Erythema multiforme major secondary to a cosmetic facial cream: first case report.

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.

Situational antiviral drug prophylaxis for HSV type 1 recurrences.

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.

Recurrent herpes simplex virus-induced erythema multiforme: different HLA-DQB1 alleles associate with severe mucous membrane versus skin attacks.

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).

Oral acyclovir for the prevention of herpes-associated erythema multiforme.

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.

Surgical treatment of recurrent herpes simplex.

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.