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Erythema multiforme, mixed dermal-epidermal type

Last edited: 4/16/2026

Overview

Erythema multiforme, mixed dermal-epidermal type, is an uncommon variant characterized by a combination of dermal and epidermal blistering, often triggered by infections or medications, presenting with classic target lesions and mucosal involvement 1.

Diagnosis

  • Clinical presentation includes target lesions, mucosal ulcers, and variable blistering 1.
  • Histopathology reveals both subepidermal blistering (with or without a dermal infiltrate) and intraepidermal blistering (bullous fixed drug eruption-like changes) 1.
  • Direct immunofluorescence may show linear deposition of IgA at the basement membrane zone in some cases 1.
  • Differential diagnosis includes Stevens-Johnson syndrome, toxic epidermal necrolysis, and other bullous dermatoses 1.

    • Management

  • First-line treatment involves identifying and discontinuing the trigger (e.g., medications, infections) 1.
  • Supportive care includes wound care for mucosal and cutaneous lesions, fluid and electrolyte management 1.
  • Corticosteroids (e.g., prednisone, 1-2 mg/kg/day) are often used for severe cases to reduce inflammation 1.
  • Adjunctive treatments may include intravenous immunoglobulin (IVIG) for refractory cases 1.

    • Special Populations

  • No specific guidance provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts 1.

    • Key Recommendations

  • Identify and remove the underlying trigger (medication, infection) to halt disease progression (Evidence: Expert opinion) 1.
  • Initiate supportive care measures including meticulous wound care and hydration management (Evidence: Expert opinion) 1.
  • Consider systemic corticosteroids for severe cases to manage inflammation (Evidence: Expert opinion) 1.

    • References

    1 Burd DA. Mixed appendageal tumour: case report. British journal of plastic surgery 1984. link90084-5)

    Original source

    1. [1]
      Mixed appendageal tumour: case report. — Burd DA British journal of plastic surgery (1984)
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