Materiały źródłowe

• #1 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470259/

  Erythema multiforme is reported worldwide without any ethnic preference. Although erythema multiforme occurs at any age, the condition presents more frequently in young adults. The average age of onset is between 20 and 40 years, with 20% of cases occurring in children. Erythema multiforme is more common in men than women, with a ratio of 1 in 5. The prevalence is not known but appears to be well below 1%. […] As the classification is not always clear, cases of Stevens-Johnson syndrome have frequently been included in studies on erythema multiforme.

• #2 Erythema Multiforme | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21300

  Erythema multiforme is reported worldwide without any ethnic preference. […] Although erythema multiforme occurs at any age, the condition presents more frequently in young adults. The average age of onset is between 20 and 40 years, with 20% of cases occurring in children. Erythema multiforme is more common in men than women, with a ratio of 1 in 5. The prevalence is not known but appears to be well below 1%. […] As the classification is not always clear, cases of Stevens-Johnson syndrome have frequently been included in studies on erythema multiforme.

• #3 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Erythema multiforme affects less than 1% of the population. It is most common in young adults (aged 20-40 years) with a modest predominance in males. There is no association with race. […] There appears to be a genetic predisposition in people carrying the HLA-DQB1*0301 allele, which shares an even stronger association with herpes-related erythema multiforme. Multiple other alleles have been associated with its recurrent form. […] Most research on the mechanism of disease has focused on the herpes-associated presentation. The herpes virus is phagocytosed by mononuclear cells which express cutaneous lymphocyte antigen (a skin-homing receptor). Engulfed viral DNA is then transferred to the epidermis and into keratinocytes. Within the keratinocyte layer, expression of viral DNA fragments induces a cell-mediated immune response, including the production of interferon- which upregulates the inflammatory process.

• #4 Erythema multiforme: Pathogenesis, clinical features, and diagnosis – UpToDate

  http://www.uptodate.com/contents/pathogenesis-clinical-features-and-diagnosis-of-erythema-multiforme

  Erythema multiforme (EM) is an acute, immune-mediated condition characterized by the appearance of distinctive target-like lesions on the skin. The epidemiology, pathogenesis, clinical features, evaluation, and diagnosis of EM will be reviewed here. The annual incidence of EM is unknown, although it is estimated to be far less than 1 percent. EM most frequently occurs in young adults between the ages of 20 and 40 and exhibits a slight male predominance. Children and older adults can also be affected.

• #5 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470259/

  Erythema multiforme is reported worldwide without any ethnic preference. Although erythema multiforme occurs at any age, the condition presents more frequently in young adults. The average age of onset is between 20 and 40 years, with 20% of cases occurring in children. Erythema multiforme is more common in men than women, with a ratio of 1 in 5. The prevalence is not known but appears to be well below 1%. […] As the classification is not always clear, cases of Stevens-Johnson syndrome have frequently been included in studies on erythema multiforme.

• #6 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  The exact incidence of EM in the United States is not defined; however, as many as 1% of dermatologic outpatient visits are for EM. Globally, the frequency of EM has been estimated to be in the range of 1.2-6 cases per million individuals per year. […] Before the HIV epidemic among young males, EM showed a slight female predominance; however, it has since become more common in younger males (male-to-female ratio, 2-3:1), mainly seen in the second to fourth decades but sometimes also in children and adolescents (20%). EM is rare in children younger than 3 years and in adults older than 50 years. […] The following medical conditions seem to predispose individuals to a higher risk of developing EM: HIV infection, corticosteroid exposure, bone marrow transplant, systemic lupus erythematosus (SLE), graft-versus-host disease (GVHD), inflammatory bowel disease (IBD). Individuals undergoing radiation therapy, chemotherapy, or neurosurgery for brain tumors are also at higher risk.

• #7 Erythema Multiforme – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/erythema-multiforme/

  Young adults, from 20 to 40, are most commonly affected, although children over 3 years and teenagers, represent 20% of cases. The estimated incidence ranges from 1.1 person every 1.000.000 per year in Germany, to 3.7 in the USA and up to 5-10 in Sweden. Recurrences are seen in 37% of the cases, often characterized by a progressive worsening of the attacks. A genetic predisposition linked to HLA-DQB1*0301 allele has been reported. […] The mucosal involvement in EM major and TEN, is early and constant, affecting the oral cavity (95-100% of the cases), eyes (70-75%), genitalia (60-65%) and occasionally pharynx, larynx, oesophagus and respiratory tract. […] There are no means to reliably prevent EM episodes nor recurrences. Some authors suggest the prophylactic use of an antiviral agent such as aciclovir in patients with oral recurrent EM with a putative viral cause. However there are insufficient data to support this. It is important to remember that drug use can cause a wide range of EM manifestations. For this reason, at the first episode of EM it is imperative to look for any drug that could be responsible, in order to avoid future administration – since the severity of the manifestations often increases in further episodes and in case of severe SJS or TEN this could be lethal.

• #8 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  The exact incidence of EM in the United States is not defined; however, as many as 1% of dermatologic outpatient visits are for EM. Globally, the frequency of EM has been estimated to be in the range of 1.2-6 cases per million individuals per year. […] Before the HIV epidemic among young males, EM showed a slight female predominance; however, it has since become more common in younger males (male-to-female ratio, 2-3:1), mainly seen in the second to fourth decades but sometimes also in children and adolescents (20%). EM is rare in children younger than 3 years and in adults older than 50 years. […] The following medical conditions seem to predispose individuals to a higher risk of developing EM: HIV infection, corticosteroid exposure, bone marrow transplant, systemic lupus erythematosus (SLE), graft-versus-host disease (GVHD), inflammatory bowel disease (IBD). Individuals undergoing radiation therapy, chemotherapy, or neurosurgery for brain tumors are also at higher risk.

• #9 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470259/

  Erythema multiforme is reported worldwide without any ethnic preference. Although erythema multiforme occurs at any age, the condition presents more frequently in young adults. The average age of onset is between 20 and 40 years, with 20% of cases occurring in children. Erythema multiforme is more common in men than women, with a ratio of 1 in 5. The prevalence is not known but appears to be well below 1%. […] As the classification is not always clear, cases of Stevens-Johnson syndrome have frequently been included in studies on erythema multiforme.

• #10 Erythema Multiforme | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617665/2.0/Erythema_Multiforme

  Predominantly affects healthy young adults but can affect people of all ages, including young children. […] Possible seasonal variation with increased frequency in spring and summer. The more severe form has been reported to occur more frequently in winter. […] Recurrences are common.

• #11 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  The exact incidence of EM in the United States is not defined; however, as many as 1% of dermatologic outpatient visits are for EM. Globally, the frequency of EM has been estimated to be in the range of 1.2-6 cases per million individuals per year. […] Before the HIV epidemic among young males, EM showed a slight female predominance; however, it has since become more common in younger males (male-to-female ratio, 2-3:1), mainly seen in the second to fourth decades but sometimes also in children and adolescents (20%). EM is rare in children younger than 3 years and in adults older than 50 years. […] The following medical conditions seem to predispose individuals to a higher risk of developing EM: HIV infection, corticosteroid exposure, bone marrow transplant, systemic lupus erythematosus (SLE), graft-versus-host disease (GVHD), inflammatory bowel disease (IBD). Individuals undergoing radiation therapy, chemotherapy, or neurosurgery for brain tumors are also at higher risk.

• #12 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470259/

  Erythema multiforme is reported worldwide without any ethnic preference. Although erythema multiforme occurs at any age, the condition presents more frequently in young adults. The average age of onset is between 20 and 40 years, with 20% of cases occurring in children. Erythema multiforme is more common in men than women, with a ratio of 1 in 5. The prevalence is not known but appears to be well below 1%. […] As the classification is not always clear, cases of Stevens-Johnson syndrome have frequently been included in studies on erythema multiforme.

• #13 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  The exact incidence of EM in the United States is not defined; however, as many as 1% of dermatologic outpatient visits are for EM. Globally, the frequency of EM has been estimated to be in the range of 1.2-6 cases per million individuals per year. […] Before the HIV epidemic among young males, EM showed a slight female predominance; however, it has since become more common in younger males (male-to-female ratio, 2-3:1), mainly seen in the second to fourth decades but sometimes also in children and adolescents (20%). EM is rare in children younger than 3 years and in adults older than 50 years. […] The following medical conditions seem to predispose individuals to a higher risk of developing EM: HIV infection, corticosteroid exposure, bone marrow transplant, systemic lupus erythematosus (SLE), graft-versus-host disease (GVHD), inflammatory bowel disease (IBD). Individuals undergoing radiation therapy, chemotherapy, or neurosurgery for brain tumors are also at higher risk.

• #14 Erythema Multiforme: 22 year-old male with a persistent red eye for two weeks

  https://webeye.ophth.uiowa.edu/eyeforum/cases/73-Erythema-Multiforme-Red-Eye.htm

  Erythema multiforme (EM) is most prevalent during the third and fourth decades of life and has a slight male predilection. (Ogundele et al. 2006) Factors involved in the etiology of EM include antecedent upper respiratory tract infection, Mycoplasma infection, herpes simplex virus infection, and medication, including antibiotics, anti-seizure, anti-gout, and anti-inflammatory drugs. Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infection. However, the precipitating cause is often not known. (Power, et al. 1995; Yi-Sheng Chang, et al. 2007) […] Adults age 20-40 years of age […] Slight male predilection […] No racial predilection […] Is often idiopathic, but can be associated with drug reactions or antecedent viral or mycoplasma infection […] Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infections.

• #15 ERYTHEMA MULTIFORME | Hand Surgery Resource

  https://www.handsurgeryresource.net/erythema-multi

  Epidemiologic data on EM is scarce and its exact incidence is not known, but is estimated to be 1%. EM typically occurs in adults aged 20-40 years and is slightly more common in women than men at a ratio of 1.5:1.0. It has a reported recurrence rate of 37% and a genetic predisposition to certain Asian ethnic groups. […] A systematic review of various interventions for EM identified only one relevant randomized controlled trial on the use of acyclovir. The study found that in patients with clinically suspected HSV-related EM, oral acyclovir was superior to placebo in suppressing recurrence.

• #16 Erythema Multiforme | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116217/all/Erythema_Multiforme?q=Rash

  Annual U.S. incidence is estimated at 1%. […] Predominant in young adults from age 20 to 40 years; rare in 3 years and 50 years of age. […] Slight female predominance is observed. […] There is no apparent race predilection.

• #17 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  The exact incidence of EM in the United States is not defined; however, as many as 1% of dermatologic outpatient visits are for EM. Globally, the frequency of EM has been estimated to be in the range of 1.2-6 cases per million individuals per year. […] Before the HIV epidemic among young males, EM showed a slight female predominance; however, it has since become more common in younger males (male-to-female ratio, 2-3:1), mainly seen in the second to fourth decades but sometimes also in children and adolescents (20%). EM is rare in children younger than 3 years and in adults older than 50 years. […] The following medical conditions seem to predispose individuals to a higher risk of developing EM: HIV infection, corticosteroid exposure, bone marrow transplant, systemic lupus erythematosus (SLE), graft-versus-host disease (GVHD), inflammatory bowel disease (IBD). Individuals undergoing radiation therapy, chemotherapy, or neurosurgery for brain tumors are also at higher risk.

• #18 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  The exact incidence of EM in the United States is not defined; however, as many as 1% of dermatologic outpatient visits are for EM. Globally, the frequency of EM has been estimated to be in the range of 1.2-6 cases per million individuals per year. […] Before the HIV epidemic among young males, EM showed a slight female predominance; however, it has since become more common in younger males (male-to-female ratio, 2-3:1), mainly seen in the second to fourth decades but sometimes also in children and adolescents (20%). EM is rare in children younger than 3 years and in adults older than 50 years. […] The following medical conditions seem to predispose individuals to a higher risk of developing EM: HIV infection, corticosteroid exposure, bone marrow transplant, systemic lupus erythematosus (SLE), graft-versus-host disease (GVHD), inflammatory bowel disease (IBD). Individuals undergoing radiation therapy, chemotherapy, or neurosurgery for brain tumors are also at higher risk.

• #19 Erythema Multiforme: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1122915-overview

  The exact incidence of EM in the United States is not defined; however, as many as 1% of dermatologic outpatient visits are for EM. Globally, the frequency of EM has been estimated to be in the range of 1.2-6 cases per million individuals per year. […] Before the HIV epidemic among young males, EM showed a slight female predominance; however, it has since become more common in younger males (male-to-female ratio, 2-3:1), mainly seen in the second to fourth decades but sometimes also in children and adolescents (20%). EM is rare in children younger than 3 years and in adults older than 50 years. […] The following medical conditions seem to predispose individuals to a higher risk of developing EM: HIV infection, corticosteroid exposure, bone marrow transplant, systemic lupus erythematosus (SLE), graft-versus-host disease (GVHD), inflammatory bowel disease (IBD). Individuals undergoing radiation therapy, chemotherapy, or neurosurgery for brain tumors are also at higher risk.

• #20 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Erythema multiforme affects less than 1% of the population. It is most common in young adults (aged 20-40 years) with a modest predominance in males. There is no association with race. […] There appears to be a genetic predisposition in people carrying the HLA-DQB1*0301 allele, which shares an even stronger association with herpes-related erythema multiforme. Multiple other alleles have been associated with its recurrent form. […] Most research on the mechanism of disease has focused on the herpes-associated presentation. The herpes virus is phagocytosed by mononuclear cells which express cutaneous lymphocyte antigen (a skin-homing receptor). Engulfed viral DNA is then transferred to the epidermis and into keratinocytes. Within the keratinocyte layer, expression of viral DNA fragments induces a cell-mediated immune response, including the production of interferon- which upregulates the inflammatory process.

• #21 Erythema Multiforme – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/erythema-multiforme/

  Young adults, from 20 to 40, are most commonly affected, although children over 3 years and teenagers, represent 20% of cases. The estimated incidence ranges from 1.1 person every 1.000.000 per year in Germany, to 3.7 in the USA and up to 5-10 in Sweden. Recurrences are seen in 37% of the cases, often characterized by a progressive worsening of the attacks. A genetic predisposition linked to HLA-DQB1*0301 allele has been reported. […] The mucosal involvement in EM major and TEN, is early and constant, affecting the oral cavity (95-100% of the cases), eyes (70-75%), genitalia (60-65%) and occasionally pharynx, larynx, oesophagus and respiratory tract. […] There are no means to reliably prevent EM episodes nor recurrences. Some authors suggest the prophylactic use of an antiviral agent such as aciclovir in patients with oral recurrent EM with a putative viral cause. However there are insufficient data to support this. It is important to remember that drug use can cause a wide range of EM manifestations. For this reason, at the first episode of EM it is imperative to look for any drug that could be responsible, in order to avoid future administration – since the severity of the manifestations often increases in further episodes and in case of severe SJS or TEN this could be lethal.

• #22 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Erythema multiforme affects less than 1% of the population. It is most common in young adults (aged 20-40 years) with a modest predominance in males. There is no association with race. […] There appears to be a genetic predisposition in people carrying the HLA-DQB1*0301 allele, which shares an even stronger association with herpes-related erythema multiforme. Multiple other alleles have been associated with its recurrent form. […] Most research on the mechanism of disease has focused on the herpes-associated presentation. The herpes virus is phagocytosed by mononuclear cells which express cutaneous lymphocyte antigen (a skin-homing receptor). Engulfed viral DNA is then transferred to the epidermis and into keratinocytes. Within the keratinocyte layer, expression of viral DNA fragments induces a cell-mediated immune response, including the production of interferon- which upregulates the inflammatory process.

• #23 Erythema Multiforme – almostadoctor

  https://almostadoctor.co.uk/encyclopedia/erythema-multiforme

  Most common in young adults age 20-40. […] Can occur at any age. […] 90% of cases are due to infection. […] HSV infection typically starts 3-14 days before erythema multiforme is seen. […] Mycoplasma pneumoniae a bacteria that causes atypical pneumonia has also been implicated. […] Can be recurrent especially when the cause is HSV1 infection.

• #24 Minor erythema multiforme case report – MedCrave online

  https://medcraveonline.com/MOJCR/minor-erythema-multiforme-case-report.html

  Erythema multiforme (EM) is an acute mucocutaneous disease that characterized by being self-limiting and immune-mediated; which is commonly associated with some medications and infections. […] About 50% of cases are idiopathic. Most notable causes are infectious agents and drugs. Infectious causes are more common in children and are implicated more commonly in EM. Herpes simplex infection is most common cause in young adults. […] The presentation of EM ranges from self limited, mild form (EM minor) to progressive and aggressive form like EM major, Steven Johnson syndrome and Toxic epidermolysis necrosis. […] Recurrence is seen approximately in 20-25% of case with two to four episodes a year. […] The diagnosis of EM is chiefly based on the history and clinical presentation, as histopathologic features and laboratory investigations are nonspecific. […] Corticosteroids are the most commonly used drugs in the management of EM, regardless of lack of evidence.

• #25

  https://austinpublishinggroup.com/dental-disorders/fulltext/jdod-v2-id1027.php

  Erythema multiforme is an acute vesiculobullous, mucocutaneous disease that most often occurs concomitantly with exposure to infections or medications most often. […] EM has often been linked to a subsequent exposure to the Herpes Simplex Virus (HSV-1) and is thought to be an immune mediated complication of the viral infection. […] The condition usually lasts 2-6 weeks and often reoccurs. […] Recurrence is the rule rather than the exception, with most affected individuals experiencing 1-2 recurrences per year. […] Mucosal involvement is present in as many as 70% of patients with erythema multiforme. […] The most common sites of mucous membrane involvement in order of frequency are the oropharynx (lips, palate, and gingiva often affected), conjunctivae, genitalia, anus, tracheobronchial tree, esophagus, and bowel.

• #26 Erythema Multiforme – almostadoctor

  https://almostadoctor.co.uk/encyclopedia/erythema-multiforme

  Most common in young adults age 20-40. […] Can occur at any age. […] 90% of cases are due to infection. […] HSV infection typically starts 3-14 days before erythema multiforme is seen. […] Mycoplasma pneumoniae a bacteria that causes atypical pneumonia has also been implicated. […] Can be recurrent especially when the cause is HSV1 infection.

• #27 Erythema Multiforme: 22 year-old male with a persistent red eye for two weeks

  https://webeye.ophth.uiowa.edu/eyeforum/cases/73-Erythema-Multiforme-Red-Eye.htm

  Erythema multiforme (EM) is most prevalent during the third and fourth decades of life and has a slight male predilection. (Ogundele et al. 2006) Factors involved in the etiology of EM include antecedent upper respiratory tract infection, Mycoplasma infection, herpes simplex virus infection, and medication, including antibiotics, anti-seizure, anti-gout, and anti-inflammatory drugs. Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infection. However, the precipitating cause is often not known. (Power, et al. 1995; Yi-Sheng Chang, et al. 2007) […] Adults age 20-40 years of age […] Slight male predilection […] No racial predilection […] Is often idiopathic, but can be associated with drug reactions or antecedent viral or mycoplasma infection […] Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infections.

• #28 Erythema Multiforme: 22 year-old male with a persistent red eye for two weeks

  https://webeye.ophth.uiowa.edu/eyeforum/cases/73-Erythema-Multiforme-Red-Eye.htm

  Erythema multiforme (EM) is most prevalent during the third and fourth decades of life and has a slight male predilection. (Ogundele et al. 2006) Factors involved in the etiology of EM include antecedent upper respiratory tract infection, Mycoplasma infection, herpes simplex virus infection, and medication, including antibiotics, anti-seizure, anti-gout, and anti-inflammatory drugs. Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infection. However, the precipitating cause is often not known. (Power, et al. 1995; Yi-Sheng Chang, et al. 2007) […] Adults age 20-40 years of age […] Slight male predilection […] No racial predilection […] Is often idiopathic, but can be associated with drug reactions or antecedent viral or mycoplasma infection […] Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infections.

• #29 Erythema multiforme after orf virus infection: a report of two cases and literature review | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/erythema-multiforme-after-orf-virus-infection-a-report-of-two-cases-and-literature-review/324F9FDF41A60A2218CE2AEE7F78B25D

  Orf virus has a worldwide distribution among sheep and goats. The hypersensitivity reaction erythema multiforme (EM) is a known complication of orf infection in humans; however, its occurrence is poorly understood and has not been extensively reviewed. […] Orf and its associated complications can occur in rural areas, as well as urban settings, where it is less well-known, through religious or cultural practices involving animal slaughter. […] Determining the pathophysiology and relative contribution of host and viral factors contributing to EM and other orf-associated hypersensitivity reactions could facilitate the identification of risk factors and inform treatment decisions. […] About 30% of sheep workers in the UK report having had an orf infection; among abattoir workers in New Zealand, mutton slaughtermen have an annual orf incidence of 4%.

• #30 Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination | Scientific Reports

  https://www.nature.com/articles/s41598-024-52099-z

  Several reports stated that erythema multiforme (EM) was associated with COVID-19 with detrimental outcomes in patients. […] Our study included 43,547 patients with a history of COVID-19 infection, of whom 92 developed EM. Patients with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19 (P0.0001). […] The prevalence of EM following COVID-19 infection or vaccination significantly differs from the general population, highlighting the importance of monitoring patients for EM after COVID-19 infection and/or vaccination. […] The prevalence of EM occurrence in the COVID-19 group was 0.2%, whereas the prevalence of EM in the general population was 0.03% (CI 5.4078.699) with P0.0001. […] People with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19.

• #31 Erythema multiforme, minus-type – Altmeyers Encyclopedia – Department Dermatology

  https://www.altmeyers.org/en/dermatology/erythema-multiforme-minus-type-119267

  Predominantly occurring in young adults (2nd-4th decade of life), also occurring in children, mostly after mycoplasma infections (see Mycoplasma pneumoniae below) m:w=1:1; no known ethnic prevalence. […] In a cross-sectional analysis (n= 43,547 patients with a history of SARS-CoV-2 infection), the risk of EM was 6.68 times higher than in patients without COVID-19 (Saleh W et al. 2024). […] The prevalence of EM after SARS-CoV-2 infection or vaccination differs significantly from that of the general population (Saleh W et al. 2024).

• #32 Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination | Scientific Reports

  https://www.nature.com/articles/s41598-024-52099-z

  Several reports stated that erythema multiforme (EM) was associated with COVID-19 with detrimental outcomes in patients. […] Our study included 43,547 patients with a history of COVID-19 infection, of whom 92 developed EM. Patients with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19 (P0.0001). […] The prevalence of EM following COVID-19 infection or vaccination significantly differs from the general population, highlighting the importance of monitoring patients for EM after COVID-19 infection and/or vaccination. […] The prevalence of EM occurrence in the COVID-19 group was 0.2%, whereas the prevalence of EM in the general population was 0.03% (CI 5.4078.699) with P0.0001. […] People with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19.

• #33 Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination | Scientific Reports

  https://www.nature.com/articles/s41598-024-52099-z

  People who received a COVID-19 vaccination were 2.7 times more likely to develop EM. The prevalence of EM after COVID-19 vaccination was 0.08% compared to 0.03% in the general population (CI 2.2343.317) with P0.0001. […] In the present study, the prevalence of EM was significantly increased in the COVID-19 group. COVID-19 patients were 6.68 times to have EM than people who didn’t experience COVID-19. […] Our study detected different types of EM, including 49 patients with EM minor, 115 with Steven Johnson syndrome, 56 with toxic epidermal necrolysis, and 42 with a history of Stevens Johnson syndrome/toxic epidermal necrolysis overlap syndrome. […] The occurrence of EM following COVID-19 vaccination may indicate an adverse drug reaction. However, the causal relationship between the vaccine and EM has not yet been established.

• #34 Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination | Scientific Reports

  https://www.nature.com/articles/s41598-024-52099-z

  We observed a prevalence of EM after vaccination of 0.08% in our study, which was significantly higher than the general population (P0.0001). […] Although there have been reports of EM after COVID-19 vaccination, the incidence appears to be very low, and the exact cause of this phenomenon is still being investigated. […] Further research is necessary to establish the association between COVID-19 and EM and develop more effective treatment protocols.

• #35 Photodistributed Erythema Multiforme | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-photodistributed-erythema-multiforme-articulo-S1578219013001728

  Erythema multiforme (EM) is an acute mucocutaneous syndrome that runs a self-limiting, usually mild, course. It is considered a hypersensitivity reaction to different antigenic stimuli, the most common of which is herpes simplex virus (HSV). EM is classified among the photoaggravated or photoaccentuated dermatoses. These are different from other photodermatoses in that they can also occur in the absence of exposure to UV radiation or visible light; indeed, only a few individuals experience eruptions triggered by light. In some cases, the lesions are confined to sun-exposed areas, with a clear division between these and unexposed areas. This explains why the use of the term photodistributed (or photosensitive) erythema multiforme (PEM) is justified. In our review of the literature, we identified 18 cases of PEM. The triggers identified were HSV reactivation, drug use, and polymorphous light eruption (PMLE). In this article, we review the epidemiologic, clinical, etiologic, diagnostic, and therapeutic aspects of PEM.

• #36 Photodistributed Erythema Multiforme | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-photodistributed-erythema-multiforme-articulo-S1578219013001728

  The prevalence of EM and PEM is unknown. EM is a relatively common condition, and while the existence of PEM has been recognized for many years, few cases have been described, possibly due to its low prevalence or to the fact that many cases go undiagnosed. […] PEM affects individuals of both sexes and all ages. In the cases reported in the literature, the mean age at diagnosis was 41.7 years, with a range of 9 to 75 years. In the case of HSV-associated PEM, the mean age was considerably lower, at 15 years (range, 9-25 years) while in that of drug-induced PEM, it was higher (53.9 years; range, 36-75 years). Overall, there was a slight male predominance (male to female ratio of 10:8). Approximately 39% of patients with PEM experience recurrences, particularly when there is associated HSV infection or no identifiable cause.

• #37 Photodistributed Erythema Multiforme | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-photodistributed-erythema-multiforme-articulo-S1578219013001728

  The prevalence of EM and PEM is unknown. EM is a relatively common condition, and while the existence of PEM has been recognized for many years, few cases have been described, possibly due to its low prevalence or to the fact that many cases go undiagnosed. […] PEM affects individuals of both sexes and all ages. In the cases reported in the literature, the mean age at diagnosis was 41.7 years, with a range of 9 to 75 years. In the case of HSV-associated PEM, the mean age was considerably lower, at 15 years (range, 9-25 years) while in that of drug-induced PEM, it was higher (53.9 years; range, 36-75 years). Overall, there was a slight male predominance (male to female ratio of 10:8). Approximately 39% of patients with PEM experience recurrences, particularly when there is associated HSV infection or no identifiable cause.

• #38 Photodistributed Erythema Multiforme | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-photodistributed-erythema-multiforme-articulo-S1578219013001728

  PEM has been described in association with drugs, HSV infection, and other conditions, such as PMLE. Of the cases described to date, 55.5% were induced by drugs, 22.2% by HSV reactivation, and 5.5% by PMLE. The remaining cases were classified as idiopathic. […] PEM is an uncommon, probably underdiagnosed, skin condition that can affect both sexes and patients of all ages. It has been associated with drugs, HSV reactivation, and PMLE. Diagnosis is based on clinical history, physical findings, histopathology, and photobiologic tests. The condition runs a self-limiting, benign course but can recur over several years if the cause is not eliminated. Treatment is symptomatic, with avoidance of triggers and the use of sun protection measures.

• #39 ERYTHEMA MULTIFORME | Hand Surgery Resource

  https://www.handsurgeryresource.net/erythema-multi

  Epidemiologic data on EM is scarce and its exact incidence is not known, but is estimated to be 1%. EM typically occurs in adults aged 20-40 years and is slightly more common in women than men at a ratio of 1.5:1.0. It has a reported recurrence rate of 37% and a genetic predisposition to certain Asian ethnic groups. […] A systematic review of various interventions for EM identified only one relevant randomized controlled trial on the use of acyclovir. The study found that in patients with clinically suspected HSV-related EM, oral acyclovir was superior to placebo in suppressing recurrence.

• #40 Erythema Multiforme – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/erythema-multiforme/

  Young adults, from 20 to 40, are most commonly affected, although children over 3 years and teenagers, represent 20% of cases. The estimated incidence ranges from 1.1 person every 1.000.000 per year in Germany, to 3.7 in the USA and up to 5-10 in Sweden. Recurrences are seen in 37% of the cases, often characterized by a progressive worsening of the attacks. A genetic predisposition linked to HLA-DQB1*0301 allele has been reported. […] The mucosal involvement in EM major and TEN, is early and constant, affecting the oral cavity (95-100% of the cases), eyes (70-75%), genitalia (60-65%) and occasionally pharynx, larynx, oesophagus and respiratory tract. […] There are no means to reliably prevent EM episodes nor recurrences. Some authors suggest the prophylactic use of an antiviral agent such as aciclovir in patients with oral recurrent EM with a putative viral cause. However there are insufficient data to support this. It is important to remember that drug use can cause a wide range of EM manifestations. For this reason, at the first episode of EM it is imperative to look for any drug that could be responsible, in order to avoid future administration – since the severity of the manifestations often increases in further episodes and in case of severe SJS or TEN this could be lethal.

• #41

  https://austinpublishinggroup.com/dental-disorders/fulltext/jdod-v2-id1027.php

  Erythema multiforme is an acute vesiculobullous, mucocutaneous disease that most often occurs concomitantly with exposure to infections or medications most often. […] EM has often been linked to a subsequent exposure to the Herpes Simplex Virus (HSV-1) and is thought to be an immune mediated complication of the viral infection. […] The condition usually lasts 2-6 weeks and often reoccurs. […] Recurrence is the rule rather than the exception, with most affected individuals experiencing 1-2 recurrences per year. […] Mucosal involvement is present in as many as 70% of patients with erythema multiforme. […] The most common sites of mucous membrane involvement in order of frequency are the oropharynx (lips, palate, and gingiva often affected), conjunctivae, genitalia, anus, tracheobronchial tree, esophagus, and bowel.

• #42 Minor erythema multiforme case report – MedCrave online

  https://medcraveonline.com/MOJCR/minor-erythema-multiforme-case-report.html

  Erythema multiforme (EM) is an acute mucocutaneous disease that characterized by being self-limiting and immune-mediated; which is commonly associated with some medications and infections. […] About 50% of cases are idiopathic. Most notable causes are infectious agents and drugs. Infectious causes are more common in children and are implicated more commonly in EM. Herpes simplex infection is most common cause in young adults. […] The presentation of EM ranges from self limited, mild form (EM minor) to progressive and aggressive form like EM major, Steven Johnson syndrome and Toxic epidermolysis necrosis. […] Recurrence is seen approximately in 20-25% of case with two to four episodes a year. […] The diagnosis of EM is chiefly based on the history and clinical presentation, as histopathologic features and laboratory investigations are nonspecific. […] Corticosteroids are the most commonly used drugs in the management of EM, regardless of lack of evidence.

• #43 Erythema Multiforme: 22 year-old male with a persistent red eye for two weeks

  https://webeye.ophth.uiowa.edu/eyeforum/cases/73-Erythema-Multiforme-Red-Eye.htm

  Erythema multiforme (EM) is most prevalent during the third and fourth decades of life and has a slight male predilection. (Ogundele et al. 2006) Factors involved in the etiology of EM include antecedent upper respiratory tract infection, Mycoplasma infection, herpes simplex virus infection, and medication, including antibiotics, anti-seizure, anti-gout, and anti-inflammatory drugs. Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infection. However, the precipitating cause is often not known. (Power, et al. 1995; Yi-Sheng Chang, et al. 2007) […] Adults age 20-40 years of age […] Slight male predilection […] No racial predilection […] Is often idiopathic, but can be associated with drug reactions or antecedent viral or mycoplasma infection […] Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infections.

• #44 Erythema Multiforme: 22 year-old male with a persistent red eye for two weeks

  https://webeye.ophth.uiowa.edu/eyeforum/cases/73-Erythema-Multiforme-Red-Eye.htm

  Erythema multiforme (EM) is most prevalent during the third and fourth decades of life and has a slight male predilection. (Ogundele et al. 2006) Factors involved in the etiology of EM include antecedent upper respiratory tract infection, Mycoplasma infection, herpes simplex virus infection, and medication, including antibiotics, anti-seizure, anti-gout, and anti-inflammatory drugs. Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infection. However, the precipitating cause is often not known. (Power, et al. 1995; Yi-Sheng Chang, et al. 2007) […] Adults age 20-40 years of age […] Slight male predilection […] No racial predilection […] Is often idiopathic, but can be associated with drug reactions or antecedent viral or mycoplasma infection […] Recurrent EM is more commonly associated with drug reactions and herpes simplex virus infections.

• #45 Photodistributed Erythema Multiforme | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-photodistributed-erythema-multiforme-articulo-S1578219013001728

  The prevalence of EM and PEM is unknown. EM is a relatively common condition, and while the existence of PEM has been recognized for many years, few cases have been described, possibly due to its low prevalence or to the fact that many cases go undiagnosed. […] PEM affects individuals of both sexes and all ages. In the cases reported in the literature, the mean age at diagnosis was 41.7 years, with a range of 9 to 75 years. In the case of HSV-associated PEM, the mean age was considerably lower, at 15 years (range, 9-25 years) while in that of drug-induced PEM, it was higher (53.9 years; range, 36-75 years). Overall, there was a slight male predominance (male to female ratio of 10:8). Approximately 39% of patients with PEM experience recurrences, particularly when there is associated HSV infection or no identifiable cause.

• #46 Erythema multiforme after orf virus infection: a report of two cases and literature review | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/erythema-multiforme-after-orf-virus-infection-a-report-of-two-cases-and-literature-review/324F9FDF41A60A2218CE2AEE7F78B25D

  Orf virus has a worldwide distribution among sheep and goats. The hypersensitivity reaction erythema multiforme (EM) is a known complication of orf infection in humans; however, its occurrence is poorly understood and has not been extensively reviewed. […] Orf and its associated complications can occur in rural areas, as well as urban settings, where it is less well-known, through religious or cultural practices involving animal slaughter. […] Determining the pathophysiology and relative contribution of host and viral factors contributing to EM and other orf-associated hypersensitivity reactions could facilitate the identification of risk factors and inform treatment decisions. […] About 30% of sheep workers in the UK report having had an orf infection; among abattoir workers in New Zealand, mutton slaughtermen have an annual orf incidence of 4%.

• #47 Erythema multiforme after orf virus infection: a report of two cases and literature review | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/erythema-multiforme-after-orf-virus-infection-a-report-of-two-cases-and-literature-review/324F9FDF41A60A2218CE2AEE7F78B25D

  Orf is under-recognized, owing to patient failure to seek care and physicians’ unfamiliarity with the disease in areas where it is uncommon. […] Complications of orf infection have been reported, including secondary bacterial infection, lymphadenopathy, lymphangitis, giant or recurring lesions, and erythema multiforme (EM). […] Within the poxvirus family, secondary immunological reactions (e.g. EM) are most frequently reported in association with orf. […] A search of the scientific literature using the terms orf or contagious pustular dermatitis and erythema multiforme or hypersensitivity found 10 case reports and about 30 instances of EM identified in epidemiological and immunological studies of human orf infections. […] Among patients receiving a diagnosis of orf, an estimated 7-18% experience EM.

• #48 Erythema multiforme after orf virus infection: a report of two cases and literature review | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/erythema-multiforme-after-orf-virus-infection-a-report-of-two-cases-and-literature-review/324F9FDF41A60A2218CE2AEE7F78B25D

  Orf-associated EM typically develops 2-4 weeks after onset of the primary orf lesion and is characterized by acute onset of symmetrically distributed papules, macules, bullae, and target lesions. […] The mechanism of orf virus induction of EM is not well understood. […] Further epidemiological and immunological studies could help to determine whether antibiotics play a role in the development of orf-associated EM. […] This report also illustrates the occurrence of orf and its complications in both rural and urban contexts. […] Physicians should be aware of orf and the array of hypersensitivity reactions it can cause.

• #49 Top Published Expert Doctors for Erythema Multiforme

  https://findexpertmd.com/d/Erythema_Multiforme

  321 top medical experts on Erythema Multiforme across 48 countries and 33 U.S. states, including 172 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials ClinicalTrials.gov : at least 7 including 1 Active, 5 Completed, 1 Recruiting.

• #50 Top Published Expert Doctors for Erythema Multiforme

  https://findexpertmd.com/d/Erythema_Multiforme

  321 top medical experts on Erythema Multiforme across 48 countries and 33 U.S. states, including 172 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials ClinicalTrials.gov : at least 7 including 1 Active, 5 Completed, 1 Recruiting.

• #51 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  All patients with recurrent erythema multiforme should be tested for herpes simplex virus, including sampling of skin or mucosal lesions. In recurrent or persistent erythema multiforme without a clear precipitant, consider work up for solid organ or haematological malignancies. […] Erythema multiforme is self-limiting with little to no ongoing complication in most patients. Recurrent or persistent disease comes with additional treatment challenges, but remission can be achieved.

• #52 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  All patients with recurrent erythema multiforme should be tested for herpes simplex virus, including sampling of skin or mucosal lesions. In recurrent or persistent erythema multiforme without a clear precipitant, consider work up for solid organ or haematological malignancies. […] Erythema multiforme is self-limiting with little to no ongoing complication in most patients. Recurrent or persistent disease comes with additional treatment challenges, but remission can be achieved.

• #53 ERYTHEMA MULTIFORME | Hand Surgery Resource

  https://www.handsurgeryresource.net/erythema-multi

  Epidemiologic data on EM is scarce and its exact incidence is not known, but is estimated to be 1%. EM typically occurs in adults aged 20-40 years and is slightly more common in women than men at a ratio of 1.5:1.0. It has a reported recurrence rate of 37% and a genetic predisposition to certain Asian ethnic groups. […] A systematic review of various interventions for EM identified only one relevant randomized controlled trial on the use of acyclovir. The study found that in patients with clinically suspected HSV-related EM, oral acyclovir was superior to placebo in suppressing recurrence.

• #54 Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination | Scientific Reports

  https://www.nature.com/articles/s41598-024-52099-z

  Several reports stated that erythema multiforme (EM) was associated with COVID-19 with detrimental outcomes in patients. […] Our study included 43,547 patients with a history of COVID-19 infection, of whom 92 developed EM. Patients with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19 (P0.0001). […] The prevalence of EM following COVID-19 infection or vaccination significantly differs from the general population, highlighting the importance of monitoring patients for EM after COVID-19 infection and/or vaccination. […] The prevalence of EM occurrence in the COVID-19 group was 0.2%, whereas the prevalence of EM in the general population was 0.03% (CI 5.4078.699) with P0.0001. […] People with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19.

• #55 Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination | Scientific Reports

  https://www.nature.com/articles/s41598-024-52099-z

  We observed a prevalence of EM after vaccination of 0.08% in our study, which was significantly higher than the general population (P0.0001). […] Although there have been reports of EM after COVID-19 vaccination, the incidence appears to be very low, and the exact cause of this phenomenon is still being investigated. […] Further research is necessary to establish the association between COVID-19 and EM and develop more effective treatment protocols.

• #56 Erythema multiforme after orf virus infection: a report of two cases and literature review | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/erythema-multiforme-after-orf-virus-infection-a-report-of-two-cases-and-literature-review/324F9FDF41A60A2218CE2AEE7F78B25D

  Orf-associated EM typically develops 2-4 weeks after onset of the primary orf lesion and is characterized by acute onset of symmetrically distributed papules, macules, bullae, and target lesions. […] The mechanism of orf virus induction of EM is not well understood. […] Further epidemiological and immunological studies could help to determine whether antibiotics play a role in the development of orf-associated EM. […] This report also illustrates the occurrence of orf and its complications in both rural and urban contexts. […] Physicians should be aware of orf and the array of hypersensitivity reactions it can cause.

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