RESUMO
BACKGROUND: Oral erythema multiforme (EM) major is an acute immune-mediated disorder typically involving the oral mucosa, triggered by a hypersensitivity reaction to an antigen. CASE SUMMARY: A 59-year-old woman presented to an oral medicine clinic with a chief complaint of "mystery disease" of 1 year's duration. The condition was described as repeated episodes of severe, painful, asymmetric oral lesions that responded to systemic steroid therapy. A previous oral biopsy described fibrinoid necrosis, mixed inflammation, and granulation tissue. A regimen of descending-dose prednisone was administered, and 3 weeks later the tissues appeared to be partially healed. Direct immunofluorescence staining of a biopsied oral mucosal lesion was negative. To rule out a drug causation, the patient discontinued hydrochlorothiazide and escitalopram oxalate. However, on steroid tapering, episodic lesions recurred. The patient was placed on combination systemic prednisone and azathioprine. The oral lesions resolved again, but new episodes occurred immediately after tapering. The patient's daily facial cosmetics were evaluated, and she was asked to stop using cosmetics with the active ingredient octocrylene. After eliminating the use of facial cosmetics containing octocrylene, the episodes no longer recurred. CONCLUSIONS: We report a case of cosmetic-induced EM major and suggest that the triggering allergen is octocrylene.
Assuntos
Acrilatos/efeitos adversos , Cosméticos/efeitos adversos , Eritema Multiforme/induzido quimicamente , Doenças da Boca/induzido quimicamente , Protetores Solares/efeitos adversos , Biópsia , Diagnóstico Diferencial , Eritema Multiforme/prevenção & controle , Feminino , Humanos , Pessoa de Meia-Idade , Doenças da Boca/prevenção & controleAssuntos
Ácidos Borônicos/efeitos adversos , Toxidermias/etiologia , Toxidermias/prevenção & controle , Eritema Multiforme/induzido quimicamente , Eritema Multiforme/prevenção & controle , Pirazinas/efeitos adversos , Idoso , Antineoplásicos/efeitos adversos , Bortezomib , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Recurrent herpes simplex virus type 1 infection is generally associated with mild morbidity. However, frequent recurrences may have a significant psychosocial impact, and reactivation in certain high-risk situations may cause considerable morbidity. Controlled trials demonstrate that antiviral drug prophylaxis can be efficacious in selected circumstances; even for other situations, clinical reports suggest that such antiviral drug prophylaxis remains effective.
Assuntos
Antivirais/administração & dosagem , Antivirais/uso terapêutico , Herpes Simples/tratamento farmacológico , Herpes Simples/prevenção & controle , Herpesvirus Humano 1/efeitos dos fármacos , Quimioprevenção , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/prevenção & controle , Eritema Multiforme/virologia , Feminino , Herpes Simples/virologia , Herpesvirus Humano 1/fisiologia , Humanos , Imunocompetência , Masculino , Prevenção Secundária , Raios Ultravioleta/efeitos adversos , Ativação Viral/efeitos dos fármacos , Ativação Viral/fisiologiaAssuntos
Aciclovir/análogos & derivados , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/prevenção & controle , Valina/análogos & derivados , Adulto , Humanos , Masculino , Pró-Fármacos/uso terapêutico , Recidiva , Fatores de Tempo , Resultado do Tratamento , Valaciclovir , Valina/uso terapêuticoRESUMO
In some individuals a local herpetic lesion precipitates a generalized inflammation of the skin, designated as erythema multiforme (EM). We determined the frequencies of the immune response genes of the HLA system by molecular HLA class II typing in 46 patients with EM and in many of their family members. Allele frequencies were correlated with disease form and disease-inducing factors. We found that specific complications of HSV infection occur preferentially in patients with certain HLA-DQB1 alleles. In 21 of the 46 patients EM was induced by recurrent HSV infection. Thirteen of these patients showing only minor or no involvement of mucous membranes had the HLA allele DQB1*0302 (phenotype frequency 61.9% versus 18.8% in controls, p corr = 0.0008) and all three patients with major involvement of mucous membranes had the rare HLA allele DQB1*0402 (phenotype frequency in controls 6,4%, p corr = 0.017).
Assuntos
Eritema Multiforme/genética , Eritema Multiforme/virologia , Antígenos HLA-DQ/genética , Herpes Simples , Simplexvirus , Alelos , Eritema Multiforme/prevenção & controle , Frequência do Gene , Genes MHC da Classe II , Cadeias alfa de HLA-DQ , Cadeias beta de HLA-DQ , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Herpes Simples/genética , Humanos , Mucosa/fisiopatologia , Fenótipo , Recidiva , Pele/fisiopatologiaAssuntos
Eritema Multiforme/diagnóstico , Herpes Labial/tratamento farmacológico , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/tratamento farmacológico , Transtornos de Fotossensibilidade/diagnóstico , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Criança , Diagnóstico Diferencial , Eritema Multiforme/etiologia , Eritema Multiforme/prevenção & controle , Herpes Labial/complicações , Infecções por Herpesviridae/complicações , Humanos , Luz/efeitos adversos , Masculino , Transtornos de Fotossensibilidade/etiologia , Protetores Solares/uso terapêutico , Resultado do TratamentoAssuntos
Eritema Multiforme/prevenção & controle , Síndrome de Stevens-Johnson/prevenção & controle , Protocolos Clínicos , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/epidemiologia , Eritema Multiforme/imunologia , Humanos , Síndrome de Stevens-Johnson/tratamento farmacológico , Síndrome de Stevens-Johnson/epidemiologia , Síndrome de Stevens-Johnson/imunologia , Terminologia como AssuntoAssuntos
Aciclovir/uso terapêutico , Eritema Multiforme/tratamento farmacológico , Aciclovir/administração & dosagem , Reações Antígeno-Anticorpo/imunologia , Esquema de Medicação , Eritema Multiforme/imunologia , Eritema Multiforme/patologia , Eritema Multiforme/prevenção & controle , Infecções por Herpesviridae/complicações , Humanos , Recidiva , Pele/imunologiaRESUMO
Herpes simplex virus is the single most common precipitator of erythema multiforme. Typically, erythema multiforme lesions appear 10 to 14 days after a recurrent herpes simplex virus infection and attacks can be disabling when they occur at frequent intervals. Prior to the introduction of acyclovir (Zovirax), there was no effective therapy to prevent herpes-associated erythema multiforme. Four patients were treated with a maintenance dose of acyclovir for periods ranging from 10 to 26 months; there were no significant side effects from the drug and only one recurrence of erythema multiforme. Oral acyclovir may become the treatment of choice for herpes-associated erythema multiforme.
Assuntos
Aciclovir/uso terapêutico , Eritema Multiforme/prevenção & controle , Herpes Simples/tratamento farmacológico , Adulto , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/etiologia , Feminino , Herpes Genital/complicações , Herpes Genital/tratamento farmacológico , Herpes Labial/complicações , Herpes Labial/tratamento farmacológico , Herpes Simples/complicações , Humanos , Masculino , RecidivaRESUMO
A case of recurrent herpes simplex that triggered recurrent severe erythema multiforme is presented herein. Erythema multiforme was controlled by high doses of prednisone. Epidermal excision of early recurrent attacks of erythema multiforme, thus avoiding the necessity of systemic steroids. A total of eighteen crops of recurrent herpes lesions have been removed to date. The treatment approach has been very acceptable to the patient.