Current Perspectives on Erythema Multiforme
Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In this review, current diagnostic guidelines, potential pitfalls, and modern/novel treatment options are summarized with the aim to help clinicians with diagnostic and therapeutic decision-making. The diagnos...
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Veröffentlicht in: | Clinical reviews in allergy & immunology 2018-02, Vol.54 (1), p.177-184 |
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description | Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In this review, current diagnostic guidelines, potential pitfalls, and modern/novel treatment options are summarized with the aim to help clinicians with diagnostic and therapeutic decision-making. The diagnosis of erythema multiforme, that has an acute, self-limiting course, is based on its typical clinical picture of targetoid erythematous lesions with predominant acral localization as well as histological findings. Clinically, erythema multiforme can be differentiated into isolated cutaneous and combined mucocutaneous forms. Atypical erythema multiforme manifestations include lichenoid or granulomatous lesions as well as lesional infiltrates of T cell lymphoma and histiocytes. Herpes simplex virus infection being the most common cause, other infectious agents like—especially in children—
Mycoplasma pneumoniae
,
hepatitis C virus
,
Coxsackie virus
, and
Epstein Barr virus
may also trigger erythema multiforme. The second most frequently identified cause of erythema multiforme is drugs. In different studies, e.g., allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described. In patients with recurrent herpes simplex virus-associated erythema multiforme, the topical prophylactic treatment with acyclovir does not seem to prevent further episodes of erythema multiforme. In case of resistance to one virostatic drug, the switch to an alternative drug, and in patients non-responsive to virostatic agents, the use of dapsone as well as new treatment options, e.g., JAK-inhibitors or apremilast, might be considered. |
doi_str_mv | 10.1007/s12016-017-8667-7 |
format | Article |
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Mycoplasma pneumoniae
,
hepatitis C virus
,
Coxsackie virus
, and
Epstein Barr virus
may also trigger erythema multiforme. The second most frequently identified cause of erythema multiforme is drugs. In different studies, e.g., allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described. In patients with recurrent herpes simplex virus-associated erythema multiforme, the topical prophylactic treatment with acyclovir does not seem to prevent further episodes of erythema multiforme. In case of resistance to one virostatic drug, the switch to an alternative drug, and in patients non-responsive to virostatic agents, the use of dapsone as well as new treatment options, e.g., JAK-inhibitors or apremilast, might be considered.</description><identifier>ISSN: 1080-0549</identifier><identifier>EISSN: 1559-0267</identifier><identifier>DOI: 10.1007/s12016-017-8667-7</identifier><identifier>PMID: 29352387</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Acetylsalicylic acid ; Acyclovir ; Adalimumab ; Allergology ; Allopurinol ; Antibacterial agents ; Antiviral drugs ; Aspirin ; Care and treatment ; Children ; Chlormezanone ; Coxsackievirus infections ; Dapsone ; Decision making ; Divalproex ; Epstein-Barr virus ; Erythema ; Erythema multiforme ; Erythromycin ; Etanercept ; Health aspects ; Hepatitis ; Hepatitis C ; Herpes simplex ; Herpes viruses ; Imiquimod ; Immunology ; Immunotherapy ; Infliximab ; Inhibitors ; Internal Medicine ; Lesions ; Localization ; Lymphocytes T ; Lymphoma ; Medicine ; Medicine & Public Health ; Medicine, Preventive ; Melanoma ; Monoclonal antibodies ; Nitrofurantoin ; Non-Hodgkin's lymphomas ; Patients ; Phenobarbital ; Phenytoin ; Preventive health services ; Statins ; Sulfonamides ; T cells ; Tetracycline ; Tetracyclines ; Vaccination ; Valproic acid ; Vemurafenib ; Viruses</subject><ispartof>Clinical reviews in allergy & immunology, 2018-02, Vol.54 (1), p.177-184</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>COPYRIGHT 2018 Springer</rights><rights>Clinical Reviews in Allergy & Immunology is a copyright of Springer, (2018). All Rights Reserved.</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c524t-8a0e581930cd794aea42ab6695e244a4743b7e1fb1197b047f74ac9e465582be3</citedby><cites>FETCH-LOGICAL-c524t-8a0e581930cd794aea42ab6695e244a4743b7e1fb1197b047f74ac9e465582be3</cites><orcidid>0000-0001-8603-3310</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12016-017-8667-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12016-017-8667-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29352387$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lerch, Marianne</creatorcontrib><creatorcontrib>Mainetti, Carlo</creatorcontrib><creatorcontrib>Terziroli Beretta-Piccoli, Benedetta</creatorcontrib><creatorcontrib>Harr, Thomas</creatorcontrib><title>Current Perspectives on Erythema Multiforme</title><title>Clinical reviews in allergy & immunology</title><addtitle>Clinic Rev Allerg Immunol</addtitle><addtitle>Clin Rev Allergy Immunol</addtitle><description>Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In this review, current diagnostic guidelines, potential pitfalls, and modern/novel treatment options are summarized with the aim to help clinicians with diagnostic and therapeutic decision-making. The diagnosis of erythema multiforme, that has an acute, self-limiting course, is based on its typical clinical picture of targetoid erythematous lesions with predominant acral localization as well as histological findings. Clinically, erythema multiforme can be differentiated into isolated cutaneous and combined mucocutaneous forms. Atypical erythema multiforme manifestations include lichenoid or granulomatous lesions as well as lesional infiltrates of T cell lymphoma and histiocytes. Herpes simplex virus infection being the most common cause, other infectious agents like—especially in children—
Mycoplasma pneumoniae
,
hepatitis C virus
,
Coxsackie virus
, and
Epstein Barr virus
may also trigger erythema multiforme. The second most frequently identified cause of erythema multiforme is drugs. In different studies, e.g., allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described. In patients with recurrent herpes simplex virus-associated erythema multiforme, the topical prophylactic treatment with acyclovir does not seem to prevent further episodes of erythema multiforme. In case of resistance to one virostatic drug, the switch to an alternative drug, and in patients non-responsive to virostatic agents, the use of dapsone as well as new treatment options, e.g., JAK-inhibitors or apremilast, might be considered.</description><subject>Acetylsalicylic acid</subject><subject>Acyclovir</subject><subject>Adalimumab</subject><subject>Allergology</subject><subject>Allopurinol</subject><subject>Antibacterial agents</subject><subject>Antiviral drugs</subject><subject>Aspirin</subject><subject>Care and treatment</subject><subject>Children</subject><subject>Chlormezanone</subject><subject>Coxsackievirus infections</subject><subject>Dapsone</subject><subject>Decision making</subject><subject>Divalproex</subject><subject>Epstein-Barr virus</subject><subject>Erythema</subject><subject>Erythema multiforme</subject><subject>Erythromycin</subject><subject>Etanercept</subject><subject>Health aspects</subject><subject>Hepatitis</subject><subject>Hepatitis C</subject><subject>Herpes simplex</subject><subject>Herpes viruses</subject><subject>Imiquimod</subject><subject>Immunology</subject><subject>Immunotherapy</subject><subject>Infliximab</subject><subject>Inhibitors</subject><subject>Internal Medicine</subject><subject>Lesions</subject><subject>Localization</subject><subject>Lymphocytes T</subject><subject>Lymphoma</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Preventive</subject><subject>Melanoma</subject><subject>Monoclonal antibodies</subject><subject>Nitrofurantoin</subject><subject>Non-Hodgkin's lymphomas</subject><subject>Patients</subject><subject>Phenobarbital</subject><subject>Phenytoin</subject><subject>Preventive health services</subject><subject>Statins</subject><subject>Sulfonamides</subject><subject>T cells</subject><subject>Tetracycline</subject><subject>Tetracyclines</subject><subject>Vaccination</subject><subject>Valproic acid</subject><subject>Vemurafenib</subject><subject>Viruses</subject><issn>1080-0549</issn><issn>1559-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kU9LHTEUxUNRqrX9AN2UB0I3ZfTm750s5WGroLQLuw6ZeXd8IzOT1yQj-O0bebYqqGRxQ-7vnHA4jH3mcMQB8DhxAdxUwLGqjcEK37F9rrWtQBjcKXeooQKt7B77kNINgIBa2vdsT1iphaxxn31bzjHSlBe_KKYNtbm_pbQI0-I03uU1jX5xOQ-570Ic6SPb7fyQ6NPDPGC_v59eLc-qi58_zpcnF1WrhcpV7YF0za2EdoVWefJK-MYYq0ko5RUq2SDxruHcYgMKO1S-taSM1rVoSB6ww63vJoY_M6XsbsIcp_KlE8VFCFTKvEVxa2WJZxAeqWs_kOunLuTo27FPrTvRwgiNKGWhjl6gylnR2Ldhoq4v788EX58I1uSHvE5hmHMfpvQc5FuwjSGlSJ3bxH708c5xcPclum2JrpTo7kt0WDRfHpLNzUir_4p_rRVAbIFUVtM1xSfRX3X9C1NQoew</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Lerch, Marianne</creator><creator>Mainetti, Carlo</creator><creator>Terziroli Beretta-Piccoli, Benedetta</creator><creator>Harr, Thomas</creator><general>Springer 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C</topic><topic>Herpes simplex</topic><topic>Herpes viruses</topic><topic>Imiquimod</topic><topic>Immunology</topic><topic>Immunotherapy</topic><topic>Infliximab</topic><topic>Inhibitors</topic><topic>Internal Medicine</topic><topic>Lesions</topic><topic>Localization</topic><topic>Lymphocytes T</topic><topic>Lymphoma</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Preventive</topic><topic>Melanoma</topic><topic>Monoclonal antibodies</topic><topic>Nitrofurantoin</topic><topic>Non-Hodgkin's lymphomas</topic><topic>Patients</topic><topic>Phenobarbital</topic><topic>Phenytoin</topic><topic>Preventive health services</topic><topic>Statins</topic><topic>Sulfonamides</topic><topic>T cells</topic><topic>Tetracycline</topic><topic>Tetracyclines</topic><topic>Vaccination</topic><topic>Valproic acid</topic><topic>Vemurafenib</topic><topic>Viruses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lerch, Marianne</creatorcontrib><creatorcontrib>Mainetti, Carlo</creatorcontrib><creatorcontrib>Terziroli Beretta-Piccoli, Benedetta</creatorcontrib><creatorcontrib>Harr, Thomas</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni 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C)</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Clinical reviews in allergy & immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lerch, Marianne</au><au>Mainetti, Carlo</au><au>Terziroli Beretta-Piccoli, Benedetta</au><au>Harr, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Current Perspectives on Erythema Multiforme</atitle><jtitle>Clinical reviews in allergy & immunology</jtitle><stitle>Clinic Rev Allerg Immunol</stitle><addtitle>Clin Rev Allergy Immunol</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>54</volume><issue>1</issue><spage>177</spage><epage>184</epage><pages>177-184</pages><issn>1080-0549</issn><eissn>1559-0267</eissn><abstract>Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In this review, current diagnostic guidelines, potential pitfalls, and modern/novel treatment options are summarized with the aim to help clinicians with diagnostic and therapeutic decision-making. The diagnosis of erythema multiforme, that has an acute, self-limiting course, is based on its typical clinical picture of targetoid erythematous lesions with predominant acral localization as well as histological findings. Clinically, erythema multiforme can be differentiated into isolated cutaneous and combined mucocutaneous forms. Atypical erythema multiforme manifestations include lichenoid or granulomatous lesions as well as lesional infiltrates of T cell lymphoma and histiocytes. Herpes simplex virus infection being the most common cause, other infectious agents like—especially in children—
Mycoplasma pneumoniae
,
hepatitis C virus
,
Coxsackie virus
, and
Epstein Barr virus
may also trigger erythema multiforme. The second most frequently identified cause of erythema multiforme is drugs. In different studies, e.g., allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described. In patients with recurrent herpes simplex virus-associated erythema multiforme, the topical prophylactic treatment with acyclovir does not seem to prevent further episodes of erythema multiforme. In case of resistance to one virostatic drug, the switch to an alternative drug, and in patients non-responsive to virostatic agents, the use of dapsone as well as new treatment options, e.g., JAK-inhibitors or apremilast, might be considered.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29352387</pmid><doi>10.1007/s12016-017-8667-7</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-8603-3310</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Acetylsalicylic acid Acyclovir Adalimumab Allergology Allopurinol Antibacterial agents Antiviral drugs Aspirin Care and treatment Children Chlormezanone Coxsackievirus infections Dapsone Decision making Divalproex Epstein-Barr virus Erythema Erythema multiforme Erythromycin Etanercept Health aspects Hepatitis Hepatitis C Herpes simplex Herpes viruses Imiquimod Immunology Immunotherapy Infliximab Inhibitors Internal Medicine Lesions Localization Lymphocytes T Lymphoma Medicine Medicine & Public Health Medicine, Preventive Melanoma Monoclonal antibodies Nitrofurantoin Non-Hodgkin's lymphomas Patients Phenobarbital Phenytoin Preventive health services Statins Sulfonamides T cells Tetracycline Tetracyclines Vaccination Valproic acid Vemurafenib Viruses |
title | Current Perspectives on Erythema Multiforme |
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