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Monaghan L, Dugdale C. An unusual case of erythema multiforme presenting to an orthodontic department: A case report. J Orthod 2024; 51:60-62. [PMID: 37113104 DOI: 10.1177/14653125231172212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 16-year-old female patient presented to the orthodontic department with a 2-week history of painful oral lesions that were affecting her ability to eat. Clinical examination revealed widespread oral ulceration, crusted bleeding from the lips with evidence of a herpes simplex infection in the region of the right buccal commissure. A diagnosis of oral erythema multiforme (EM) was made after a detailed clinical history and examination by the oral and maxillofacial team. Supportive care was provided alongside management with topical corticosteroids. Within 6 weeks of initial presentation, complete resolution of the lesions had occurred and the patient was able to resume active orthodontic treatment.
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Affiliation(s)
- Liam Monaghan
- University Dental Hospital Manchester, Manchester, UK
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2
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Tavares-Júnior JWL, Pompeu Filho JCJ, Galvão LEG. Post nirmatrelvir/ritonavir erythema multiforme in a patient with coronavirus disease infection. Rev Soc Bras Med Trop 2023; 56:e0008. [PMID: 37283342 DOI: 10.1590/0037-8682-0008-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/19/2023] [Indexed: 06/08/2023] Open
Abstract
Erythema multiforme (EM), an immune-mediated skin condition, can occur after infection or following the use of medications. In this study, we describe a patient who developed EM after nirmatrelvir/ritonavir administration. An 81-year-old woman presented with fever and dyspnea. Laboratory investigations showed positive coronavirus disease (COVID-19) based on polymerase chain reaction assay, and she received a 5-day regimen of nirmatrelvir/ritonavir. We observed development of EM after this treatment and initiated prednisone (1 mg/kg) therapy, which led to rapid improvement. Our study is the first to report EM in a patient with COVID-19, who received nirmatrelvir/ritonavir and showed a favorable response.
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Surowiecka A, Barańska-Rybak W, Strużyna J. Multidisciplinary Treatment in Toxic Epidermal Necrolysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2217. [PMID: 36767584 PMCID: PMC9916139 DOI: 10.3390/ijerph20032217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Toxic epidermal necrolysis, Leyll's syndrome (TEN), is a rare mucocutaneous blistering disease burdened with high mortality rates. The diagnosis of TEN is based on clinical symptoms and histopathological findings. In approximately 90% of cases, it is a severe adverse reaction to drugs. In TEN, not only is the skin affected, but also mucosa and organs' epithelium. There are no unequivocal recommendations in regard to systemic and topical treatment of the patients. The aim of this paper is to review available literature and propose unified protocols to be discussed. Early management and multidisciplinary treatment are necessary to improve patients' outcome. Treatment of patients with TEN suspicions should be initiated with early drug withdrawal. TEN patients, like patients with burns, require intensive care and multidisciplinary management. Each patient with TEN should be provided with adequate fluid resuscitation, respiratory support, nutritional treatment, pain control, infection prophylaxis, anticoagulant therapy, and gastric ulcer prophylaxis. The key to local treatment of patients with TEN is the use of nonadherent dressings that do not damage the epidermis during the change. The aim of the systemic treatment is purification of the blood stream from the causative agent. The most efficient way to clarify serum of TEN patients' is the combination of plasmapheresis and IVIG. Immunomodulatory therapy can reduce the mortality five times in comparison with the patients with immunosuppression or lack of full protocol.
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Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Lublin, Poland
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-059 Lublin, Poland
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4
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Abstract
A variety of acute oral lesions may be encountered in the scope of dermatology. Oral lesions may be single or multiple; may arise secondary to infectious, immune, congenital, medication use, or idiopathic causes; and may take a variety of forms. A thorough evaluation of the oral cavity is required to assess patients with oral lesions. Affected patients may be monitored, treated, or referred to an appropriate specialist for further management as needed. Many acute oral lesions are self-limiting in nature and patients may require only assessment and reassurance. Several common acute oral lesions are discussed in this article.
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Affiliation(s)
- Katherine France
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, 513 Parnassus Avenue, Suite 512A, San Francisco, CA 94143, USA
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5
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Frizzell M, Nguyen NM, Parikh SA, Sinai M, Goldberg L. Erythema multiforme following exposure to the herbicide atrazine. Proc AMIA Symp 2020; 34:91-92. [PMID: 33456156 DOI: 10.1080/08998280.2020.1829935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Erythema multiforme is an acute hypersensitivity eruption with sharply demarcated papules and plaques. It has many known causes, from herpes simplex virus and drugs to malignancy and environmental factors. Although other herbicides have been linked to erythema multiforme, no previous reports have described a link with atrazine. We present a 24-year-old man with difficulty breathing, bilateral eye pain with redness, and a diffuse rash consistent with erythema multiforme following occupational exposure to atrazine.
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Affiliation(s)
| | - Nhan M Nguyen
- DermSurgery Associates, Houston Methodist, Houston, Texas
| | - Sonal A Parikh
- DermSurgery Associates, Houston Methodist, Houston, Texas
| | - Maya Sinai
- DermSurgery Associates, Houston Methodist, Houston, Texas
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6
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Mounica IL, Tejaswi K, Chennaiah T, Thanmai JV. Erythema multiforme: integrating the superfluous diagnosis to a veracious conclusion (case report). Pan Afr Med J 2020; 37:129. [PMID: 33425162 PMCID: PMC7755351 DOI: 10.11604/pamj.2020.37.129.25295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022] Open
Abstract
Erythema multiforme (EM) is an acute, self-limiting hypersensitivity reaction that ranges from a mild cutaneous, exanthematous variant with minimal oral involvement to a progressive fulminating severe variant with extensive mucocutaneous epithelial necrosis (SJS & TEN). Knowing the etiological spectrum is the key for management in EM where sometimes leads to mortality. There are no specific diagnostic tests for EM, diagnosis is mainly clinically supported. Here in we report series of cases of EM with different etiological spectrum.
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Affiliation(s)
- Inukonda Lakshmi Mounica
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
| | - Katne Tejaswi
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
| | - Tirumala Chennaiah
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
| | - Janumpally Varshitha Thanmai
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
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7
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Sunil Kumar S, Elumalai K, Eluri K, Elumalai M, Mallu K, Srinivasan S, Ranjan C, Sivannan S. A case report on hydroxychloroquine induced maculopapular rashes: The immunosuppressant and corticosteroid therapy. PRECISION MEDICAL SCIENCES 2020. [DOI: 10.1002/prm2.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Salkapuram Sunil Kumar
- Department of Postgraduate Research in Clinical Pharmacy Santhiram College of Pharmacy Nandyal India
| | - Karthikeyan Elumalai
- Department of Medicinal Chemistry School of Pharmaceutical Sciences, Vels Institute of Science, Technology and Advanced Studies Chennai India
| | - Kalpana Eluri
- Faculty of Pharmaceutical Sciences, Faculty of Medicine and Health Sciences UCSI University Kuala Lumpur Malaysia
| | - Manogaran Elumalai
- Faculty of Pharmaceutical Sciences UCSI University Kuala Lumpur Malaysia
| | - Keerthana Mallu
- Department of Postgraduate Research in Clinical Pharmacy Santhiram College of Pharmacy Nandyal India
| | | | - Chanda Ranjan
- Department of Medicinal Chemistry The Oxford College of Pharmacy Bangalore India
| | - Srinivasan Sivannan
- Department of Pharmacy Practice Karpagam College of Pharmacy Coimbatore India
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8
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Cho M, Lee DH, Doh EJ, Kim Y, Chung JH, Kim HC, Kim S. Development and clinical validation of a novel photography-based skin erythema evaluation system: a comparison with the calculated consensus of dermatologists. Int J Cosmet Sci 2017; 39:426-434. [DOI: 10.1111/ics.12393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/04/2017] [Indexed: 12/30/2022]
Affiliation(s)
- M. Cho
- Interdisciplinary Program for Bioengineering; Graduate School; Seoul National University; Seoul 110-744 Korea
| | - D.-H. Lee
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - E. J. Doh
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - Y. Kim
- Department of Biomedical Engineering; Seoul National University Hospital; Seoul 110-744 Korea
| | - J. H. Chung
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - H. C. Kim
- Department of Biomedical Engineering; Seoul National University College of Medicine; Seoul 110-799 Korea
- Institute of Medical and Biological Engineering; Seoul National University; Seoul 151-742 Korea
| | - S. Kim
- Department of Biomedical Engineering; Seoul National University College of Medicine; Seoul 110-799 Korea
- Institute of Medical and Biological Engineering; Seoul National University; Seoul 151-742 Korea
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Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic reactions with mucocutaneous involvement that carry elevated mortality rates. They differ along a spectrum of severity based upon body surface area affected. These conditions, usually caused by a drug or infection, are believed to result from cell-mediated and often drug-specific cytotoxic reactions against keratinocytes, leading to widespread dermal-epidermal detachment. Studies attempting to identify potential curative therapies such as intravenous immune globulin (IVIG) and corticosteroids remain inconclusive. However, improved outcomes have been demonstrated by early withdrawal of offending medications, early transfer to an intensive care unit or burn unit, and aggressive supportive care. Due to the rare incidence of SJS and TEN, its recurrence among survivors hints at future vulnerability for these patients, and notorious offending medications should thus be avoided. This clinical review will highlight the diagnostic and therapeutic challenges posed by SJS and TEN, while emphasizing the need to maintain them high on the emergency medicine physician's differential. The review will also detail the supportive measures to take for preventing the rapid progression of mucocutaneous complications and subsequent sepsis-related mortality.
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Brown RS. Oral erythema multiforme: trends and clinical findings of a large retrospective: European case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:681. [DOI: 10.1016/j.oooo.2015.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 11/25/2022]
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In reply: Oral erythema multiforme: trends and clinical findings of a large retrospective: European case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:681-2. [DOI: 10.1016/j.oooo.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 11/24/2022]
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12
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Erythema multiforme major secondary to a cosmetic facial cream: first case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e10-5. [DOI: 10.1016/j.oooo.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 12/13/2022]
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13
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Gantala R, Devaraju RR, G SG, Aitha H, Kubbi JR. Condiments Costing High. . . ! A Case Report of Erythema Multiforme. J Clin Diagn Res 2015; 9:ZD22-4. [PMID: 26393224 DOI: 10.7860/jcdr/2015/12075.6221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
Adverse drug associated mucocutaneous reactions having a preponderance to occur above 1% include urticaria, angioedema, photosensitivity, fixed drug eruptions and Erythema Multiforme (EM). EM is an acute inflammatory disease of the skin and mucous membranes that causes a variety of skin lesions-hence named 'multiforme'. The aetiological spectrum of EM is wide and is attributed to infectious agents, drugs and food additives. EM is diagnosed based on stringent clinical findings which are pathognomic as microscopic evaluation carries least significance. We report a case of a 38-year-old male who presented with a complaint of severe oral & cutaneous lesions making him difficult to eat & drink. History revealed the usage of clove to get rid of tooth pain following which he developed ulcers in the mouth which made him to visit a general physician where he was administered gentamycin. Later on oral lesions worsened along with the emergence of dermal lesions. In the present case, based on the patient history, clove was found to be a probable aetiological agent and the condition was further precipitated owing to the administration of gentamycin. The patient was successfully treated with corticosteroids adhering to systemic corticosteroid administrative protocols and no remissions and exacerbations were noticed in a year follow up.
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Affiliation(s)
- Ramlal Gantala
- Associate Professor, Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences , Appanapally, Mahabubnagar, Telangana, India
| | - Rama Raju Devaraju
- Professor and HOD, Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences , Appanapally, Mahabubnagar, Telangana, India
| | - Srikanth Goud G
- Post Graduate Student, Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences , Appanapally, Mahabubnagar, Telangana, India
| | - Harisha Aitha
- Assistant Professor, Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences , Appanapally, Mahabubnagar, Telangana, India
| | - Jitender Reddy Kubbi
- Associate Professor, Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences , Appanapally, Mahabubnagar, Telangana, India
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14
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Moitra S, Sen S, Banerjee I, Das P, Tripathi SK. Diclofenac-serratiopeptidase combination induced stevens - johnson syndrome - a rare case report with review of literature. J Clin Diagn Res 2014; 8:YD08-11. [PMID: 25177625 DOI: 10.7860/jcdr/2014/9509.4610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 06/06/2014] [Indexed: 11/24/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) which are frequently caused by exposure to drugs and cause significant morbidity and mortality. A careful literature search revealed that only a few reports of diclofenac induced and one case of serratiopeptidase associated case report of SJS or TEN have been published till date. However, to our knowledge, no case report of diclofenac-serratiopeptidase combination induced SJS have been published till date. In this backdrop, we describe the first case of a 62-year-old woman who developed diffuse, erythematous rash on face, trunk and both extremities which later turned into blisters following five day treatment with diclofenac and serratiopeptidase combination. There was extensive ulceration of buccal, genital and ocular mucosa. The body surface area involvement of the patient at the time of presentation was 9%. A provisional diagnosis of SJS was made by the treating physician. After administration of intravenous antibiotic, topical antiseptic, anti-histamine, topical lubricants, fluid therapy and parenteral nutrition patient recovered and were discharged.
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Affiliation(s)
- Saibal Moitra
- Pulmonologist, Department of Respiratory and Allergy Medicine, Charnock Hospital & Research Centre Pvt. Ltd , West Bengal, India
| | - Sukanta Sen
- Post Doctoral Trainee (DM- Clinical Pharmacology), Department of Clinical & Experimental Pharmacology, Department of Clinical & Experimental Pharmacology, School of Tropical Medicine , 108 C.R. Avenue, Kolkata, West Bengal, India
| | - Indranil Banerjee
- Post Doctoral Trainee (DM- Clinical Pharmacology), Department of Clinical & Experimental Pharmacology, Department of Clinical & Experimental Pharmacology, School of Tropical Medicine , 108 C.R. Avenue, Kolkata, West Bengal, India
| | - Prasanta Das
- Respiratory Therapist, Department of Respiratory and Allergy Medicine, Department of Respiratory and Allergy Medicine, Charnock Hospital & Research Centre Pvt. Ltd , Kolkata, West Bengal, India
| | - Santanu K Tripathi
- Professor & Head, Department of Clinical & Experimental Pharmacology, Department of Clinical & Experimental Pharmacology, School of Tropical Medicine , Avenue, Kolkata, West Bengal, India
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15
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[Erythema multiforme: Description of cases and phenotypic variants]. Semergen 2014; 41:232-4. [PMID: 24830602 DOI: 10.1016/j.semerg.2014.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/19/2014] [Accepted: 03/13/2014] [Indexed: 11/23/2022]
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16
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Khudhur AS, Di Zenzo G, Carrozzo M. Oral lichenoid tissue reactions: diagnosis and classification. Expert Rev Mol Diagn 2014; 14:169-84. [DOI: 10.1586/14737159.2014.888953] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Samim F, Auluck A, Zed C, Williams PM. Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment. Dent Clin North Am 2013; 57:583-596. [PMID: 24034067 DOI: 10.1016/j.cden.2013.07.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Erythema multiforme (EM) is an acute, immune-mediated disorder affecting the skin and/or mucous membranes, including the oral cavity. Target or iris lesions distributed symmetrically on the extremities and trunk characterize the condition. Infections are the most common cause of EM and the most frequently implicated infectious agent causing clinical disease is the herpes simplex virus. The diagnosis of EM is typically based on the patient's history and clinical findings. Management involves controlling the underlying infection or causative agent, symptom control, and adequate hydration. The epidemiology, pathogenesis, clinical features, diagnosis, and treatment of EM are reviewed in this article.
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Affiliation(s)
- Firoozeh Samim
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Rodríguez-Pazos L, Gómez-Bernal S, Rodríguez-Granados M, Toribio J. Eritema multiforme fotodistribuido. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Rodríguez-Pazos L, Gómez-Bernal S, Rodríguez-Granados MT, Toribio J. Photodistributed erythema multiforme. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:645-53. [PMID: 23962583 DOI: 10.1016/j.adengl.2012.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 01/07/2012] [Indexed: 11/29/2022] Open
Abstract
Although the existence of photodistributed erythema multiforme has been recognized for years, few cases have been described to date. It is an uncommon, and probably underdiagnosed, skin disorder that can affect individuals of both sexes and all ages. It has been associated with drugs, reactivation of herpes simplex virus infection, and polymorphous light eruption. A diagnosis is made on the basis of history, physical examination, histology, and phototesting. The condition runs a benign, self-limiting course but patients may experience outbreaks for several years if the causative agent is not eliminated. It is treated symptomatically and patients are advised to avoid triggers and excessive sun exposure.
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Affiliation(s)
- L Rodríguez-Pazos
- Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, Spain.
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Edwards D, Boritz E, Cowen EW, Brown RS. Erythema multiforme major following treatment with infliximab. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e36-40. [PMID: 23036796 PMCID: PMC3540144 DOI: 10.1016/j.oooo.2012.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/24/2012] [Accepted: 08/04/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND The growth in the use of anti-tumor necrosis factor α (TNF-α) agents for treatment of inflammatory conditions has led to increased recognition of the side effects associated with this class of drugs. CASE DESCRIPTION We report a case of a patient who developed erythema multiforme (EM) major with characteristic oral and cutaneous lesions following treatment with the anti-TNF-α medication infliximab therapy for Crohn's disease (CD). CLINICAL IMPLICATIONS To our knowledge, this is the first reported case of infliximab-induced EM secondary to the treatment of CD. It is important for dental clinicians evaluating patients using anti-TNF-α agents to be aware of this possible complication.
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Affiliation(s)
- Dean Edwards
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland 20892, USA.
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21
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Joseph TI, Vargheese G, George D, Sathyan P. Drug induced oral erythema multiforme: A rare and less recognized variant of erythema multiforme. J Oral Maxillofac Pathol 2012; 16:145-8. [PMID: 22434953 PMCID: PMC3303512 DOI: 10.4103/0973-029x.92995] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oral erythema multiforme (EM) is considered as a third category of EM other than EM minor and major. Patients present with oral and lip ulcerations typical of EM but without any skin target lesions. It has been reported that primary attacks of oral EM is confined to the oral mucosa but the subsequent attacks can produce more severe forms of EM involving the skin. Hence, it is important to identify and distinguish them from other ulcerative disorders involving oral cavity for early management. This article reports two cases of oral EM that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of early diagnosis and proper management.
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Affiliation(s)
- T Isaac Joseph
- Department of Oral and Maxillofacial Pathology, Sree Mookambika Institute of Dental Sciences, Kulashekhram, Tamil Nadu, India
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Kim H, Min J, Park J, Lee S, Lee J. Erythema multiforme major due to occupational exposure to the herbicides alachlor and butachlor. Emerg Med Australas 2012; 23:103-5. [PMID: 21284821 DOI: 10.1111/j.1742-6723.2010.01381.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Alachlor and butachlor are commonly used chloroacetanilide herbicides. They are cytotoxic, but there have been rare reported cases of alachlor or butachlor induced erythema multiforme major. We report the case of a 38-year-old farmer with erythema multiforme major due to the occupational exposure to alachlor/butachlor. The patient presented to the ED because of itching. Confluent erythematous to violaceous maculopatches with bullae and erosions were seen on the trunk, both upper extremities and both lower extremities. He had no relevant past or family history of a similar skin disease. He had used alachlor/butachlor for 3 days before he developed the itch. We performed a skin incisional biopsy and found diffuse hydropic degeneration with many necrotic keratinocytes in the epidermis and mild to moderate superficial perivascular lymphocytic infiltrate admixed with neutrophils and eosinophils in the upper dermis. These results confirmed the diagnosis of erythema multiforme major. The patient was admitted and received systemic and topical steroids. After 18 days, most lesions had healed, and he was discharged.
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Affiliation(s)
- Hoon Kim
- Departments of Emergency Medicine Dermatology, College of Medicine, Chungbuk National University, Cheongju, Korea
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23
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Woo SB. Immune-Mediated, Autoimmune, and Granulomatous Conditions. ORAL PATHOLOGY 2012:150-184. [DOI: 10.1016/b978-1-4377-2226-0.00008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
Many drugs used for the treatment of HIV disease (including the associated opportunistic infections) can cause drug hypersensitivity reactions, which vary in severity, clinical manifestations and frequency. These reactions are not only seen with the older compounds, but also with the newer more recently introduced drugs. The pathogenesis is unclear in most cases, but there is increasing evidence to support that many of these are mediated through a combination of immunologic and genetic factors through the major histocompatibility complex (MHC). Genetic predisposition to the occurrence of these allergic reactions has been shown for some of the drugs, notably abacavir hypersensitivity which is strongly associated with the class I MHC allele, HLA-B*5701. Testing before the prescription of abacavir has been shown to be of clinical utility, has resulted in a change in the drug label, is now recommended in clinical guidelines and is practiced in most Western countries. For most other drugs, however, there are no good methods of prevention, and clinical monitoring with appropriate (usually supportive and symptomatic) treatment is required. There is a need to undertake further research in this area to increase our understanding of the mechanisms, which may lead to better preventive strategies through the development of predictive genetic biomarkers or through guiding the design of drugs less likely to cause these types of adverse drug reactions.
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Affiliation(s)
- Mas Chaponda
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 3GL, UK
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PURANIK SUREKHAR, PURANIK RS, SATTIGERI ANUPAMA. Recurrent Oral Ulceration. Aust Dent J 2011; 56:241-2; author reply 242. [DOI: 10.1111/j.1834-7819.2011.01336_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Liu YC, Desai A, Lee B, Srinivasan M. It's not Behçet's! J Gen Intern Med 2011; 26:559-60. [PMID: 21116869 PMCID: PMC3077480 DOI: 10.1007/s11606-010-1546-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/08/2010] [Accepted: 10/06/2010] [Indexed: 11/03/2022]
Affiliation(s)
- Yen Chen Liu
- School of Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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Clinical evaluation of oral lesions associated with dermatologic diseases. An Bras Dermatol 2010; 85:150-6. [PMID: 20520929 DOI: 10.1590/s0365-05962010000200004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 01/20/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dermatologic diseases are not only represented by lesions affecting the skin but also by manifestations that may involve the mucous membranes, including oral mucosa. OBJECTIVES To evaluate the frequency of oral manifestations associated with dermatologic diseases considering location and clinical characteristics of the lesions found and also gender, age and race of patients. METHOD It was an observational, cross-sectional study of patients who sought for treatment at the Dermatology Service of the University Hospital (Hospital Presidente Dutra-HUPD); UFMA, between October 2007 and October 2008 (n=88). RESULTS Age varied from 5 to 88 and there was predominance of female patients. 35% of the cases studied were diagnosed as lichen planus; 33% as lupus erythematosus; 24% as erythema multiforme; 7% as pemphigus vulgaris and 1% as pemphigoid group. Oral manifestations were more common among patients suffering from lichen pplanus (51%) and lupus erythematosus (20%). The most common clinical presentation found was reticular lichen planus located most predominantly in the buccal mucosa. CONCLUSIONS It is essential that dentists know these pathologies to be able to diagnose them in an early stage of the disease and to direct patients to adequate treatment. Furthermore, intraoral examination should be included as a routine practice in dermatological services.
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Lissia M, Mulas P, Bulla A, Rubino C. Toxic epidermal necrolysis (Lyell's disease). Burns 2010; 36:152-63. [DOI: 10.1016/j.burns.2009.06.213] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 04/21/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
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Recurrent erythema multiforme after alcohol ingestion in a patient receiving ciprofloxacin: a case report. CASES JOURNAL 2009; 2:7787. [PMID: 19830014 PMCID: PMC2740177 DOI: 10.4076/1757-1626-2-7787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 06/18/2009] [Indexed: 11/08/2022]
Abstract
The incidence of cutaneous adverse reactions to quinolones is low; moreover their development in patients with concomitant alcohol consumption is a phenomenon that has been scarcely reported. We present a case of 46-year-old male who developed erythema multiforme after ingestion of alcohol, while being treated with ciprofloxacin. The lesion was self-limiting and abstinence from alcohol permitted the completion of the course of therapy without any other adverse reaction.
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30
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Sina B, Kao GF, Deng AC, Gaspari AA. Skin biopsy for inflammatory and common neoplastic skin diseases: optimum time, best location and preferred techniques. A critical review. J Cutan Pathol 2009; 36:505-10. [PMID: 19187117 DOI: 10.1111/j.1600-0560.2008.01175.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The diagnosis of skin diseases, particularly inflammatory dermatoses, is based primarily on clinical information. Pathologic examination of the biopsied specimen often serves as a complementary or confirmative part of the diagnosis. However, the clinical diagnosis of skin diseases may be challenging, as the clinical information and appearance of skin lesions invariably overlap. Evidence for a correct diagnosis may be lacking without histopathologic examination of skin biopsies. It is well known that the histologic diagnosis of inflammatory and other skin diseases requires clinicopathologic correlation, and there is evolution of skin lesions into different stages as the diseases progress. Other factors important for accurate dermatopathologic diagnosis are optimum time, best location and preferred techniques of skin biopsy. In searching for available information concerning when, where and how to take skin biopsies, it is noted that there are only limited practical guidelines currently available. We present this review article in hopes that our collective dermatopathologic and dermatologic experience can provide a quick reference for accurate diagnosis and proper management of skin diseases.
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Affiliation(s)
- Bahram Sina
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD 21201-1524, USA
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31
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Abstract
Erythema multiforme (EM) is a rare acute mucocutaneous condition caused by a hypersensitivity reaction with the appearance of cytotoxic T lymphocytes in the epithelium that induce apoptosis in keratinocytes, which leads to satellite cell necrosis. EM can be triggered by a range of factors, but the best documented association is with preceding infection with herpes simplex virus (HSV). Most other cases are initiated by drugs. EM has been classified into a number of variants, mainly minor and major forms, as it may involve the mouth alone, or present as a skin eruption with or without oral or other lesions of the mucous membrane. EM minor typically affects only one mucosa, and may be associated with symmetrical target skin lesions on the extremities. EM major typically involves two or more mucous membranes with more variable skin involvement. A severe variant of EM major is Stevens-Johnson syndrome, which typically extensively involves the skin. Both EM major and Stevens-Johnson syndrome can involve internal organs and produce systemic symptoms. Treatment of EM is controversial, as there is no reliable evidence. Precipitants should be avoided or treated and, in severe cases, corticosteroids may be needed. Toxic epidermal necrolysis may be similar to Stevens-Johnson syndrome, but many experts regard it as a discrete disease, and therefore it is not discussed here.
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Erythema multiforme after radiotherapy with aromatase inhibitor administration in breast-conservation treatment for breast cancer. Breast Cancer 2008; 15:321-3. [DOI: 10.1007/s12282-008-0041-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Accepted: 12/18/2007] [Indexed: 10/21/2022]
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Al-Johani KA, Fedele S, Porter SR. Erythema multiforme and related disorders. ACTA ACUST UNITED AC 2007; 103:642-54. [PMID: 17344075 DOI: 10.1016/j.tripleo.2006.12.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 12/12/2006] [Accepted: 12/12/2006] [Indexed: 01/07/2023]
Abstract
Erythema multiforme (EM) and related disorders comprise a group of mucocutaneous disorders characterized by variable degrees of mucosal and cutaneous blistering and ulceration that occasionally can give rise to systemic upset and possibly compromise life. The clinical classification of these disorders has often been variable, thus making definitive diagnosis sometimes difficult. Despite being often caused by, or at least associated with, infection or drug therapy, the pathogenic mechanisms of these disorders remain unclear, and as a consequence, there are no evidence-based, reliably effective therapies. The present article reviews aspects of EM and related disorders of relevance to oral medicine clinical practice and highlights the associated potential etiologic agents, pathogenic mechanisms and therapies.
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Affiliation(s)
- Khalid A Al-Johani
- Division of Medical, Surgical and Diagnostic Sciences, Eastman Dental Institute for Oral Health Care Sciences, University College of London, London, England
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