Recurrent Erythema Multiforme with Paracetamol

Introduction: Erythema multiforme (EM) is an acute eruptive dermatosis induced by various agents, the most common being herpes virus simplex [1]. Certain drugs may be implicated, in particular nonsteroidal anti-inflammatory drugs, sulfonamides and penicillins. Cases of EM attributed to paracetamol are relatively rare [2]. Objective: We report a case of recurrent erythema multiforme minor induced by paracetamol. Methods: This case was notified in June 2019 and was analyzed according to the Naranjo causality scale method [3]. Results: A 25-year-old woman with a history of atopy, namely dust mite, pollen allergic rhinitis and allergic asthma, regularly takes paracetamol for dysmenorrhea. She consulted us for a predominant rash on the palmar side of the hands, which appeared 2 days after taking paracetamol. These lesions would be recurrent for 6 years, and coincide with taking paracetamol. The diagnosis of EM caused by paracetamol was suspected. A biopsy was performed and confirmed the diagnosis of EM. Paracetamol was stopped. The evolution was spontaneously favorable after 9 days with regression of symptoms and persistence of residual pigmentation. There has been no recurrence since paracetamol withdrawal. Conclusion: EM is an acute pathology that can be recurrent and even disabling without the triggering factor being highlighted. It is therefore important to draw attention to the possible EM induced by paracetamol, a drug widely prescribed but rarely incriminated.