Methotrexate-Induced Oral Erythema Multiforme

Abstract

Objective: To discuss the management of oral erythema multiforme (EM) due to methotrexate (MTX) in gestational trophoblastic tumor patients.
 Methods: A 28-year-old woman was referred to the Oral Medicine Clinic with complaints of pain throughout the oral cavity accompanied by blackish encrustation on the upper and lower lip for 5 d. She previously underwent the first cycle of chemotherapy using MTX for the treatment of a gestational trophoblastic tumor. Extraoral, multiple diffuse blackish patches on the face and haemorrhagic crusts on the lips with painful erosions. Intraoral, multiple erosive and ulcerative lesions on the labial and buccal mucosa.
 Results: Management involved topical 0.025% hyaluronic acid mouthwash for erosion and ulceration, compressed 0.9% NaCl for crusted lesions on the lips, and petroleum jelly for the non-crusted lesions on the lips. Complete healing of oral and lip lesions was achieved within 10 d.
 Conclusion: Pharmacological management should be tailored to each patient with careful consideration of treatment risk or benefit. In our case, the use of non-steroidal anti-inflammatory topical agents was considered successful in treating oral EM.