1. Triggers, clinical manifestations, and management of pediatric erythema multiforme: A systematic review.
- Author
-
Zoghaib S, Kechichian E, Souaid K, Soutou B, Helou J, and Tomb R
- Subjects
- Adolescent, Age Factors, Anti-Bacterial Agents therapeutic use, Antiviral Agents therapeutic use, Child, Child, Preschool, Diagnosis, Differential, Drug Eruptions diagnosis, Drug Eruptions etiology, Drug Eruptions therapy, Erythema Multiforme diagnosis, Erythema Multiforme therapy, Glucocorticoids therapeutic use, Herpes Simplex complications, Herpes Simplex drug therapy, Humans, Infant, Mouth Mucosa microbiology, Mouth Mucosa pathology, Pneumonia, Mycoplasma complications, Pneumonia, Mycoplasma drug therapy, Rare Diseases diagnosis, Rare Diseases therapy, Recurrence, Severity of Illness Index, Erythema Multiforme etiology, Palliative Care methods, Rare Diseases etiology, Vaccination adverse effects
- Abstract
Background: Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants., Objective: To investigate the triggers, clinical manifestations, and treatment of pediatric EM., Methods: Systematic literature review of pediatric EM., Results: After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children., Limitations: Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias., Conclusion: Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF