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Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Classically described as target-like, the erythema multiforme lesions can be isolated, recurrent, or persistent. Most commonly, the lesions of erythema multiforme present symmetrically on the extremities (especially on extensor surfaces) and spread centripetally. Infections, especially herpes simplex virus and Mycoplasma pneumoniae, and medications constitute most of the causes of erythema multiforme; immunizations and autoimmune diseases have also been linked to erythema multiforme. Erythema multiforme can be differentiated from urticaria by the duration of individual lesions. Erythema multiforme lesions are typically fixed for a minimum of seven days, whereas individual urticarial lesions often resolve within one day. Erythema multiforme can be confused with the more serious condition, Stevens-Johnson syndrome; however, Stevens-Johnson syndrome usually contains widespread erythematous or purpuric macules with blisters. The management of erythema multiforme involves symptomatic treatment with topical steroids or antihistamines and treating the underlying etiology, if known. Recurrent erythema multiforme associated with the herpes simplex virus should be treated with prophylactic antiviral therapy. Severe mucosal erythema multiforme can require hospitalization for intravenous fluids and repletion of electrolytes.

A 26-year-old patient in France who worked as a butcher sought care initially for erythema multiforme. Clinical examination revealed a nodule with a crusty center, which upon investigation appeared to be an orf nodule. Diagnosis was confirmed by PCR. The patient was not isolated and had a favorable outcome after basic wound care.

Blood test results for leucocyte, lymphocyte, and neutrophil counts, C reactive protein level, erythrocyte sedimentation rate, and hepatic function were within normal ranges. Samples were negative for varicella zoster virus and herpes simplex virus on polymerase chain reaction but positive for immunoglobulin M to Mycoplasma pneumoniae. Answer Erythema multiforme induced by M pneumoniae Herpes simplex virus, M pneumoniae, and antibiotics such as penicillins and cephalosporins are the most common causes of erythema multiforme in children.1Box 1 Main causes of erythema multiforme in children12 Penicillins and cephalosporins—14% Herpes simplex virus—18% (42% in adults) Mycoplasma pneumoniae—16% Other causes include Epstein Barr virus, cytomegalovirus, vaccines, and autoimmune disease. The two major infectious causes of erythema multiforme in children are M pneumoniae and herpes simplex virus.

•VAERS received 1086 reports of EM/SJS/TEN during 1999–2017, mostly EM (984, 91%).•Most reports of SJS or TEN (52–100%), but few reports of EM (9%), were serious.•Overall, 55% of reports described males, and 48% described children aged <4 years.•Overall, childhood vaccines were most commonly reported. Since the last review of vaccine safety surveillance data for erythema multiforme (EM), Stevens Johnson syndrome (SJS), SJS/TEN, and toxic epidermal necrolysis (TEN) (EM/SJS/TEN), over 37 new vaccines have been introduced in the United States. We sought to describe reported EM/SJS/TEN after vaccines during 1999–2017. We identified U.S. reports of EM/SJS/TEN received by the Vaccine Adverse Event Reporting System (VAERS) during 1999–2017. We stratified analysis by condition (EM, SJS, or TEN), and analyzed reports by serious or non-serious status, sex, age group, time from vaccination to symptom onset, exposure to known causes of EM/SJS/TEN, and vaccines administered. We used Empirical Bayesian data mining to detect vaccine-AE pairs reported more frequently than expected. Of 466,027 reports to VAERS during 1999–2017, we identified 984 reports of EM, 89 reports of SJS, 6 reports of SJS/TEN, and 7 reports of TEN. Few reports of EM (9%), and most reports of SJS (52%), SJS/TEN (100%), and TEN (100%) were serious. Overall, 55% of reports described males, 48% described children aged < 4 years; 58% of EM/SJS/TEN occurred ≤ 7 days after vaccination. Few reports (≤5%) described exposure to known causes of EM/SJS/TEN. Overall, childhood vaccines (e.g., combined measles, mumps, and rubella vaccine) were most commonly reported. We identified 6 deaths; 4 were exposed to medications associated with EM/SJS/TEN. EM after smallpox vaccine was reported disproportionately among people aged 19–49 years. EM/SJS/TEN were rarely reported after vaccination; data mining identified a known association between EM and smallpox vaccine.

Abstract Objective: Vaccine-associated erythema multiforme (EM) remains under-researched, impacting global vaccine safety evaluations. This study examines the global and regional burden of EM and its association with specific vaccines to optimize vaccination strategies. Subject and Methods: We analyzed data from the WHO pharmacovigilance database on vaccine-associated EM from 1967 to 2023 (n = 131,255,418 reports). Reporting frequencies, reported odds ratios (RORs), and information components (IC) were calculated for 16 vaccines across 170 countries. Results: We identified 6,355 cases (males, n = 3,182 [50.07%]) of vaccine-associated EM from a total of 46,378 reports of all-cause EM. While vaccine-associated EM has been consistently reported, there has been a notable increase in reported incidence particularly in 2010 and 2020. Measles, mumps, and rubella vaccines had the highest association with vaccine-associated EM reports (ROR: 8.75 [95% confidence interval, 8.11–9.44]; IC, 3.10 [IC0.25, 2.97]), followed by hepatitis B (8.54 [7.66–9.51]; 3.06 [2.88]), hepatitis A (8.11 [7.01–9.39]; 2.98 [2.74]), typhoid (6.50 [4.75–8.90]; 2.60 [2.07]), encephalitis (5.86 [4.35–7.91]; 2.47 [1.96]), diphtheria, tetanus toxoids, pertussis, polio, and Hemophilus influenza type b (5.70 [5.42–5.99]; 2.46 [2.38]), pneumococcal (5.56 [5.11–6.06]; 2.45 [2.31]), rotavirus (4.96 [4.21–5.84]; 2.29 [2.01]), varicella-zoster (4.44 [3.99–4.95]; 2.13 [1.95]). Vaccine-associated EM reports were more strongly correlated with younger age groups and males. The overall fatality rate of vaccine-associated EM was 0.04%. Conclusions: The rise in vaccine-associated EM across multiple vaccines, especially in younger populations, highlights the need for closer monitoring and more informed vaccination practices to mitigate adverse reactions. Objective: Vaccine-associated erythema multiforme (EM) remains under-researched, impacting global vaccine safety evaluations. This study examines the global and regional burden of EM and its association with specific vaccines to optimize vaccination strategies. Subject and Methods: We analyzed data from the WHO pharmacovigilance database on vaccine-associated EM from 1967 to 2023 (n = 131,255,418 reports). Reporting frequencies, reported odds ratios (RORs), and information components (IC) were calculated for 16 vaccines across 170 countries. Results: We identified 6,355 cases (males, n = 3,182 [50.07%]) of vaccine-associated EM from a total of 46,378 reports of all-cause EM. While vaccine-associated EM has been consistently reported, there has been a notable increase in reported incidence particularly in 2010 and 2020. Measles, mumps, and rubella vaccines had the highest association with vaccine-associated EM reports (ROR: 8.75 [95% confidence interval, 8.11–9.44]; IC, 3.10 [IC0.25, 2.97]), followed by hepatitis B (8.54 [7.66–9.51]; 3.06 [2.88]), hepatitis A (8.11 [7.01–9.39]; 2.98 [2.74]), typhoid (6.50 [4.75–8.90]; 2.60 [2.07]), encephalitis (5.86 [4.35–7.91]; 2.47 [1.96]), diphtheria, tetanus toxoids, pertussis, polio, and Hemophilus influenza type b (5.70 [5.42–5.99]; 2.46 [2.38]), pneumococcal (5.56 [5.11–6.06]; 2.45 [2.31]), rotavirus (4.96 [4.21–5.84]; 2.29 [2.01]), varicella-zoster (4.44 [3.99–4.95]; 2.13 [1.95]). Vaccine-associated EM reports were more strongly correlated with younger age groups and males. The overall fatality rate of vaccine-associated EM was 0.04%. Conclusions: The rise in vaccine-associated EM across multiple vaccines, especially in younger populations, highlights the need for closer monitoring and more informed vaccination practices to mitigate adverse reactions.

Radiodermatitis (radiation dermatitis, radiation-induced skin reactions, or radiation injury) is a significant side effect of ionizing radiation delivered to the skin during cancer treatment as well as a result of nuclear attacks and disasters, such as that which occurred in Fukushima in 2011. More specifically, 95 % of cancer patients receiving radiation therapy will develop some form of radiodermatitis, including erythema, dry desquamation, and moist desquamation. These radiation skin reactions result in a myriad of complications, including delays in treatment, diminished aesthetic appeal, and reduced quality of life. Recent technological advancements and novel treatment regimens have only been successful in partly ameliorating these adverse side effects. This article examines the current knowledge surrounding the pathogenesis, clinical manifestations, differential diagnoses, prevention, and management of radiodermatitis. Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures.

A 32-year-old man presented with itchy lesions on his palms that appeared several days after oral infection with herpes simplex virus. A diagnosis of herpes-associated erythema multiforme was made.

Background The 2019 Coronavirus disease (Covid-19) has affected thousands of people worldwide. To date, vaccines appear to be the only method to prevent and reduce mortality. Four vaccinations have been outwardly approved by European Medicine Agency (EMA) in Europe: BNT162b2 (Comirnaty-BioNTech/Pfizer), mRNA-1273 (Spikevax-Moderna), ChAdOx1 (VaxzevriaAstrazeneca), and Ad26.COV2-S (Janssen-Johnson&Johnson). After vaccination, local and systemic adverse effects can occur. Cutaneous reactions like urticaria, local injection site pain, morbilliform rash have been documented after vaccination. Cases presentation We report four cases of oral erythema multiforme flare arising after BNT162b2 vaccination administration. All the patients denied previous erythema-like and herpetic manifestations history. Two of the reported cases (number 1 and 2) presented with both oral and cutaneous lesions, while cases 3 and 4 showed only oral manifestations. Three of the cases presented the erythema after the first vaccination dosage administration, only one case reported lesions after the second vaccination dosage administration. All the cases were treated with prednisone via oral administration and topical 0.05% clobetasol ointment. Conclusions The present reports represent some of the few cases of erythema multiforme occurring as a side effect of the BNT162b2 COVID-19 vaccination. The causal role of the vaccine for the erythema multiforme has not been proven yet; nevertheless, it is not uncommon for medications to trigger this disease. The vaccine could surface a silent herpes virus infection, which would induce the erythema multiforme instead.

A 38-year-old man with Fitzpatrick type V skin was presented to the emergency department with a 2-week history of fever, productive cough, rhinorrhea and 5 days of oral pain. He was otherwise healthy and took no medications. He had been vaccinated against SARS-CoV-2, but SARS-CoV-2 infection was suspected and confirmed with a nasopharyngeal swab. Examination revealed erosive plaques to the oral mucosa and glans penis, as well as hemorrhagic crusting of the lips. Lesions on the upper and lower extremities had targetoid plaques with 3 concentric zones -- a central necrotic region, a palpable edematous halo and a well-circumscribed erythematous ring -- typical lesions of erythema multiforme major. However, atypical erythematous--violaceous lesions featuring 2 concentric zones with central bullae and indistinct outer borders made the clinical diagnosis unclear.