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Cho YJ, Huh SY, Hong JS, Jung JY, Suh DH. Neonatal erythema multiforme: a case report. Ann Dermatol 2011; 23:382-5. [PMID: 21909214 PMCID: PMC3162273 DOI: 10.5021/ad.2011.23.3.382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 07/25/2010] [Accepted: 07/25/2010] [Indexed: 11/23/2022] Open
Abstract
Erythema multiforme (EM) is an extremely rare condition in infancy. To the best of our knowledge, there have been only three cases of neonatal EM described in the literature, and no such cases have been reported in Korea. A preterm neonate born at 35 weeks and six days of gestation presented with multiple annular erythematous patches with a targetoid shape over his entire body at 36 days of age (corrected age of 7 days). He had no systemic symptoms except for transient mild fever. No triggering factor except for hepatitis B and BCG vaccination was found. Neutropenia was noted upon laboratory analysis. Skin biopsy specimens showed findings suggestive of erythema multiforme. The skin lesions improved rapidly upon administration of intravenous methylprednisolone; however, neutropenia continued for a much longer period. The significance of neutropenia with respect to the development of EM was not clarified. There has been no recurrence of skin lesions over a one-year follow-up period.
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Britton P, Deng L. Intravenous immunoglobulin in the treatment of childhood Stevens Johnson syndrome. J Paediatr Child Health 2011; 47:392-5. [PMID: 21649751 DOI: 10.1111/j.1440-1754.2011.02131.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philip Britton
- General Paediatrics, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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McYheng, Allen S, Heng H. Intact nuclear membrane in necrotic keratinocytes of Stevens-Johnson syndrome distinguishes complement-mediated target cell lysis in ADCC from cytotoxic T-lymphocyte-mediated cytolysis. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639309084516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Erupciones inflamatorias y purpúricas. DERMATOLOGÍA NEONATAL 2009. [PMCID: PMC7161408 DOI: 10.1016/b978-84-8086-390-2.50019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Baselga E, Torrelo A. Inflammatory and Purpuric Eruptions. NEONATAL DERMATOLOGY 2008. [PMCID: PMC7315339 DOI: 10.1016/b978-1-4160-3432-2.50022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mydlarski PR, Ho V, Shear NH. Canadian consensus statement on the use of intravenous immunoglobulin therapy in dermatology. J Cutan Med Surg 2007; 10:205-21. [PMID: 17234104 DOI: 10.2310/7750.2006.00048] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND As a safe, well-tolerated, and potentially beneficial therapy, intravenous immunoglobulin (IVIG) has been increasingly used by dermatologists to treat immune-mediated skin disease. However, practical and comprehensive guidelines for the use of IVIG have yet to be established. OBJECTIVE To develop the first Canadian consensus statement on the use of IVIG therapy in skin disease. METHODS A group of Canadian dermatologists convened to discuss current issues in IVIG therapy. The participants reviewed and evaluated the literature and shared clinical experience. Using a modified Delphi process, a consensus statement was developed. RESULTS Herein we provide a brief overview of pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Recommendations for the management of these diseases are detailed, and therapeutic algorithms for the treatment of various autoimmune mucocutaneous blistering diseases are presented. The appropriate use of IVIG therapy is placed in context for each disease. CONCLUSION Although preliminary data suggest that IVIG is a safe and effective therapy for many skin disorders, uncontrolled clinical trials, case series, and anecdotal case reports dominate the literature. Collaborative randomized controlled trials are required to firmly establish the role of IVIG in dermatology.
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Affiliation(s)
- P Régine Mydlarski
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada.
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Burch J, Weston W. Serious drug rashes in children. Adv Pediatr 2005; 52:207-22. [PMID: 16124342 DOI: 10.1016/j.yapd.2005.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Joanna Burch
- University of Colorado School of Medicine, Denver, Colorado, USA
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Hynes AY, Kafkala C, Daoud YJ, Foster CS. Controversy in the use of high-dose systemic steroids in the acute care of patients with Stevens-Johnson syndrome. Int Ophthalmol Clin 2005; 45:25-48. [PMID: 16199965 DOI: 10.1097/01.iio.0000177430.89645.6d] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Alla Y Hynes
- MERSI, 100 Charles River Plaza, 3rd Floor, Suite 301, 165 Cambridge Street, Boston, MA 02114, USA
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Abstract
A thorough examination of the oral mucosa can provide helpful clues toward making a diagnosis in a number of developmental, neoplastic, inflammatory, and infectious conditions. A number of oral lesions seen in infants and children are benign and of no medical significance. In these instances, the ability of the physician to confidently identify the diagnosis, and reassure parents that a lesion is not worrisome, carries significant value. Likewise, the ability to recognize an underlying systemic illness or genetic disease based on an oral examination can also be of tremendous value, particularly when oral involvement is the presenting feature.
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Affiliation(s)
- Patricia M Witman
- Department of Dermatology, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA.
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Affiliation(s)
- Salah M Salman
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
OBJECTIVES Male reproductive health has deteriorated in recent decades. It is proposed that increased testicular temperature in early childhood, due to the use of modern disposable plastic lined nappies (diapers), could be an important factor contributing to this decline. STUDY DESIGN Scrotal skin temperature was measured non-invasively in 48 healthy children aged 0-55 months (three age groups) for two 24 hour periods in randomised order (either cotton or disposable plastic lined nappies) using a portable, miniature recorder. RESULTS Mean 24 hour scrotal temperature (2880 measurements) was significantly higher in all age groups during the periods of plastic nappy use than with cotton nappies (p < 0.001). The rectoscrotal temperature difference was significantly higher with cotton than with plastic nappy use (p < 0.01). CONCLUSIONS Scrotal hypothermia is an important factor for normal spermatogenesis. This study shows that scrotal temperature, which closely reflects testicular temperature, is increased in boys wearing disposable plastic lined nappies. The physiological testicular cooling mechanism is blunted and often completely abolished during plastic nappy use. The present results establish the basis for further research on the impact of increased testicular temperature in infancy on later spermatogenesis.
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Affiliation(s)
- C J Partsch
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian-Albrechts- University of Kiel, Schwanenweg 20, D-24105 Kiel, Germany
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Léauté-Labrèze C, Lamireau T, Chawki D, Maleville J, Taïeb A. Diagnosis, classification, and management of erythema multiforme and Stevens-Johnson syndrome. Arch Dis Child 2000; 83:347-52. [PMID: 10999875 PMCID: PMC1718505 DOI: 10.1136/adc.83.4.347] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In adults, erythema multiforme (EM) is thought to be mainly related to herpes infection and Stevens-Johnson syndrome (SJS) to drug reactions. AIMS To investigate this hypothesis in children, and to review our experience in the management of these patients. METHODS A retrospective analysis of 77 paediatric cases of EM or SJS admitted to the Children's Hospital in Bordeaux between 1974 and 1998. RESULTS Thirty five cases, inadequately documented or misdiagnosed mostly as urticarias or non-EM drug reactions were excluded. Among the remaining 42 patients (14 girls and 28 boys), 22 had EM (11 EM minor and 11 EM major), 17 had SJS, and three had isolated mucous membrane involvement and were classified separately. Childhood EM was mostly related to herpes infection and SJS to infectious agents, especially Mycoplasma pneumoniae. Only two cases were firmly attributed to drugs (antibiotics). No patient died. EM and SJS sequelae were minor and steroids were of no overall benefit. CONCLUSION In paediatric practice EM is frequently misdiagnosed. The proposal that SJS is drug related in adults does not apply to children, and in our recruitment EM and SJS are mostly triggered by infectious agents. The course of both diseases, even though dramatic at onset, leads to low morbidity and mortality when appropriate symptomatic treatment is given.
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Affiliation(s)
- C Léauté-Labrèze
- Unité de Dermatologie Pédiatrique, Hôpital Pellegrin-Enfants, Place Amélie Raba-Leon, 33 076 Bordeaux Cedex, France
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Affiliation(s)
- S S Lehman
- Department of Surgery, duPont Hospital for Children, Wilmington, Delaware 19899, USA
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Weston WL, Morelli JG, Rogers M. Target lesions on the lips: childhood herpes simplex associated with erythema multiforme mimics Stevens-Johnson syndrome. J Am Acad Dermatol 1997; 37:848-50. [PMID: 9366850 DOI: 10.1016/s0190-9622(97)80009-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Erythema multiforme and Stevens-Johnson syndrome are both characterized by areas of epithelial necrosis. An important clinical feature that distinguishes the two is the extensive mucosal necrosis in Stevens-Johnson syndrome but not in erythema multiforme. Because significant and serious complications may develop with Stevens-Johnson syndrome and not with erythema multiforme, it is important to differentiate between the conditions. We describe three boys with herpes simplex virus-associated erythema multiforme who had severe necrosis of the lips develop and were initially diagnosed with Stevens-Johnson syndrome. The lip lesions were large target lesions of erythema multiforme rather than the extensive necrosis seen in Stevens-Johnson syndrome and all three had a benign course.
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Affiliation(s)
- W L Weston
- Royal Alexandria Hospital for Children, Sydney, Australia
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Affiliation(s)
- J D Fine
- Department of Dermatology, University of North Carolina at Chapel Hill 27599, USA
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Stewart MG, Duncan NO, Franklin DJ, Friedman EM, Sulek M. Head and neck manifestations of erythema multiforme in children. Otolaryngol Head Neck Surg 1994; 111:236-42. [PMID: 8084631 DOI: 10.1177/01945998941113p112] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are related disorders of skin and mucous membranes, which are typically associated with antecedent medication use or infection. We review 108 cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis from Texas Children's Hospital, Houston, Texas, from 1981 to 1991, and illustrate the characteristic skin and mucosal lesions. In addition, we describe in detail two unusual cases requiring intensive airway management. Head and neck manifestations were present in 4 of 79 patients (5%) with erythema multiforme and 26 of 28 patients (93%) with Stevens-Johnson syndrome. In Stevens-Johnson syndrome, mucosal involvement of the lip (93%), conjunctiva (82%), oral cavity (79%), and nose (36%) were most common. Antecedent medication use was identified in 59% of erythema multiforme patients and 68% of Stevens-Johnson syndrome patients. We note a striking increase in the number of cases in our series caused by cephalosporins. Fifty percent of Stevens-Johnson syndrome patients required supplemental hydration or alimentation because of the severity of the oral cavity involvement. The head and neck mucosal manifestations largely respond to local care, and the routine use of prophylactic antibiotics or systemic steroids is not recommended.
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Affiliation(s)
- M G Stewart
- Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas
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Abstract
Infectious mononucleosis is rarely associated with skin lesions. A 23-year-old woman with acute infectious mononucleosis who presented with moderately severe erythema multiforme is reported. The role of steroids in the management of this condition is briefly discussed.
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Affiliation(s)
- J Hughes
- Department of Medicine, Royal Postgraduate Medical School, London, UK
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Abstract
Erythema multiforme is a florid mucocutaneous disease characterized by oral, cutaneous, and ocular manifestations. The cutaneous lesions are pathognomonic because of their unique "target-like" appearance. A severe form of EM has been termed "Stevens-Johnson Syndrome". Although the etiology of EM is unknown, much of the research suggests an immunological association with HSV. The diagnosis of EM is based on signs and symptoms, and a differential diagnosis should include other ulcerative, mucocutaneous diseases, such as erosive lichen planus, pemphigus, varicella zoster, ANUG, TEN, aphthous stomatitis, and primary HSV. Therapeutic measures are palliative, including a soft bland diet, topical anesthetics, and corticosteroids. A case of EM is described which underscores the appearance of the disease and its clinical course.
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Abstract
The epidermis, as the body's first line of defense against many pathogens, reacts in a variety of ways to the assault of foreign antigens. Allergic contact dermatitis, drug eruption, urticaria, and erythema multiforme are examples. The clinician must usually rely on clinical evidence for diagnosis. The first therapeutic strategy is to identify and avoid the antigen or drug causing the reaction. Beyond this, therapy consists of relief of symptoms in mild to moderate cases. In severe cases, systemic treatment can be helpful, but the therapeutic options and their efficacy are limited.
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Affiliation(s)
- R J Pariser
- Department of Medicine, Eastern Virginia Medical School, Norfolk 23507
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