Clinical features, etiologic findings, and therapeutic response in a series of 44 patients with recurrent erythema multiforme

Abstract

Background: Erythema multiforme (EM) is a mucocutaneous disorder usually self-limited but potentially recurrent. Recurrent erythema multiforme (REM) etiology is not always evident and represents a therapeutic challenge. Aim: To report clinical, etiologic, and therapeutic aspects in 44 REM patients from São Paulo, Brazil. Methods: Datawereretrospectively collected from 44 REM cases from 2000 to 2011. Results: Out of 44 patients, 29 (66%) were female, mean age at disease onset was 35.2 and average of 4.6 outbreaks per year. Forty-three patients (98%) had cutaneous lesions. Mucous membranes involvement was present in 37 patients (84%), 37 patients with oral, 19 with genital and 4 with ocular involvement. Nineteen patients out of 44 (43%) referred herpetic lesions preceding EM outbreaks, 16 were submitted to Tzanck smear and six presented a positive result for herpes simplex cytophatic effect findings. Thirty-seven patients (84%) received prednisone, 39 (88%) prophylactic acyclovir, 8 (18%) valacyclovir, and 10 (23%) dapsone. Twenty-seven of 39 patients receiving continuous acyclovir treatment had partial or complete treatment response. Recalcitrant cases were submitted to alternative treatments: 3 out of 8 patients had partial response to valacyclovir and 5 out of 9 patients had either partial or complete response to dapsone. Three patients used either thalidomide or azathioprine without enough follow-up. Conclusion: REM maintains etiologic uncertainties that lead, at times, to suboptimal therapeutic responses. The relationship between HSV and REM cannot always be proved by laboratory examination, but prophylactic therapy with acyclovir should be considered.