Treatment Following Erythema Multiforme in the Oral Mucosa After qHPV Vaccine with Low-Level Laser Therapy: case Report / Tratamiento del Eritema Multiforme en la Mucosa Oral Después de la Vacuna Contra el qHPV con Terapia con Láser de Baja Potencia: reporte de un Caso

Erythema multiforme (EM) is a mucocutaneous condition of uncertain etiology, although the hypersensitivity reaction to a wide variety of agents may be related to the onset of the lesions. In about half of the affected patients it is possible to identify a previous infection. This article aims to report a case of EM in the oralmucosa after qHPV vaccine (Gardasil®), to highlight the diagnostic process and the proposed treatment. Female patient, 16 years old, after 10 days of receiving the first dose of the qHPV vaccine. On physical examination, she presented multiple ulcers and hemorrhagic crusts to the touch, based on the clinical picture and the history of the disease, a diagnostic hypothesis was EM. Low-level laser therapy (LLLT) was chosen as an alternative treatment, since the exercises applied were not successful. The patient was followed up, reported decreased pain and burn and, after one year of treatment, there was no recurrence of the lesions. Laser treatment showed an effective treatment alternative, in addition to the low cost and ease of application.

El eritema multiforme (EM) es una afección mucocutánea de etiología incierta, aunque la reacción de hipersensibilidad a una amplia variedad de agentes puede estar relacionada con la aparición de las lesiones. En aproximadamente la mitad de los pacientes afectados es posible identificar una infección previa. Este artículo tiene como objetivo informar un caso de EM en la mucosa oral después de la vacuna qHPV (Gardasil®), para resaltar el proceso de diagnóstico y el tratamiento propuesto. Paciente de 16 años, después de 10 días de recibir la primera dosis de la vacuna qHPV. En el examen físico, presentó múltiples úlceras y costras hemorrágicas al tacto, según el cuadro clínico y la historia de la enfermedad, una hipótesis diagnóstica fue EM. La terapia con láser de baja potencia (TLBP) se eligió como un tratamiento alternativo, ya que los ejercicios aplicados no tuvieron éxito. La paciente fue seguida, informó disminución del dolor y las quemaduras y, después de un año de tratamiento, no hubo recurrencia de las lesiones. El tratamiento con láser mostró una alternativa de tratamiento efectivo, además del bajo costo y la facilidad de aplicación.

Plant Associated Irritant & Allergic Contact Dermatitis (Phytodermatitis).

With more than 350,000 plant species recognized and new species continually being identified, it is not surprising that humans contact plants or plant-containing products daily. The nearly endless list of potential exposures leaves us with a challenging task when attempting to categorize and study potential plant-related irritants and allergens. This article focused on laying a sound framework for understanding some of the more pertinent potential irritants and allergens.

Erythema multiforme like reaction to santos rosewood (Machaerium scleroxylon) and Torreya nucifera.

Erythema multiforme is a skin disorder characterised by target epithelial eruption, which is mainly caused by infection or drugs. In this case, we report an erythema multiforme like reaction caused by contact dermatitis against wood, especially santos rosewood. During the hospitalisation, we performed a patch test with lumber used in the patient's workplace, and recognised a positive response to multiple woods and a simultaneous recurring eruption (flare up) outside of the test site. The findings from this case of contact dermatitis caused by frequently used industrial wood type is important for the management of occupational environments. A review of the literature on erythema multiforme like reaction due to contact dermatitis, including past case reports, has also been provided.

Dietary supplement product composed of natural ingredients as a suspected cause of erythema multiforme: A case report and identification for the confident false positivity of lymphocyte transformation test.

Growing and sustainable consumption of health-care products raises a controversial issue underlying the reliability of an in vitro diagnostic approach for adverse skin reaction. This report aimed to: (i) discuss the causative nature of a commercial dietary supplement composed of natural ingredients, particularly an Euglena-containing product, suspicious for erythema multiforme in our exemplified case; and (ii) to address the assay suitability of the lymphocyte transformation test (LTT) for identifying allergic reaction to any ingredient(s) of the product. A Japanese elderly man developed erythema multiforme after intake of a commercially available natural dietary product, whose LTT was positive. His clinical course and positive LTT suggested a provisional diagnosis of natural dietary product-induced eruption. We conducted an inquiry survey for the standard LTT with any commercial products containing Euglena in three major Japanese laboratory services and identified 22 subjects, almost all of whom (21/22, 95.6%) showed a positive LTT for any Euglena-containing products as a suspected causative. Seven normal healthy volunteers who had no intake history of Euglena-containing products showed an equivalent LTT positivity rate with the same product taken by our case; culprit components of the product included Euglena, Angelica keiskei, Barley grass and Chlorella. A cell-free culture system and enzyme-linked immunoassay suggest that the high LTT positivity relies on the non-specific lymphoproliferative activity, and not contamination of uncharacterized microorganisms and endotoxins. Because of the constitutive false positivity of LTT, this assay is unreliable for in vitro supportive diagnosis of adverse skin events caused by dietary products containing particular natural ingredients, as well as herbal materials.

Exanthems and drug reactions.

BACKGROUND: Drug reactions are a common cause of rashes and can vary from brief, mildly annoying, self limiting rashes to severe conditions involving multiple organ systems. OBJECTIVE: This article outlines an approach to exanthems that may be related to drug reactions and details appropriate management. DISCUSSION: Rashes related to drug reactions are both nonallergic and allergic. Nonallergic rashes are usually predictable and may be avoidable. Allergic rashes include morbilliform erythema, urticaria and angioedema, erythema multiforme and vasculitic rashes. The vast majority of cases are rapidly resolving and self limiting once the offending agent is removed. Early recognition and supportive measures are the keys to care in the majority of cases. However, an awareness of serious drug reactions (Stevens- Johnson syndrome and toxic epidermal necrolysis), which are potentially life threatening conditions and require immediate specialist assessment and treatment in hospital, is important.

Erupción cutanea recurrente en las manos: eritema multiforme / Recurrent rash on the hands: multiforme erythema

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Clinical patterns of phytodermatitis.

Exposure to plants is very common, through leisure or professional activity. In addition, plant products and botanic extracts are increasingly present in the environment. Cutaneous adverse reactions to plants and their derivatives occur fairly frequently, and establishing the correct diagnosis is not always easy. The astute clinician relies on a detailed history and a careful skin examination to substantiate his opinion. This article reviews the characteristic clinical patterns of phyto- and phytophotodermatitis and some less common presentations.

Erythema multiforme-like generalized allergic contact dermatitis caused by Alpinia galanga.

This study reports a case of localized contact dermatitis and subsequently generalized erythema multiforme-like eruptions after topical application of herbal remedies. Patch tests showed there was an allergen in fresh and dried Alpinia galanga, which is also a popular spice in Southeast Asian cuisines.

The cutaneous manifestations and common mimickers of physical child abuse.

The cutaneous manifestations of physical child abuse are some of the most common and easily recognized forms of injury. To make an accurate assessment and diagnosis, it is important to differentiate between inflicted cutaneous injuries and mimickers of physical abuse. Likewise, an understanding of reporting guidelines helps guide practitioners in their decision making.

Oral diseases of immunological background

From a clinician's point of view, diseases of the immune system are broadly grouped into the following categories: I. Immunodeficiency disorders II.Autoimmune diseases III. Hypersensitivity reactions (AU)

Erythema multiforme due to contact with weeds: a recurrence after patch testing.

Erythema multiforme (EM) as a complication of patch testing (PT) is rare. A 52-year-old woman with a 13-year history of episodes of EM, after contact with weeds during home gardening, had had no recent history of herpes simplex, other infection, drug ingestion or vaccination. On examination, EM lesions were distributed on the exposed skin. 5 weeks after complete resolution, PT and photopatch testing (PPT) were done with fresh plants she brought in. She was PT with a standard series and the Hermal-Trolab plants, woods, tars, balsams and flavors series. Intradermal testing, with a 3 + reaction to mixed weed pollens, was done 3 weeks later. Specific IgE to weed pollens class 1 (CAP-Pharmacia) was detected. Eczematous PT reactions were obtained with fresh leaves: common chickweed (Stellaria media Caryophyllaceae), dandelion (Taraxacum officinale Compositae), field-milk thistle (Sonchus arvensis Compositae) and white clover (Trifolium repens Leguminosae). Photoaggravation was seen to common chickweed and dandelion. Positive PT was also seen with alantolactone. By the 4-day reading, a typical EM had commenced, coming up to quite the same extent as seen on admission. There was no photosensitivity (UV skin tester, K. Waldmann). In the essential oil obtained from common chickweed, thin layer chromatography (TLC) revealed the well-known contact allergens borneol, menthol, linalool, 1,8-cineole, and other terpenes such as epoxy-dehydro-caryophyllene, monoterpene alcohol-ester and caryophyllene. Up to now, no data on essential oil in Stellaria media (common chickweed) have been reported. It can be concluded that EM developed due to contact with weeds, and recurred after patch testing. Neither blistering nor eczematous lesions have been seen on her skin, making this case very unusual. As far as the world literature is concerned, this is only the 4th report of EM developing in association with patch testing.

Allergic contact dermatitis to tea tree oil with erythema multiforme-like id reaction.

The commercial production of tea tree oil, extracted from Melaleuca alternifolia Cheel, has considerably increased over the past 15 years in response to a strong demand for natural remedies and aromatic substances. The number of case reports that describe allergic contact dermatitis (ACD) to this essential oil is also on the rise. We report an additional case of ACD to tea tree oil that presented with an extensive erythema multiforme-like reaction. A skin biopsy was performed from a targetlike lesion distant from the site of the initial dermatitis. The patient was treated with systemic and topical corticosteroids. Five months later, he was patch tested to the North American standard series, to his own tea tree oil, to a fresh batch of tea tree oil, and to some related allergens. The skin biopsy showed a spongiotic dermatitis without histological features of erythema multiforme. Patch testing elicited a 3+ reaction to old, oxidized tea tree oil, a 2+ reaction to fresh tea tree oil, a 2+ reaction to colophony, a 1+ reaction to abitol, and a 1+ reaction to balsam of Peru. We believe this is the first report of erythema multiforme-like reaction secondary to ACD from tea tree oil. Other interesting features are the stronger reaction to oxidized than to fresh tea tree oil, and concomitant reactivity to colophony, abitol, and balsam of Peru.