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.

A topical imiquimod-induced oral mucosal lichenoid reaction: a case report.

BACKGROUND: Imiquimod (IMI) is a topical immune response modifier used in the treatment of actinic keratosis and cheilitis. Actinic cheilitis is a potentially premalignant condition that requires therapeutic intervention. IMI therapy is noted for producing cutaneous and mucosal adverse effects. The authors report the case of an 88-year-old woman who was treated for actinic cheilitis of the upper lip with IMI and who consequently experienced an oral mucosal lichenoid reaction of the lower lip and right buccal mucosa. RESULTS: The patient was treated successfully with high-dose steroid therapy, and the oral lesions resolved in 17 days. CONCLUSIONS: To our knowledge, this is the first case report regarding an IMI-induced oral mucosal lichenoid reaction. Clinicians should be aware of the potential of IMI to cause lichenoid reactions. PRACTICAL IMPLICATIONS: IMI is an efficacious therapeutic agent when used in the treatment of actinic cheilitis, but it is prone to cause oral mucosal side effects such as lichenoid reactions. Therefore, it is important for dentists to be knowledgeable concerning potential mucosal IMI side effects.

Oral erythema multiforme major: a triple case report.

This article presents three cases of erythema multiforme (EM) major with predominant oral mucosal lesions. Two males, aged 28 and 10, and a 19-year-old woman came to the clinic with oral vesiculoerosive lesions consistent with a diagnosis of EM major. All three patients reported histories consistent with an initial oral herpetic infection. Management with topical and systemic steroids resolved the lesions successfully in all three cases. The relatively recent literature has documented differences between EM and Stevens-Johnson syndrome. It is important for dentists to understand the etiology of EM and the associated diagnostic and management issues.

Medical consultations for medically complex dental patients.

In order to discuss the issue of the medical consultation letter for medically complex dental patients, information is provided with regard to the specifics of the process. Medical, dental, and legal implications are discussed. Specific scripting and format are provided.

A retrospective evaluation of 56 patients with oral burning and limited clinical findings.

This study retrospectively evaluated the charts of 56 patients who had been referred to an oral medicine clinic between 1995 and 2004 with oral burning and limited clinical findings. Of the 56 patients, 35 had a final diagnosis of essential burning mouth disorder (EBMD). Five patients with EBMD had a family history of diabetes and two had been diagnosed with late-onset diabetes. Other oral burning diagnoses included sialoadenitis (burning lips syndrome), irritation or allergic reactions to triclosan, diabetic neuropathy, subclinical oral candidiasis, nutritional deficiency/neuropathy, and a drug reaction to an ACE inhibitor (scalded mouth syndrome) that resulted in oral burning.