Lesions may coalesce and become generalized. Vesiculobullous lesions develop within preexisting macules, papules, or wheals. Rash favors palms and soles, dorsum of the hands, and extensor surfaces of extremities and face. Resolution usually occurs over 7-10 days. Postinflammatory hyperpigmentation or hypopigmentation may occur.
Fever is common.
Skin findings may be similar to EM minor but often are more variable and severe. Inflammatory vesiculobullous lesions, often with hemorrhage and necrosis, are typical. Fixed macules and target lesions may be larger and more confluent than in EM minor. Skin tenderness usually is not present. Lips may be edematous, bloody, or crusted.