Main Article Content
Background: Erythema multiforme (EM) manifests on the skin and mucosa surfaces such as the oral mucosa and the genitals as ulcerative lesions. The spectrum of clinical presentation underscores the importance of describing the clinical features observed in patients presenting in an oral medicine clinic for treatment.
Aim: To describe the epidemiology and the clinical features of patients presenting with erythema multiforme in the oral medicine clinic of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC).
Methodology: A retrospective study of cases diagnosed as EM in the Oral Medicine clinic of OAUTHC between August 2009 and August 2019. Patients’ hospital records were retrieved and reviewed. Information extracted included biodata, clinical findings, presence of co morbidity and treatment received. Diagnosis of EM was mostly clinical; some patients also had histopathologic and/or Direct Immunofluorescence (DIF) investigations. Data was analyzed using STATA 13 statistical software.
Results: Out of the total number of 923 patients seen in the clinic during the study period, 19 (2.08%) patients had EM. Nine males and 10 females were affected. The age ranged from 9 years to 73 years with mean age of 35.53± 16.20 years. EM minor was diagnosed in 17(89.47%) while EM major was diagnosed in 2(10.53%). The affected oral sites were upper and lower lips 16(84.21%), buccal mucosa 9(47.3%), hard and soft palate had 3(15.79%) and tongue 2(10.52%). Seven patients (36.84%) presented with target skin lesions. Seventeen patients (89.47%) had recurrence. Sixteen (84.47%) patients had no identifiable causative factor while one patient each presented with ciprotab® (5.26%), septrin® (5.26%) and sulphonamide (5.26%) as the implicating triggers. Two (10.53%) of the patients presented with oral and genital ulcers. The 2 patients had histopathology and Direct Immunofluorescence investigation. Patients were treated with steroids and other supportive therapy.
Conclusion: Erythema Multiforme appears to be an uncommon presentation in the oral medicine clinic, but may be associated with recurrent lesion in and around the oral tissue. The lips were the most common site of oral presentation. Drug reactions were identifiable etiological factor. Topical or systemic steroids were effective in patient management.
Hebra F. On diseases of the skin, including the exanthemata translated by CH Fagge. London: New Sydenham Society. 1866; 285-89.
Kennett F. Erythema multiforme affecting the oral cavity. Oral Surg. 1968;25:366-73.
Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau JC. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129(1):92–96.
Samim F, Auluck A, Zed C, Williams PM. Erythema multiforme: A review of epidemiology, pathogenesis, clinical features, and treatment. Dent Clin North Am. 2013;57(4):583-96.
Hellgren L Hersley K. Erythema multiforme. Statistical evaluation of clinical and laboratory data in 224 patients and matched healthy controls. Acta Allergol. 1965;21:45-51.
Clark Huff WLWMD, Marciih G. Tonnesen M. Erythema multiforme: A critical review of characteristics, diagnostic criteria, and causes. JAAD. 1983;8(6):763-75.
Lynch FW. Erythema multiforme: A review. South Med J. 1955;48:279-85.
Wetter DADM. Recurrent erythema multiforme: Clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic 2000-2007. J Am Acad Dermatol. 2010;62:45-53.
Assier HB-GS, Revuz J, Roujeau JC. Erythema multiforme with mucous membrane involvement and Stevens–Johnson syndrome are clinically different disorders with distinct causes. Arch Dermatol. 1995;131:539-43.
Burket LW, Greenberg MS, Glick M, Ship JA. Ulcerative, Vesicular, and Bullous Lesions. Burket's oral medicine. 12 ed. Hamilton, Ont: BC Decker; 2008;68-70.
Lerch M, Mainetti C, Beretta-Piccoli BT, Harr T. Current perspectives on erythema multiforme. Clinical Reviews in Allergy & Immunology. 2018;54(1):177-84.
Schofield JKTF, Leigh IM. Recurrent erythema multiforme: clinical features and treatment in a large series of patients. Br J Dermatol. 1993;128:542-43.
Ayangco Lilibeth RRS. Oral manifestations of erythema multiforme. Dermatol Clin. 2003;195-205.
Lozada-Nur FGM, Silverman JrS. Oral erythema multiforme: Clinical observations and treatment of 95 patients. Oral Surg Oral Med Oral Path Oral Radiol Endod. 1989;67:36-40.
Lozada FSJS. Erythema multiforme: Clinical and natural history in fifty patients. Oral Surg. 1978;46:628-36.
Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: A review for the practicing dermatologist. International Journal of Dermatology. 2012;51(8):889-902.
Williams PM CR. Erythema multiforme: a review and contrast from Stevens-Johnson syndrome/toxic epidermal necrolysis. Dent Clin N Am. 2005;49:67-76.
Pope E KB. Involvement of three mucous membranes in herpes-induced recurrent erythema multiforme. J Am Acad Dermatol Clin 2005;52:171-72.
Aurelian L OF, Burnett J. Herpes simplex virus (HSV)-associated erythema multiforme (HAEM): A viral disease with an autoimmune component. Dermatol Online J. 2003;9(1).
Tennesson MG SN. Erythema multiforme. Dermatol J Am Acad. 1979;1:357-64.
Sun Y CR, Tan SH, Ng PP. Detection and genotyping of human herpes simplex viruses in cutaneous lesions of erythema multiforme by nested PCR. J Med Virol. 2003;71:423-28.