Erythema multiforme major has been considered by many to be the same entity as SJS. This may be true, because the pathogenesis and clinical appearance can be similar. However, subtle differences exist and warrant classifying this condition independently. Both erythema multiforme major and SJS are most often induced by medications. The mucocutaneous surfaces are affected to a significant degree. In severe cases, the mucosal membranes of the respiratory and gastrointestinal tract may also be affected. Erythema multiforme major and SJS typically begin with a nonspecific prodrome of fever and malaise. Fever is the most frequent nonmucocutaneous symptom. The rash begins insidiously as pink macules that quickly develop a dusky purple central region. The typical target-like lesion of erythema multiforme minor is usually absent in SJS but may be seen in erythema multiforme major. Erythema multiforme major is differentiated from erythema multiforme minor in that it affects a larger surface area and affects two mucous membranes.
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