Neonatal Erythema Multiforme: A Case Report

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.     

Randomized clinical study comparing Compeed® cold sore patch to acyclovir cream 5% in the treatment of herpes simplex labialis

Background Hydrocolloid technology has been proven effective in treating dermal wounds. A previous study showed that a newly developed thin hydrocolloid patch [Compeed® cold sore patch (CSP)] provided multiple wound‐healing benefits across all stages of a herpes simplex labialis (HSL) outbreak. Methods An assessment of CSP efficacy and safety was conducted in an international, multicentre, assessor‐blinded study, which enrolled 728 subjects with a history of recurrent HSL. Of these, 351 experienced an HSL outbreak and were randomized to use CSP (n = 179) or acyclovir cream 5% (n = 172) at the onset of symptoms until the lesion healed, for a maximum of 10 days. The primary end point was the subject's global assessment of therapy (SGAT; 0–10 scale; 0 = no response, 10 = excellent response). Multiple secondary end points included clinician‐assessed healing time and subject assessment of lesion protection, noticeability and social embarrassment. Results CSP and acyclovir were highly effective (mean SGAT = 7.89 and 8.00, respectively), with no significant difference observed (P = 0.65). The difference in healing times between products was not significant (median, 7.57 days with CSP vs. 7.03 days with acyclovir, P = 0.37). Both treatments were well tolerated. Conclusion CSP using hydrocolloid technology provides an efficacious and safe alternative to topical antivirals in treating HSL as a wound while affording additional immediate benefits of wound protection, discretion and relief of social embarrassment.     

阿达木单抗联合丙种球蛋白治疗HSV相关性慢性复发性多形红斑一例

本文报道种球蛋白联合阿达木单抗治疗单纯疱疹病毒(HSV)相关的复发性多形红斑1例并复习相关文献。患儿,男,9岁。口唇反复糜烂、渗出15个月,全身反复红斑8个月。皮肤科查体:口唇糜烂,背部、四肢散在暗红色斑片,局部周边可见松弛水疱。病理检查符合多形红斑,单纯疱疹病毒I型IgG滴度444.72 RU/mL。诊断为单纯疱疹病毒感染相关多形红斑,给予伐昔洛韦抗病毒治疗的同时,给予阿达木单抗联合人免疫球蛋白治疗,2周后皮损消退,单纯疱疹病毒I型IgG滴度明显下降。     

Drug Eruption (Erythema Multiforme Type) Due to a Digestive Enzyme Drug

An 84-year-old Japanese male had pruritic indurated erythema on his upper limb and left lower abdomen, which had developed abruptly two months before visiting our hospital. Hematological examination showed eosinophilia, 550/mm³. Histopathological findings were suggestive of erythema multiforme in response to a drug. By means of patch tests and a p.o. challenge test, Aczym^®, a digestive enzyme drug, was shown to be the cause of his condition. Further study revealed that the specific ingredients involved were pancreatin and Taka-diastase. An eruption resulting from ingestion of a digestive enzyme drug has not previously been reported.     

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Are Severity Variants of the Same Disease which Differs from Erythema Multiforme

A new classification, based on the pattern and distribution of cutaneous lesions, separates erythema multiforme major from Stevens-Johnson syndrome. A retrospective reclassification of 76 cases supported the validity of that separation by demonstrating differing causes and pathology. Another prospective international case-control study found differing demographic characteristics and risk factors between erythema multiforme major on the one hand and Stevens-Johnson syndrome or toxic epidermal necrolysis on the other. Erythema multiforme major was mainly related to Herpes virus infection, while Stevens-Johnson syndrome and toxic epidermal necrolysis were associated with drug reactions.     

Urethral Orifice Genital Herpes Caused by HSV-1 in a Female Patient: A Case Report

Introduction:Genital herpes is one of the most common sexually transmitted infections worldwide.Most genital herpes occur on the genitalia,perineum,buttocks,upp...     

Eczema herpeticum in three siblings: clinical features and acyclovir treatment

Three atopic siblings with sequential primary herpes simplex virus (HSV) infection on their eczematous lesions following their father's recurrent herpes labialis were presented. Eczema herpeticum was diagnosed on the basis of their characteristic grouped umbilicated vesicles superimposed on pre-existing atopic eczematous lesions. HSV type 1 was identified from the three patients' Tzanck smears and viral isolation of vesicular contents by monoclonal antibodies. The skin lesions faded spontaneously in the first case, although this elder brother did not receive any antiviral treatment. Later, he developed mild recurrence of skin lesions on his extremities. His younger twin sisters were treated with systemic acyclovir and no recurrences occurred during 2 years of follow up. All of them developed anti-HSV antibody about 7 to 14 days after clinical onset. Acyclovir seems to be an effective antiviral agent in treating eczema herpeticum and reducing subsequent recurrences after primary herpes simplex virus infection.     

Recurrent herpes labialis in the pediatric population: Prevalence,therapeutic studies,and associated complications

Recurrent herpes labialis (RHL) is an incredibly common condition, though the medical literature evaluating pediatric aspects is limited. This paper assesses prevalence and therapeutic studies of pediatric RHL as well as disease complications. A comprehensive literature search of English‐language citations based on PubMed queries of selected terms was performed, with exclusion if methodology was not discussed, or if studies had 10 or fewer patients. RHL prevalence in pediatrics has been assessed by measures of point and periodic prevalence, though methodologic limitations may under‐ or over‐estimate the true prevalence of RHL. Studies have been conducted to evaluate therapeutic safety, tolerability, and efficacy of antivirals in the pediatric population. Pediatric RHL point prevalence ranges from 0.72% to 5.2% depending on the population study and the methodologies used. Pediatric RHL carries a significant public health burden and is often implicated in patients with eczema herpeticum, erythema multiforme, reactive infectious mucositis eruptions, and hypersensitivity reactions. There are few studies that evaluate the rates of occurrence of these sequelae associated with pediatric RHL.     

Erythema multiforme ID reaction in atypical dermatophytosis: a case report

BACKGROUND: Erythema multiforme (EM) is an uncommon mucocutaneous disorder, characterized by widespread erythematous-oedematous targetoid lesions, considered as a reaction pattern to many different stimuli. OBSERVATION: Presentation is made of a classical EM eruption concomitant to an inflammatory, atypical dermatophytosis of the ala nasi, observed in a 37-year-old male at the Dermatology Department of Cagliari, Italy. METHODS: Laboratory investigations revealed normal complete blood count and biochemistry profile. A direct microscopic examination with 20% potassium hydroxide of the nasal skin scales and of the vibrissae indicated the presence of dermatophyte hyphae and spores invading the rhinothrix. Culture confirmed a Trycophyton mentagrophytes infection. Specific determination of antiviral immunity in the blood (TORCH) was negative for recent infections, while the cell-mediated response, investigated with a delayed skin multitest, showed a marked positivity for the tricophyton antigen. Systemic therapy with terbinafine (250 mg/day) led to complete clinical and mycological recovery of the atypical ringworm in 30 days. Multiforme lesions rapidly improved and completely disappeared in 7 days. CONCLUSIONS: ID reaction to a distant focus of dermatophyte infection very rarely presents as EM. The presented case fits all the essential criteria required for the diagnosis of an ID reaction. The atypical clinical presentation of the ringworm infection, with marked involvement of the intranasal hairs, seems to have induced an inflammatory allergic response, similar to that evoked by sycosis.     

Erythema multiforme in children: unusual clinical features with seasonal occurrence

Eighty-six cases of erythema multiforme (EM) were studied based on the distribution of skin lesions. Twenty-nine patients had distinct facial skin lesions as well as lesions on the extremities (Group A) and 57 patients had skin lesions only on the extremities (Group B). Patients in Group A were younger than those in Group B; the average ages being 7.5 and 25.2 years, respectively. In Group A, the disease occurred mainly in winter, while, in Group B, it began most frequently in summer. Preceding ulcerated pernio was seen in 11 patients of Group A, but only one of Group B. Histopathologically, both groups are compatible with a diagnosis of EM, although the seasonal occurrence of facial involvement in Group A may suggest a specific etiological relationship to cold.     

Incidence of serum antibody titers against herpes simplex virus in Japanese patients

Herpes simplex virus (HSV) establishes latency in the sensory neuronal ganglia after primary infection, and occasionally causes recurrent infection, mainly on the lips or genitalia. Previous reports revealed an age‐related increase in HSV‐immunoglobulin G seropositive subjects in a hospital‐based study and the general population in Japan. In this report, we retrospectively analyzed the results of serological tests against HSV, in which subjects were diagnosed with or suspected as having HSV infection. A total of 1216 subjects with at least one complement fixation (CF) result were included. Of these, 771 subjects (63.4%) were positive at first visit. When stratified by age, incidence of positive patients linearly increased with age from teenagers (44.9%) to those in their 80s (88.9%). Positivity in women was higher than in men overall; significantly higher incidence was observed in women aged in their 30s, 40s and 60s. When observing changing HSV‐CF titers over time in 81 initially negative patients, 18 (22%) seroconverted during the 2121‐day observation period. In this study, we clearly show that distribution of HSV‐CF titers is similar to previous HSV‐immunoglobulin G results. This correlation is probably caused by the continual subclinical proliferation of HSV, thus maintaining CF titers. Our observations provide current data on the incidence of HSV, reconfirming that serological examination is unreliable in diagnosing recurrent herpes, and the majority of infected subjects are asymptomatic.     

Multicenter randomized study of inosine pranobex versus acyclovir in the treatment of recurrent herpes labialis and recurrent herpes genitalis in Chinese patients

The objective of the study is to evaluate the efficacy and safety of oral inosine pranobex as compared with acyclovir in the treatment of recurrent herpes labialis (RHL) and recurrent herpes genitalis (RHG). A multicenter double‐blind, double‐dummy, randomized, controlled, parallel group trial was conducted in 144 patients with RHL and 144 RHG. Patients were assigned to treatment in one of two groups: (i) inosine pranobex group (active inosine pranobex, 1 g four times daily, and acyclovir placebo); or (ii) acyclovir group (active acyclovir, 200 mg five times daily, and inosine pranobex placebo). The total symptom score (TSS) of patients with RHL did not differ in the inosine pranobex and acyclovir group on the 3rd or 7th day of treatment. There was also no difference in the efficacy rates between the two groups. No difference of TSS was observed between patients with RHG taking inosine pranobex and acyclovir on days 3 or 5 of the treatment, respectively. The short‐term clinical recurrence rate of RHG at 3‐month follow‐up was much lower in the inosine pranobex group than acyclovir group. The incidence of hyperuricemia was higher in the inosine pranobex group than acyclovir group. In conclusion, inosine pranobex was as effective as acyclovir in treating RHL and RHG with significantly greater reduction of the short‐term recurrence rate of herpes genitalis at 3‐month follow up. Long‐term recurrence rates at 6 months or longer remain to be determined. Hyperuricemia should be monitored during the treatment.     

复发性疼痛性红斑1例

患者女,67岁,胸前、腹部反复红斑伴疼痛4年.皮损组织病理示:表皮轻度萎缩变薄,灶状基底细胞液化变性,真皮少量单一核细胞浸润.诊断:复发性疼痛性红斑.     

Erythema multiforme: Differences between HSV‐1 and HSV‐2 and management of the disease—A case report and mini review

Erythema multiforme (EM) is an immune‐mediated reaction characterized by target lesions and with possible mucosal involvement. Its most frequent cause is HSV, with HSV‐1 more common than ?2. It is usually self‐limited but it can show recurrences. We report a peculiar case of recurrent herpes‐associated erythema multiforme (HAEM) in a 35‐year‐old man. The patient was affected by both herpes labialis and genitalis, but the typical target lesions were only associated with recurrent herpes labialis. Here, we hypothesize about the pathogenic differences between HSV‐1 and HSV‐2, and discuss the therapeutic management of HAEM.     

A Case of Herpetic Whitlow Associated with Erythema Multiforme

Abstract: We report a 6-month-old girl with erythema multiforme minor occurring during the course of a herpetic whitlow. Erythema multiforme minor is unusual in infants, and in this population herpes simplex virus has not been reported as a significant etiologic factor. The clinical coexistence of erythema multiforme minor and the herpetic lesion is also atypical. To our knowledge, this is the first report of erythema multiforme minor associated with a concomitant HSV infection in an infant.     

以面部浮肿性红斑为主要表现的二期梅毒1例

患者男,21岁。全身皮疹5天,经检查TPHA(+),RPR1∶64(+)。诊断为二期梅毒。予苄星青霉素240万U分两侧臀肌注射,1次/周,连续3周治疗后治愈。     

Erythema multiforme on exposed and non-exposed skin following polymorphic light eruption: a case report

We report a 35-year-old caucasian female with a history of polymorphic light eruption (PLE) who, after the outbreak of pruritic papules following the first sun exposure of the year, developed target lesions in two different bouts, the first on sun-exposed skin and the second on sun-protected sites. A diagnosis of erythema multiforme (EM) developing as a result of PLE was made. As far as we were able to search in the literature, EM occurring in two bouts has not been described previously. We discuss the differential diagnosis.