Mild symptoms including feeling unwell, low-grade fevers, sore joints or coughing may precede the classic rash. Early on, itching and burning in the skin may be present. In some cases there may be no preceding symptoms.
EM starts abruptly over two to three days as dull, red spots, which later become raised or blistered. The condition progresses into classic target-like lesions consisting of concentric rings. Typically there is a dusky/purple pink centre, surrounded by a zone of pale pink and an outer red ring. Commonly, these occur on the palms, soles and extremities. The lesions often come up as clusters in a symmetrical distribution.
EM major typically involves mucosal surfaces with painful blistering, ulceration and crusting. Affected individuals are often quite unwell with high fevers and may have enlarged lymph glands.