Erythema multiforme can spread quickly, escalating in severity. Don’t hesitate to contact your health care provider or visit the emergency room for diagnosis and pain management. When I was in the hospital in 2008, I was told severe cases needed to be treated in the burn unit to keep skin infections to a minimum. Please seek medical treatment ASAP for the best care and outcome of an erythema multiforme flare.

Until next time,
Choose healthy!

PS: Visit me on Facebook at Cupcakes and Yoga Pants! Search the hashtag #ErythemaMultiforme to read updates on this health condition.

Note: This blog post was last updated on July 19, 2022.

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