Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist

Abstract

Erythema multiforme (EM) is an uncommon, immune-mediated disorder that presents with cutaneous or mucosal lesions or both. In herpes simplex virus (HSV)-associated EM, the findings are thought to result from cell-mediated immune reaction against viral antigenpositive cells that contain the HSV DNA polymerase gene (pol ). The target lesion, with concentric zones of color change, represents the characteristic cutaneous finding seen in this disorder. Although EM can be induced by various factors, HSV infection continues to be the most common inciting factor. Histopathologic testing and other laboratory investigations may be used to confirm the diagnosis of EM and to differentiate it from other clinical imitators. Imitators of EM include urticaria, Stevens-Johnson syndrome, fixed drug eruption, bullous pemphigoid, paraneoplastic pemphigus, Sweet's syndrome, Rowell's syndrome, polymorphus light eruption, and cutaneous small-vessel vasculitis. Because disease severity and mucosal involvement differ among patients, treatment should be tailored to each patient, with careful consideration of treatment risk vs benefit. Mild cutaneous involvement of EM can be managed primarily with a goal of achieving symptomatic improvement; however, patients with HSV-associated recurrent EM and idiopathic recurrent EM require treatment with antiviral prophylaxis. Inpatient hospitalization may be required for patients with severe mucosal involvement that causes poor oral intake and subsequent fluid and electrolyte imbalance. With this review, we strive to provide guidance to the practicing dermatologist in the evaluation and treatment of a patient with EM.

Hair-Dye induced erythema multiforme like allergic contact dermatitis

“…The commonest precipitating factors for EM include infections like Herpes, Mycoplasma and drugs [1]. Numerous allergens have been implicated in causing EM following contact dermatitis which includes chemicals like colophony, fragrances, epoxy resin, PPD, drugs like acetaminophen, antibiotics, metals like nickel and plant allergens like rubber and poison ivy [2].…”

“…The most common precipitating factors include viral infections and drugs [1]. EM induced by contact allergy is a rare entity.…”

Herpes virus infection in dermatology: problems and modern approach to treatment

“…Доказа-тельством этиологической роли ВПГ в ПЭЭ служит обнаружение ДНК ВПГ-1 и ВПГ-2 методом поли-меразной цепной реакции (ПЦР) в биоптатах кожи у 60% из числа обследованных пациентов с НАЕМ, причем у 66,7% больных обнаружили ВПГ-1, у 27,8% -ВПГ-2, у 5,6% -оба типа вируса. Показано, что НАЕМ рецидивирует у 20-25% пациентов, при этом число рецидивов составляет от 4 до 24 в тече-ние года [13][14][15]. Так, R. Osterne и соавт.…”

Erythema and Acute Pain in the Hands

“…Urticaria extremities, particularly on the acral extensor surfaces. The palms or plantar surfaces are often involved [1,2]. The "target" lesion is characteristic.…”

“…EM is most frequently secondary to the herpes simplex virus (HSV) [1,2] which causes an immune mediated reaction [2] with cutaneous manifestations. After HSV, the next two most common causes of EM are Mycoplasma pneumonia infection and drugs; with non-steroidal anti-inflammatories (NSAIDS) and sulfa medications being the…”