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Erythema Multiforme and Stevens-Johnson Syndrome

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Pigmented Ethnic Skin and Imported Dermatoses

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Abstract

Erythema multiforme (EM) is an acute, self-limited, occasionally recurring skin disease considered to be a type IV hypersensitivity reaction to certain infections, medications, and other triggering factors. The skin disease may present within a wide spectrum of severity: EM minor is characterized by pathognomonic target- or iris-like cutaneous lesions with minimal or no mucosal involvement, whereas EM major shows extensive involvement of the mucosal membranes and frequently systemic symptoms. The timely affection of skin and mucous membranes in EM has created confusion with other severe dermatoses, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). In recent years, evidence has been provided that EM major and SJS/TEN are separate entities clinically manifested with similar cutaneous and mucosal involvement differing not only in severity but also in several demographic characteristics and causes [1, 2].

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References

  1. Bastuji-Garin S, Rzany B, Stern RS, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129:92–6.

    Article  CAS  PubMed  Google Scholar 

  2. Auquier-Dunant A, Mockenhaupt M, Naldi L, et al. Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study. Arch Dermatol. 2002;138:1019–24.

    Article  PubMed  Google Scholar 

  3. Huff JC. Erythema multiforme and latent herpes simplex infection. Semin Dermatol. 1992;11:207–10.

    PubMed  CAS  Google Scholar 

  4. Aurelian L, Ono F, Burnett J. Herpes simplex virus (HSV)-associated erythema multiforme (HAEM): a viral disease with an autoimmune component. Dermatol Online J. 2003;9:1.

    PubMed  CAS  Google Scholar 

  5. Langley A, Anooshiravani N, Kwan S, et al. Erythema multiforme in children and Mycoplasma pneumoniae aetiology. J Cutan Med Surg. 2016;20:453–7.

    Article  CAS  PubMed  Google Scholar 

  6. Huff JC. Erythema multiforme. Dermatol Clin. 1985;3:141–52.

    Article  CAS  PubMed  Google Scholar 

  7. Joseph TI, Vargheese G, George D, et al. Drug induced oral erythema multiforme: a rare and less recognized variant of erythema multiforme. J Oral Maxillofac Pathol. 2012;16:14514–8.

    Article  Google Scholar 

  8. Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol. 2012;51:889–902.

    Article  PubMed  Google Scholar 

  9. Kokuba H, Aurelian L, Burnett J. Herpes simplex virus associated erythema multiforme (HAEM) is mechanistically distinct from drug-induced erythema multiforme: interferon-gamma is expressed in HAEM lesions and tumor necrosis factor-alpha in drug-induced erythema multiforme lesions. J Invest Dermatol. 1999;113:808–15.

    Article  CAS  PubMed  Google Scholar 

  10. Lemak MA, Duvic M, Bean SF. Oral acyclovir for the prevention of herpes-associated erythema multiforme. J Am Acad Dermatol. 1986;15:50–4.

    Article  CAS  PubMed  Google Scholar 

  11. Tatnall FM, Schofield JK, Leigh IM. A double-blind, placebo-controlled trial of continuous acyclovir therapy in recurrent erythema multiforme. Br J Dermatol. 1995;132:267–70.

    Article  CAS  PubMed  Google Scholar 

  12. Kerob D, Assier-Bonnet H, Esnault-Gelly P, et al. Recurrent erythema multiforme unresponsive to acyclovir prophylaxis and responsive to valacyclovir continuous therapy. Arch Dermatol. 1998;134:876–7.

    Article  CAS  PubMed  Google Scholar 

  13. Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39. https://doi.org/10.1186/1750-1172-5-39.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Creamer D, Walsh SA, Dziewulski P, et al. UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. J Plast Reconstr Aesthet Surg. 2016;69:e119–53.

    Article  CAS  PubMed  Google Scholar 

  15. Tan SK, Tay YK. Profile and pattern of Stevens-Johnson syndrome and toxic epidermal necrolysis in a general hospital in Singapore: treatment outcomes. Acta Derm Venereol. 2012;92:62–6.

    Article  PubMed  Google Scholar 

  16. Saka B, Kombaté K, Mouhari-Toure A, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis in a teaching hospital in Lomé, Togo: retrospective study of 89 cases. Med Trop (Mars). 2010;70:255–8.

    CAS  Google Scholar 

  17. Saka B, Barro-Traoré F, Atadokpédé FA, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa: a multicentric study in four countries. Int J Dermatol. 2013;52:575–9.

    Article  PubMed  Google Scholar 

  18. Mockenhaupt M, Viboud C, Dunant A, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCARstudy. J Invest Dermatol. 2008;128:35–44.

    Article  CAS  PubMed  Google Scholar 

  19. Yip LW, Thong BY, Lim J, et al. Ocular manifestations and complications of Stevens-Johnson syndrome and toxic epidermal necrolysis: an Asian series. Allergy. 2007;62:527–31.

    Article  CAS  PubMed  Google Scholar 

  20. Lissia M, Figus A, Rubino C. Intravenous immunoglobulins and plasmapheresis combined treatment in patients with severe toxic epidermal necrolysis: preliminary report. Br J Plast Surg. 2005;58:504–10.

    Article  CAS  PubMed  Google Scholar 

  21. Yamane Y, Matsukura S, Watanabe Y, et al. Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 87 Japanese patients—treatment and outcome. Allergol Int. 2016;65:74–81.

    Article  CAS  PubMed  Google Scholar 

  22. Hirahara K, Kano Y, Sato Y, et al. Methylprednisolone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis: clinical evaluation and analysis of biomarkers. J Am Acad Dermatol. 2013;69:496–8.

    Article  CAS  PubMed  Google Scholar 

  23. Valeyrie-Allanore L, Wolkenstein P, Brochard L, et al. Open trial of ciclosporin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol. 2010;163:847–53.

    Article  CAS  PubMed  Google Scholar 

  24. Paradisi A, Abeni D, Bergamo F, et al. Etanercept therapy for toxic epidermal necrolysis. J Am Acad Dermatol. 2014;71:278–83.

    Article  CAS  PubMed  Google Scholar 

  25. Smith SD, Dodds A, Dixit S, et al. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/Stevens-Johnson syndrome overlap. Australas J Dermatol. 2015;56:298–302.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Dermatology and Venereology, Ain Shams University, Cairo, Egypt

    Mohamed Badawy Abdel-Naser

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  1. Mohamed Badawy Abdel-Naser
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Editors and Affiliations

  1. The Free University of Berlin, Medical School Charité, Berlin, Germany

    Constantin E. Orfanos

  2. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Saxony-Anhalt, Germany

    Christos C. Zouboulis

  3. Department of Dermatology and Venereology, HELIOS Klinikum Krefeld, Krefeld, Nordrhein-Westfalen, Germany

    Chalid Assaf

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Abdel-Naser, M.B. (2018). Erythema Multiforme and Stevens-Johnson Syndrome. In: Orfanos, C., Zouboulis, C., Assaf, C. (eds) Pigmented Ethnic Skin and Imported Dermatoses. Springer, Cham. https://doi.org/10.1007/978-3-319-69422-1_27

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  • DOI: https://doi.org/10.1007/978-3-319-69422-1_27

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-69421-4

  • Online ISBN: 978-3-319-69422-1

  • eBook Packages: MedicineMedicine (R0)

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