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At least 19 recordsLinked to original sources
PubMed1979

Erythema multiforme.

Erythema multiforme (EM) is an episodic, variable, self-limited, and often recurrent inflammatory disorder of the skin and mucous membranes. In this article a definition of EM is proposed, its known clinical and histopathologic spectrum is reviewed, an approach to diagnosis and treatment is suggested, and documented evidence regarding its etiology and pathogenesis is presented. EM would appear to be a hypersensitivity reaction to a variety of precipitating agents. It has been directly linked to Mycoplasma pneumoniae and herpes simplex virus infections and possibly is triggered by a number of other infectious agents and by certain drugs. Accumulating observations of diverse immunologic phenomena suggest an underlying immune mechanism of as yet unclear type. Future investigation should be directed toward defining diagnostic criteria, evaluating reported etiologic associations, and clarifying the immunologic basis of this complex and enigmatic disorder.

Diagnosis, Differential↗
PubMed1992

Erythema multiforme: pathomechanism of papular erythema and target lesion.

Skin lesions of erythema multiforme show time-dependent changes from early papular erythema to the late target lesion which consists of a peripheral elevated erythematous area and a central depressed area. We investigated the pathomechanism of erythema multiforme, by examining the papular erythema and target lesion separately. In the early papular erythema, a small number of polymorphonuclear leukocytes and nuclear debris were seen intermingled with mononuclear cells around the slightly swollen blood vessels, on which immunoglobulin and complement components were deposited. Circulating immune complex levels were occasionally elevated. Sera from the patients generated high levels of reactive oxygen species and nitroblue tetrazolium test revealed positive reaction on the infiltrating cells around the blood vessels. These findings suggest that the papular erythema develops via incomplete type III allergic reaction, followed by damage through reactive oxygen species. In the target lesion, the activity of histamine-N-methyltransferase, which is the major histamine-degrading enzyme, was markedly decreased in the peripheral elevated erythematous area and it was recovering in the central clearing area. ICAM-1 and HLA-DR antigens were expressed on the surfaces of the keratinocytes. An increased number of epidermal Langerhans cells and CD4 cell infiltration were observed in the peripheral elevated erythematous area, while a decreased number of epidermal Langerhans cells and CD8 cell infiltration in the central depressed area were observed. These findings suggest that impaired histamine metabolism and cellular allergic reactions play important roles in the development of the target lesion.

Antigen-Antibody Complex↗
PubMed1979

Eruptive nevocytic nevi following erythema multiforme.

A patient with erythema multiforme developed many nevocytic nevi, including a large cluster of such lesions at the sites of healed blisters. The development of eruptive nevocytic nevi in this pattern suggests that cutaneous injury plays a role in their pathogenesis.

Blister↗
PubMed1992

Mast cells in oral erythema multiforme.

We compared the number of mast cells in erythema multiforme lesions, in clinically healthy mucosa between the EM attacks and in healthy mucosa from healthy volunteers. The mast cell count in patients with erythema multiforme was numerically higher than in healthy controls, but the differences were not statistically significant. In erythema multiforme lesions the mast cell count was low in the intensely inflamed superficial lamina propria, but high in normal appearing mucosa between the attacks suggesting local mast cell degranulation in the most intensely inflamed areas.

Adolescent↗
PubMedDate not supplied

Erythema multiforme infantum atrophicans.

A new case of erythema multiforme is described, characterized by multiforme eruption of erythematous papules, plaques and occasional bullous lesions. The acute stage lasts several seeks, then atrophy is noted. The face appears senile. Histopathologically, the lesions show erythema multiforme in the acute phase; in the atrophic stage, a disappearance of the elastic fibers was observed.

Acute Disease↗
PubMed1976

Histopathological spectrum of erythema multiforme.

Lesions of erythema multiforeme from seventy-five patients have been studied histologically. In addition to peculiar intercellular epidermal oedema, subepidermal separation and a lymphohistiocytic inflammatory infiltrate in the papillary dermis, epidermal cell necrosis was observed in a variable percentage of the lesions. While dermal disturbance was a predominant finding in the macular lesions, focal or generalized keratinocytic necrosis was seen in the macular, papular, bullous and iris lesions in that order of frequency. Significant numbers of eosinophils were present in the inflammatory infiltrate in 60% of the bullous and 28% of the macular lesions. Our findings suggest that erythema nultiforme represents a tissue reaction with spectral expression, one end presenting as a predominantly dermal disturbance and the other merging into the adult type of toxic epidermal necrolysis. Yet, the histological features remain sufficiently characteristic for differentiation from other erythematous and vesiculobullous eruptions.

Edema↗
PubMed1978

Erythema multiforme. Clinical characteristics and natural history in fifty patients.

Erythema multiforme is a chronic mucocutaneous inflammatory disease with a variable recurrent pattern. Thirty female and twenty male patients, ranging in age from 11 to 75 years, were studied. Twelve patients had oral lesions only, nineteen had oral and lip changes, and nineteen had oral, lip, and skin involvements. Most of the patients had a noncyclical pattern of attacks which required systemic corticosteroid therapy. When the disease attacks electively were not treated, healing would vary between 2 and 24 weeks. This study confirmed the idiopathic nature and extremely variable features of erythema multiforme. Frequency, location, duration, and severity of attacks did not shed any clues as to trigger mechanisms (etiology), persons who might be predisposed to such attacks, treatment responses, or prognosis.

Adolescent↗
PubMed1992

Epstein-Barr virus-related persistent erythema multiforme in chronic fatigue syndrome.

BACKGROUND: Erythema multiforme (EM) has been rarely reported in Epstein-Barr virus (EBV)-associated diseases; this includes patients with chronic fatigue syndrome who have chronic or recurrent and disabling illness and an abnormal antibody reactivity to EBV. We describe a patient fulfilling the chronic fatigue syndrome diagnostic criteria who had developed an unusually persistent EM resistant to corticosteroids therapy. The EBV DNA was studied in skin EM lesions, throat washings, peripheral mononuclear cells, and plasma. The EBV antigens were studied in skin EM lesions and in mononuclear cells. The patient was followed up to 2 years. OBSERVATIONS: The patient had abnormal titers of antibodies against various EBV antigens and by immunofluorescence she disclosed the EBV nuclear antigen and the viral capsid antigen in the blood vessels of the affected skin. The dot blot hybridization assay detected viral DNA in throat washings and mononuclear cells, but not in plasma. The presence of the viral genomic content in lesional skin is suggested by the autoradiographic signal and by the difference from appropriate control specimens. Skin lesions and constitutional symptoms cleared after acyclovir sodium therapy and recurred after discontinuation of this therapy. CONCLUSIONS: This is the first EM case in which evidence of the EBV causal role has been provided. The association with chronic fatigue syndrome suggests the EBV role in selected cases of this syndrome.

Adult↗
PubMed1979

Erythema multiforme and urticaria. Eruptions induced by chemically related ophthalmic anticholinergic agents.

Erythema multiforme developed in an 80-year-old man following the use of scopolamine hydrobromide ophthalmic drops. The erythema multiforme cleared when the medication was discontinued and recurred on challenge. Later, he was given tropicamide, an anticholinergic ophthalmic preparation that, like scopolamine, has a tropic acid residue. Within 15 minutes an immediate hypersensitivity reaction with generalized urticaria developed in the patient.

Aged↗
PubMed1992

Herpes simplex virus in childhood erythema multiforme.

Although an association between herpes simplex virus (HSV) infection and erythema multiforme (EM) minor has been documented in adults, this has not been reported in the pediatric population. This study assessed the potential role of HSV infection in the pathogenesis of EM minor in children. Erythema multiforme skin lesions from 20 children, aged 1 to 16 years, were examined for the presence of HSV by using the polymerase chain reaction. The children included all fit strict clinical criteria for EM minor. Ten had a clinical history of an antecedent herpes infection ("herpes-associated EM"), and 10 did not ("idiopathic EM"). Herpes simplex virus DNA was detected in skin lesions of 8 of 10 children with herpes-associated EM and in 8 of 10 with idiopathic EM. Control skin biopsies from children with other bullous inflammatory diseases were negative. In addition, no HSV could be detected in a biopsy of normal uninvolved skin of a child in whom HSV was present in lesional skin. In situ hybridization on selected biopsies by means of an HSV-specific riboprobe confirmed the presence of HSV and localized it to the epidermis. It is concluded that HSV is a significant precipitating factor for EM minor in children, as it is in adults, and that clinicians should maintain a high index of suspicion of HSV even in the absence of a known history of herpes infection.

Adolescent↗
PubMed1978

Erythema multiforme and the Stevens-Johnson syndrome.

Erythema multiforme (EM) is clinically characterized by a "minor" form and a "major" form. The latter is known as the Stevens-Johnson syndrome. Infections (particularly herpes simplex and Mycoplasma pneumoniae) and drugs seem to predispose toward the development of EM. The pathogenesis is poorly understood. The treatment is supportive. Prognosis varies with the severity of the eruption. Recurrences are commonly seen.

Diagnosis, Differential↗
PubMed1979

Erythema multiforme bullosum due to rifampicin.

A case of Erythema Multiforme Bullosum in patient of lepromatous leprosy with pulmonary tuberculosis due to Rifampicin is described. It is stressed that ethambutol may act as a trigger factor to the toxic effects of Rifampicin.

Adult↗
PubMed1976

Erythema multiforme in children. Response to treatment with systemic corticosteroids.

It is generally accepted that the correct treatment for patients with severe erythema multiforme is systemic corticosteroids. This paper is a review of thirty-two paediatric patients with severe erythema multiforme (Stevens-Johnson syndrome) who were treated with either large doses of systemic corticosteroids or supportive care only. Those patients treated with steroids did not recover sooner than those treated in other fashions and the steroid treated group had a significant incidence of medical complications. This retrospective study proves nothing but it does suggest that treatment of patients with the Stevens-Johnson syndrome with systemic corticosteroids may be associated with significant side effects and prolonged recovery.

Adolescent↗
PubMed1979

Kawasaki's disease appearing as erythema multiforme.

In 1967, Kawasaki reported an acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes that affected infants and young children in Japan. He called it mucocutaneous lymph node syndrome. We report here a case of Kawasaki's disease with characteristic findings that demonstrated a typical erythema multiforme rash. With the increased number of reported cases of Kawasaki's disease in the United States, it becomes increasingly important to differentiate the exanthem of Kawasaki's disease from early erythema multiforme.

Diagnosis, Differential↗
PubMed1976

Erythema multiforme. Review of twenty-six cases.

A survey of twenty-six cases of erythema multiforme was undertaken. All patients had oral lesions and seventeen had skin involvement, mainly on the hands. The average age was 32 years, and female patients predominated in the group. Nearly one third gave a history of a severe emotional disturbance prior to the attack, four patients developed lesions after penicillin therapy, and two presented initially with acute primary herpes simples stomatitis. Skin and mucosal biopsies were undertaken in some patients, and it was concluded that no pathognomonic features were identifiable; a subepithelial bulla, however, could occasionally help in the differential diagnosis. Other laboratory investigations, including a complete blood count, determination of herpesimplex titer, and urinalysis, were not helpful, except that the erythrocyte sedimentation rate was raised in sever cases. Possible etiologic factors were discussed in relation to the survey. It was thought that the cause is still obescure except in drug-induced cases and that the diagnosis is essentially a clinical one, since various laboratory investigations cannot be shown to produce consistent pathognomonic findings.

Adolescent↗