Jun 18, 2018 erythema multiforme em is a rare skin disorder that mainly affects children. Theres also a rare, severe form that can affect the mouth, genitals and eyes and can be lifethreatening. The incidence of em has been estimated to be between 0. Erythema multiforme major with swollen lips and crusted erosions. Acute annular urticaria is a common and benign cutaneous hypersensitivity reaction seen in children that manifests with characteristic annular, arcuate, and polycyclic urticarial lesions in association with acral edema. Variations in clinical course, a complicated nomenclature, and the artificial hiatus separating dermatology from internal medicine have been contributory. Feb 20, 2020 erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. A 41yearold woman presented to our clinic because of the sudden appearance of erosions on and swelling of her lips. Although these 3 entities may present in a similar manner, specific. A recent update article pdf available in biomedical and pharmacology journal 111. Em minor, a mild allergic reaction, occurs most commonly.
Cyclosporine therapy for bullous erythema multiforme jama. Erythema multiforme em is an acute, immunemediated dermatological condition affecting the skin and mucous membranes. Erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Em major is lifethreatening, bullous, and has extensive mucosal involvement and severe constitutional. Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme. On clinical examination, diffuse erythema of the labial mucosae with small vesicles and crusted erosions on both the superior and inferior vermillion borders were noted figure. Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus hsv. Although erythema multiforme em is usually considered a single disease, a useful way of looking at it has been emphasized by tonnenson and huff,1 who separate major and minor types.
Erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. Erythema multiforme history and exam bmj best practice. Some spots can have a small blister or scab in the middle. Recurrent erythema multiforme dermatology jama network. A relationship between erythema multiforme and histoplasmosis.
Due to the similarities in clinical and histological findings, it was. In rare cases, it is caused by certain medicines or bodywide. Marco yamazakinakashimada has received lecture fees from shire, csl behring and octapharma, the other authors declare that they do not have any conflict of interests. The mean number of attacks per year was six range 224. There are two variants of this condition, one with mucosal involvement, termed erythema multiforme major, and one without mucosal involvement, known as erythema multiforme minor. Erythema multiforme may be a mild condition erythema multiforme minor, or it may be a severe, possibly lifethreatening condition erythema multiforme major or stevensjohnson syndrome. Few patients are ill enough to require hospitalization, and disease generally remits without specific therapy. Clinical features, diagnosis, and treatment of erythema. The diagnosis of erythema multiforme, that has an acute, selflimiting course, is based on its typical. Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. Erythema multiforme em is an immunemediated, mucocutaneous condition characterized by target lesions.
Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In recurrent erythema multiforme, either of unknown etiology or hsvassociated, continuous hsv antiviral therapy is recommended for at least 6 months to prevent recurrence. Here we report a case of kd associated with erythema multiforme em as a variation from the expected. Figure 5 course of illness em is generally regarded as a selflimiting skin disease. Erythema multiforme is a cutaneous reaction pattern precipitated by varied agents, notably herpes simplex and drugs. Erythema multiforme induced by secukinumab clinical, dermoscopic, and histological features. Erythema multiforme usually occurs as a reaction to an infectious agent such as herpes simplex virus or mycoplasma but may be a reaction to a. Jan 19, 2018 recognition and timely adequate treatment of erythema multiforme remain a major challenge. Erythema multiforme airuhtheemuh multehformee starts with pink or red blotches.
It is estimated that 2040% of cases of erythema multiforme are secondary to herpes simplex virus infection. Erythema multiforme major caused by topical imiquimod. We present a case of erythema multiforme involving the oral mucosa, trunk, and extremities that followed broad application of topical imiquimod for the management of suspected superficial basal cell skin. Further inspection of her mouth showed erythema and erosions on the inner cheek and mild. Erythema multiforme em is an acute skin reaction that comes from an infection or another trigger. It consists of a polymorphous eruption of macules, papules, and characteristic target lesions that are symmetrically distributed with a propensity for the distal extremities. Erythema multiforme em is an acute, selflimited, inflammatory cutaneous disorder caused by infection or drugs that is characterized by bulls eye lesions, blisters, and erythematous plaques on the skin fitzpatrick and bernhard 1987. Erythema multiforme in a child with kawasaki disease jaad. Erythema multiforme em is a rare skin disorder that mainly affects children. Panniculitis, inflammation of the subcutaneous fat, is a relatively uncommon condition that usually presents with inflammatory nodules or plaques. Target or iris lesion bulls eye is the classical cutaneous lesion of em. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. Both hsv 1 and hsv 2 trigger the erythema multiforme lesions.
Detection of herpes simplex virus dna in cutaneous lesions of erythema multiforme. Management of erythema multiforme associated with recurrent. Diagnosis of kd is based on wellknown clinical criteria. Power wj, ghoraishi m, merayolloves j, neves ra, foster cs. One of the most intriguing discoveries of the past 20 y is the finding that herpes simplex virus hsv is responsible for precipitating most of the erythema multiforme em episodes in adults and children brice et al, 1989 x brice et al. From the dermatology clinic, maggiore hospital, university of trieste, trieste unit of allergology, clinical immunology and rheumatology, universita campus biomedico di roma, rome institute of pathological anatomy department of rheumatology, university of trieste, cattinara hospital, trieste, italy. Erythema multiforme em is an acute, selflimited inflammatory skin disease that is associated with an immune reaction to various triggers, such as herpes simplex virus, mycoplasma pneumoniae, and medications.
Despite being listed with many etiological factors, the exact pathogenic mechanism of em remains unclear, and as a consequence, there are no evidencebased. Erythema multiforme lesions are usually acute in nature with mild or no prodromal symptoms. Erythema multiforme in a child with kawasaki disease. A rare and less recognized variant of erythema multiforme. Erythema multiforme em is the name applied to a group of hypersensitivity disorders, affecting mostly children and young adults, and characterized by symmetric red, patchy lesions, primarily on the arms and legs. Management involves treating the existing infectious agent or. Lesions spontaneously resolve but frequently recur. The journal of the american osteopathic association, january 2020, vol. Topical imiquimod is commonly used in the nonsurgical management of actinic keratosis and superficial basal cell carcinoma. Although adverse effects have been limited primarily to local irritation, another rare adverse reaction is erythema multiforme. Recurrent erythema multiforme is an uncommon disorder. Topically applied medications are a rare cause of em or emlike eruptions.
Immunosuppressive therapy with cyclosporine introduced in the 1970s dramatically improved the survival of kidney, liver, and heart transplants. The reported use of cyclosporine for treatment of dermatological disease is increasing in frequency, and favorable responses have been observed in the treatment of psoriasis, behcets disease, bullous pemphigoid, pemphigus vulgaris. Erythema multiforme nord national organization for rare. Erythema multiforme is a skin condition considered to be a hypersensitivity reaction to infections or drugs. Erythema multiforme em is an uncommon, immunemediated disorder that presents with cutaneous or mucosal lesions or both. Erythema multiforme major with swollen lips and crusted.
Nov 14, 2011 erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. Erythema multiforme em is an inflammatory reaction, characterized by target or iris skin lesions. Erythema multiforme for parents nemours kidshealth. It presents with a skin eruption characterised by a typical target lesion. Erythema multiforme em is an acute mucocutaneous condition caused by a hypersensitivity reaction. Erythema multiforme may be present within a wide spectrum of severity. Cyclosporine therapy for bullous erythema multiforme. Clinical features, diagnosis, and treatment of erythema multiforme.
Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. Erythema multiforme following antibiotic therapy for pneumonia chianze peng emergency department, taipei veterans general hospital and department of emergency medicine, national yangming university school of medicine, taiwan. Erythema multiforme after use of topical dorzolamide. Herpes associated erythema multiformea diagnostic dilemma. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. It predominantly occurs in adolescents and young adults but may be seen at other ages also. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. Em minor is milder, and may have mucosal involvement, but usually is without constitutional symptoms. Topical imiquimod and subsequent erythema multiforme. Erythema nodosum en is clinically the most frequent form of panniculitis and is considered a reactive process that may be triggered by a wide variety of stimuli. It is mistaken most often for erythema multiforme and, occasionally, for a serumsicknesslike reaction. Aug 18, 2018 a 41yearold woman presented to our clinic because of the sudden appearance of erosions on and swelling of her lips. It is acute and selflimiting, usually resolving without complications.
When seen in adults, it usually occurs between the ages of 20 and 40, although it can happen to people of any age. It develops as a type iv hypersensitivity reaction. Erythema multiforme after orf virus infection cambridge core. Article pdf available in indian journal of medical and paediatric oncology august 2018 with 88 reads how we measure reads. Dorzolamide is a carbonic anhydrase inhibitor, which reduces intraocular pressure by suppressing aqueous production.
In em minor, lesions often present as papules, which might enlarge and eventually form the typical target lesion with. Drugs adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1% 14. This means it usually resolves on its own without treatment. Erythema multiforme, especially em major and sjs can occur after.
Pdf erythema multiforme following vaccination in an. Erythema multiforme in children pubmed central pmc. Erythema multiforme mainly affects adults under 40. Cutaneous lesions labeled as erythema multiforme are often encountered in medical practice. Dec 01, 2006 erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages. Erythema multiforme genetic and rare diseases information.
We report here a case of a two monthold infant with. Paul telner, md arthur leznoff, md harold frank, md references 1. Erythema multiforme an overview sciencedirect topics. Further inspection of her mouth showed erythema and erosions on the inner cheek and mild focal. Current perspectives on erythema multiforme springerlink. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Full length report a relationship between erythema multiforme and histoplasmosis from the department of medicine, jewish general hospital, montreal, canada. Em without mucous membrane involvement em minor and em with mucous membrane involvement em major. In half of the cases, the triggering agents appear to be medications, including anticonvulsants. Figure 5 course of illness em is generally regarded as a. In em minor, lesions often present as papules, which might enlarge and.
While vaccination is rarely a precipitating factor for erythema multiforme, it may occasionally be seen in infants and children. In most cases, it occurs in response to an infection. Erythema multiforme following antibiotic therapy for. Topical imiquimod and subsequent erythema multiforme the.
1424 741 616 362 170 758 323 875 1036 1197 11 520 691 871 1211 620 736 1596 409 973 489 1388 1400 67 649 67 528 372 949 952 341 853