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BACKGROUND: Polymorphous light eruption is the most common idiopathic photodermatosis. It presents as an itchy rash in areas exposed to the sun for hours, appearing hours or days after intense sun exposure. Lesions vary greatly among those affected. Forms similar to papular, papulovesicular, plaque, vesicoampolar, insect bites and erythema multiforme are described, rarely it is exclusively pruritic. The most common variant is the papular form, characterized by large or small, separate or confluent, erythematous and edematous papules that tend to group together. CLINICAL CASE: A 23-year-old female patient with asthma, cutaneous phototype IV/ VI according to Fitzpatrick, who presented localized dermatosis in sun-exposed areas, bilateral and symmetrical, characterized by erythematous-violaceous plaques with regular edges, well defined, with fine white scales on the surface, pruritic, that were exacerbated after sun exposure, of 6 months of evolution. CONCLUSIONS: Polymorphous light eruption is a photodermatosis, of varied presentation and severity, which appears after intense sun exposure. It predominantly affects females and people with skin phototype I-III. Treatment varies according to severity, the main objective is prevention. [ABSTRACT FROM AUTHOR]

BACKGROUND: The appearance of the SARS-CoV-2 virus has generated a high rate of morbidity and mortality throughout the world, causing the COVID-19 pandemic. Since now it persists, the availability of vaccines has increased and there are few approved by the World Health Organization because of their quality, safety, and efficacy. These were created in order to prevent serious illness and hospitalization, essential to control the pandemic. Although erythema multiforme has been associated with different types of immunizations, there are very few reported cases as an adverse reaction to mRNA vaccines against COVID-19. CLINICAL CASE: A 31-year-old female patient with erythema multiforme and myocarditis secondary to the application of the second dose of the Pfizer vaccine against COVID-19, who presented a clinical picture of dyspnea, precordial pain and subsequent attack on general condition, unquantified fever, and rash. The diagnosis of these diseases was made with symptoms presented, as well as electrocardiogram and laboratory studies. The patient was treated with metoprolol and prednisone, achieving remission of the clinical picture. CONCLUSIONS: This is the first reported case of erythema multiforme and myocarditis as an adverse reaction to the vaccine, without history of these diseases. It is important to communicate the different adverse reactions to provide suitable information to patients and thus avoid rejection of vaccination. [ABSTRACT FROM AUTHOR]

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Erythema multiforme (EM) is an immune-mediated condition characterized by symmetric erythematous rash with typical target lesions. Drugs, infections, immunologic conditions and food additives are among etiologic causes; but Herpes simplex virus infection is the most commonly seen reason. We report three cases of recurrent EM associated with herpes labialis infection. They all presented with typical target lesions appearing nearly one week after the herpes labialis lesion had begun. Each patient had similar EM episodes with different frequencies. All three patients were initially treated orally with valacyclovir, then prophylactic valacyclovir with a daily dose of 500 mg for six month period. Autoreactive T cells triggered by Herpes virus infection, are suggested to play an important role in Herpes-associated EM (HAEM) pathogenesis. The first line management of recurrent HAEM is antiviral treatments and they are generally safe and well tolerated in pediatric and general populations. Early administration of oral acyclovir or valacyclovir are recommended to reduce the severity and duration of the EM rash. Prophylactic antiviral treatment using for 6 months may be effective in controlling recurrent epizodes of HAEM. HSV infection and HAEM may recur; but prophylactic treatment may reduce the frequency and severity of epizodes. [ABSTRACT FROM AUTHOR]

Erythema multiforme (EM) also known as polymorph erythema is an acute skin disease of immunological nature with or without mucous membrane involvement, which may behave as chronic recurrent. It presents with distinctive targets like skin lesions, often together with ulcers or bullae in mucous membranes (oral, genital or ocular). Among its clinical forms are: a minor form characterized by a mild skin syndrome and its major form that manifests as a skin disease with marked mucosal damage. Among its main differential diagnoses are Stevens-Johnson Syndrome (SJS) and Lyell Syndrome (Toxic Epidermal Necrolysis (TEC)). It has an estimated incidence < 1%, with its major form being slightly more frequent than its minor form (0. 8-6 per million/year). It can occur at any age, presenting a peak incidence at the age between 20 and 30 years, with a slight predominance of males with a 3:2 ratio, without racial predilection. Its presentation in pediatric age is rare, even more so in early childhood. Minor recurrent EM is more common in this population. This paper reports a case of EM in the pediatric population as a rare form of exanthematic presentation, addressed at the Department of Pediatrics of the Complejo Asistencial Victor Rios Ruiz (CAVRR) in the city of Los Angeles, Chile this year. [ABSTRACT FROM AUTHOR]

El eritema multiforme es una enfermedad aguda de la piel y/o de las mucosas de naturaleza inmunológica, siendo está de etiología desconocida. Solo el 20% de los casos se dan en niños. El diagnóstico se basa en la historia clínica y el examen físico y el tratamiento no está sistematizado. La terapia con láser de baja potencia está siendo cada vez más utilizada en el campo estomatológico. El objetivo fue evidenciar los beneficios del láser de baja potencia como alternativa terapéutica. Este caso corresponde a un paciente de 10 años de edad, que acudió a la cátedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción (UNA), derivado del Hospital General de Barrio Obrero con antecedentes de internación por presentar lesiones erosivas en labios, boca y máculas en toráx, abdomen, orejas y miembros. En el examen intraoral costras serohemáticas negruzcas en labios, lesiones ulceradas en lengua, piso de boca, paladar duro y mucosa yugal. Se procedió a hacer una lavado de la zona con agua oxigenada, en las áreas afectadas se colocó azul de metileno al 0,01% por 5 minutos, y para la aplicación de laserterapia se realizó una única sesión. El paciente mostró gran evolución a las 24 horas de la aplicación del tratamiento. A los 8 días estaba sin lesiones y asintomático. La fotobioestimulación a nivel celular que ofrece el láser de baja potencia es una herramienta verosímil que se suma a nuevas opciones terapéuticas.

Pendahuluan: Eritema multiforme (EM) adalah penyakit peradangan akut yang merupakan reaksi hipersensitivitas pada mukokutan dan jarang ditemukan. Gambaran klinis EM berupa lesi erosi-ulseratif dan memiliki tendensi perdarahan. Kualitas eritrosit yang menurun dapat mempengaruhi proses penyembuhan penyakit ini, namun hal ini dapat diatasi dengan pemenuhan asupan mikronutrien. Tujuan laporan kasus ini untuk memaparkan hasil terapi suplementasi mikronutrien yang diberikan untuk tatalaksana EM pada pasien yang mengalami penurunan kualitas eritrosit. Laporan kasus: Seorang wanita berusia 21 tahun mengeluhkan perdarahan bibir dan sariawan dalam rongga mulut, terasa sakit sejak 3 minggu sebelumnya. Riwayat keluhan yang sama pernah dialami 7 tahun sebelumnya. Pemeriksaan ekstraoral memperlihatkan krusta hemoragik pada bibir, sedangkan hasil pemeriksaan intraoral menunjukkan ulserasi multipel pada hampir seluruh mukosa rongga mulut. Hasil pemeriksaan laboratorium menunjukkan adanya penurunan kualitas eritrosit berdasarkan parameter Mean Corpuscular Volume (MCV), Mean Cell Hemoglobin (MCH), dan Mean Cell Hemoglobin Concentration (MCHC); peningkatan jumlah eritrosit; dan eosinofil pada borderline atas, serta anti HSV-I IgG non-reaktif. Diagnosis pasien adalah eritema multiforme dengan riwayat stomatitis aftosa rekuren (SAR). Tatalaksana farmakologis diberikan asam folat dan vitamin B12 sebagai suplementasi mikronutrien. Diberikan pula chlorhexidine digluconate 0,12% mouthrinse sebagai antiseptik, dan petroleum jelly untuk pelembab bibir. Lesi oral pasien sembuh setelah 2 minggu terapi. Simpulan: Suplementasi mikronutrien berperan penting dalam mempercepat penyembuhan lesi mukosa oral pada pasien eritema multiforme yang mengalami penurunan kualitas eritrosit. Mikronutrien berupa asam folat dan vitamin B12 berperan penting dalam sintesis DNA eritrosit, pembelahan sel, dan perbaikan jaringan. Kata kunci: Mikronutrien, eritema multiforme, kualitas eritrosit. ABSTRACT Introduction: Erythema multiforme (EM) is an acute inflammatory disease as a hypersensitivity reaction to mucocutaneous and is rarely found. The clinical feature of EM is an erosive-ulcerative lesion with a tendency of bleeding. Decreasing erythrocyte quality can affect its healing process, although able to be overcome by fulfilling the micronutrient intake. The purpose of this case report was to describe the results of micronutrient supplementation therapy given in the management of EM patients with decreasing erythrocyte quality. Case report: A 21-year-old woman complained of lip bleeding and oral thrush, which felt pain three weeks prior. A similar complaint history had been experienced in the previous seven years. Extraoral examination revealed haemorrhagic crusting on the lips, whereas intraoral examination showed multiple ulcerations of almost the entire oral mucosa. Laboratory examination results showed a decreasing erythrocyte quality based on the parameters of Mean Corpuscular Volume (MCV), Mean Cell Haemoglobin (MCH), and Mean Cell Haemoglobin Concentration (MCHC); an increasing number of erythrocytes and eosinophils in the upper borderline, as well as non-reactive anti-HSV-I IgG. The patient was diagnosed with erythema multiforme with a history of recurrent aphthous stomatitis (RAS). Pharmacological management was performed by given folic acid and vitamin B12 as micronutrient supplementation. Also, given a 0.12% chlorhexidine digluconate mouth rinse as an antiseptic and petroleum jelly for lip balm. The patient’s oral lesions resolved after two weeks of therapy. Conclusion: Micronutrient supplementation plays an essential role in accelerating the oral mucosal lesions healing in erythema multiforme patients with decreasing erythrocyte quality. Micronutrients in folic acid and vitamin B12 play an important role in erythrocyte DNA synthesis, cell division, and tissue repair. Keywords: Micronutrient, erythema multiforme, erythrocyte quality.

El síndrome de Rowell se caracteriza por la asociación de lupus eritematoso y lesiones de tipo eritema multiforme, asociado con marcadores inmunológicos como los anticuerpos antinucleares con patrón moteado, anticuerpos anti-La y factor reumatoide positivo. El objetivo de la comunicación es reportar el caso de una mujer de 42 años, con diagnóstico hace años de lupus eritematoso sistémico, últimamente con lesiones tipo eritema multiforme. Presenta anticuerpo antinuclear con patrón moteado y factor reumatoide positivos, Se concluye tratarse de un caso de síndrome de Rowell.

RESUMO O eritema multiforme é uma doença incomum em cães, que afeta pele e mucosas, cuja etiologia ainda não foi completamente elucidada. Contudo, o envolvimento exclusivo da cavidade oral é considerado raro, tendo sido descrito poucas vezes até o presente momento. O objetivo deste trabalho é descrever um caso de eritema multiforme limitado à cavidade oral em um canino. Um cão, fêmea, Akita, com sete anos de idade, apresentou histórico de ulcerações na cavidade oral e nas laterais da língua, sem alterações cutâneas ou sistêmicas. O diagnóstico definitivo foi realizado por meio do exame histopatológico da mucosa oral, e a terapia imunossupressora empregada mostrou-se eficaz. Embora o eritema multiforme seja considerado incomum na espécie canina, este relato de caso apresenta a forma mais rara da doença, com poucos casos descritos em medicina veterinária.

Copyright of Archives of Dental Science / Arquivos em Odontologia is the property of Universidade Federal de Minas Gerais, Faculdade de Odontologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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A urticária multiforme é uma reação de hipersensibilidade aguda, sendo um subtipo morfológico de urticária. É mais comum em crianças e, uma vez que sua apresentação clínica se assemelha a outras dermatoses, como o eritema multiforme, a vasculite urticariana e a doença do soro-like, tem sido subdiagnosticada. Relatamos assim, um caso de uma criança de 1 ano e 9 meses com lesões cutâneas exuberantes associado a manifestações sistêmicas, com recuperação completa do quadro após tratamento com anti-histamínicos e corticosteróides endovenoso em unidade de medicina intensiva.

Figura A. Simblefaron, es decir adherencia de los bordes de los dos párpados (flecha blanca) y queratinización del limbo esclero-corneal (flecha amarilla) en el ojo derecho. Figura B. Ojo derecho: irregularidad del borde del párpado inferior con obstrucción completa y queratinización de los puntos de drenaje de las Glándulas de Meibomio, como consecuencia de la inflamación crónica secundaria al Síndrome de Stevens - Johnson. Figura C. Ojo derecho: conjuntivalización completa por falla del limbo y pérdida del epitelio corneal en el ojo derecho de la paciente, llevando a una córnea totalmente opaca como secuela del ojo seco severo crónico secundario al síndrome de Stevens - Johnson. Figura D. Ojo izquierdo: queratoprótesis de Boston Tipo I in situ. Se aprecia el cilindro central que permite el paso de la luz al interior del ojo. Los agujeros que translucen a través del tejido se encuentran en la placa de titanio que sostiene fijo el cilindro óptico al tejido corneal de un donante, que se suturó a la córnea periférica de la paciente. Ese tejido corneal donante se encuentra completamente conjuntivalizado y opaco, pero el extremo del cilindro óptico, al ser de material sintético, mantiene la transparencia. Se evidencia queratinización de la superficie con acúmulo de queratina en la interfase entre el material sintético del cilindro y el tejido corneal. Figure A. Symblepharon, i.e., adhesion from the edges of the two eyelids (white arrow) and keratinization of the sclerocorneal limbus (yellow arrow) in the right eye. Figure B. Right eye: irregularity from the edge of the lower eyelid with complete obstruction and keratinization of the excretory ducts of the Meibomian glands, due to chronicity of the inflammation in consequence to Stevens - Johnson syndrome. Figure C. Right eye: showing complete conjunctivalization due to limbus failure and loss of the corneal epithelium in the patient’s right eye, leading to corneal haze as a sequel to chronic severe dry eye secondary to Stevens - Johnson syndrome. Figure D. Left eye: Boston type I keratoprosthesis in situ. As showed, the central cylinder allows light to enter through the eye. The holes seen through the tissue are on the titanium plate that holds the optical cylinder in place on the corneal tissue of a donor, sutured to the patient’s peripheral cornea. This donor corneal tissue is completely conjunctivalized and hazy, but since the end of the optical cylinder is made of synthetic material, it remains transparent. Keratinization of the surface is evident, with an accumulation of keratin in the interface between the synthetic material of the cylinder and the corneal tissue. Figura A. Simbléfaro, ou seja, aderência das bordas das pálpebras (seta branca) e queratinização do limbo esclerocorneano (seta amarela) no olho direito. Figura B. Olho direito: irregularidade da borda da pálpebra inferior com obstrução completa e queratinização dos pontos de drenagem das glândulas meibomianas, como consequência da inflamação crônica secundária à síndrome de Stevens - Johnson. Figura C. Olho direito: conjuntivalização completa devido a falha do limbo e perda do epitélio corneano no olho direto da paciente, ocasionando uma córnea completamente opaca como sequela do olho seco crônico grave secundário à síndrome de Stevens-Johnson. Figura D. Olho esquerdo: ceratoprótese de Boston Tipo I in situ. O cilindro central que permite a passagem da luz para o olho é apreciado. Os orifícios translúcidos através do tecido estão na placa de titânio que segura o cilindro óptico ao tecido corneano de um doador, o qual foi suturado à córnea periférica da paciente. Esse tecido corneano doado está completamente conjuntivalizado e opaco, mas o extremo do cilindro óptico, por ser feito de material sintético, mantém a transparência. É evidente a queratinização da superfície com acúmulo de queratina na interface entre o material sintético do cilindro e o tecido corneano.

The present work consists of an integrative review about Stevens-Johnson Syndrome, a severe skin hypersensitivity reaction first described in 1922. Electronic bibliographic surveys were performed on the BVS®, LILACS® and SCIELO® databases. The historical cut of the publications was established from 2014 to 2019 and only articles published in Portuguese were selected. Most consisted of case studies. The variables analyzed in the selected articles were gender, most susceptible drugs, associated diseases and death. From the analysis, it was found that the publication of articles on the disease was increasing, but the publications in Portuguese were much smaller. It was also found that the main drug associated with the syndrome is allopurinol and that inadequate or late care to the individual is one of the main risk factors for death, along with advanced age, and that there is a great recurrence of associated eye diseases. Thus, the study demonstrated the importance of an early diagnosis, that allow the appropriate treatment to be started as soon as possible, avoiding the associated complications, and raising the general population's awareness of the disease to promote its mitigation. [ABSTRACT FROM AUTHOR]

Na atualidade, a facilidade de acesso a drogas aumentou incidência de reações farmacológicas que podem envolver diferentes órgãos e sistemas. Farmacodermia: hipersensibilidade medicamentosa, mediada pela imunidade individual, e difere da intolerância a drogas ou de reações idiossincrásicas. Reações tendem a ser na re-exposição a droga, pois imunidade especifica não costuma existir antes da primeira exposição. Principais fármacos causadores hipersensibilidade são antibióticos, seguidos por anti-inflamatórios, anticonvulsivantes, analgésicos/antipiréticos. Relatar caso de farmacodermia divulgando aos profissionais informações sobre diagnóstico e terapêutica. M. D. L. L., 63 anos, feminino, branca, divorciada, psicanalista, católica e natural do Rio de Janeiro. Paciente relata que há 2 (dois) meses iniciou quadro de eritema , calor, edema com, descamação epitelial em membros inferiores associados a dor de intensidade 9+/10+, dilacerante, que piorava à deambulação e melhora ao repouso. Foi levada ao pronto socorro de Miguel Pereira por uma amiga. Foi medicada com cefalexina 7 dias, 50mg 6/6 horas, e retornou ao seu domicílio permanecendo por 10 (dez) dias. No dia 03/08/2015, houve piora da dor, edema e hiperemia nos membros inferiores associada a dispneia, levando a paciente a procurar auxílio no Hospital Universitário Sul Fluminense (HUSF). Deu entrada no setor de urgência do HUSF com queixa de dispneia, apresentando quadro de lesões hiperemiadas e edematosas nos membros superiores e inferiores, com discreta lesão descamativa nos membros inferiores. Em relação aos antecedentes pessoais, paciente relata que, há aproximadamente 1 (um) ano, sofreu queda da própria altura, com trauma nos tornozelos. Foi avaliada por ortopedista não sendo constatadas fraturas. Após o trauma houve piora da dor e edema nos membros inferiores. Relata ser hipertensa e tabagista (47 maços/ano). Escarlatina e varicela na infância. Alega alergia à adoçantes e nega alergia a medicações. Tem histórico de Linfedema crônico. Ao exame físico, durante a internação (03/08/2015), mostrava-se cianótica, taquipnéica, com dificuldade de deambular. Havia dificuldade na palpação dos pulsos pedioso e tibial posterior. À inspeção, os membros superiores e inferiores estavam hiperemiados e os pés cianóticos. No momento da internação da paciente, foi considerado o diagnóstico de Celulite dos membros inferiores, sendo tratada com esquema de: ceftriaxona (2g IV uma vez ao dia) + oxacilina (2g IV de 4/4 horas) durante 7 dias e Clindamicina (600mg IV de 6/6 horas por 5 dias). Após ser internada no HUSF foram realizados os seguintes exames: 1- Doppler Venoso Profundo dos membros inferiores, o qual constatou ausência de ectasias, compressões extrínsecas ou trombos. Evidenciou-se infiltrado intersticial difuso bilateral em membros inferiores e espessamento do tecido subcutâneo com sinais flogísticos; 2 - Ultrassonografia abdominal, que revelou infiltrado difuso em toda a parede, porém com mais intensidade em região periumbilical. Fígado com volume aumentado, textura homogênea. Pâncreas parcialmente visualizado. As vias biliares com parede espessada, contraída com imagemsistêmicos acelerariam a recuperação de casos graves de hipersensibilidade medicamentosa. Corticóides tópicos e antihistamínicos orais melhorariam os sintomas dermatológicos. Um estudo sobre a prevalência das farmacodermias em pacientes hospitalizados no serviço de dermatologia da UMAE do Centro Médico Nacional do Ocidente constatou que os principais fatores de risco para uma reação adversa medicamentosa foram: gênero feminino, a idade, e em menor média, comorbidades associadas. A idade mais freqüente dos pacientes com farmacodermia foi na média dos 48 anos. Quanto a maior prevalência do sexo feminino, não há explicação clara, porém uma das hipóteses é que existe maior susceptibilidade da pele e do intestino da mulher aos estímulos nocivos de medicamentos, podendo haver uma influencia hormonal. Em um outro estudo sobre reações cutâneas desencadeadas por drogas, a principal doença associada aos indivíduos que desenvolveram farmacodermia foi a hipertensão arterial, no entanto a maioria dos pacientes não apresentava quaisquer comorbidades.

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This is a systematic review (SR) which examined the issue of Stevens-Johnson syndrome (SJS) in adults. Electronic literature surveys were implemented in BVS®, LILACS®, MEDLINE®, SCIELO® and PubMed® databases. Eleven were elected (11) articles published in the historical period from 2007 to 2015, in Portuguese, Spanish and English, with the majority consisting of case studies. Patients described in articles, the average age of 39,42 being the youngest had 22 years and the oldest 61 years old, 53,85% (n=07) were female, 53,85% (n=07) developed SJS and 46,15% (n=06) progressed to Toxic Epidermal Necrolysis (TEN), 15,40% (n=02) had epilepsy or AIDS, 23,10% (n=03) consumed antibiotics, 92,30% (n=12) did not come to death. The study demonstrated the complexity and the potential of SJS, with almost half of those have evolved to NET. Therefore, it is of fundamental importance a greater awareness of society to mitigate the SSJ. [ABSTRACT FROM AUTHOR]

Drug-induced skin disorders cause very different clinical symptoms in the skin that sometimes mimic well-defined dermatologic diseases and cause confusion with them. The immediate elimination of the drug is essential to the management of these patients. It is reported the case of a drug-induced skin disorder secondary to the use of carbamazepine in a 29.3-week-pregnant woman who attended the Internal Medicine Consultation due to a maculopapular rash that was generalized to encompass 90% of the skin surface. The patient progressed satisfactorily after discontinuing the anticonvulsant treatment; dermatological symptoms disappeared.

FUNDAMENTOS: A síndrome de Sweet corresponde a um conjunto de alterações cutâneas, sistêmicas e histopatológicas como resposta a diversos estímulos, semelhantes ao eritema nodoso, ao eritema multiforme e à vasculite leucocitoclásica. São descritas condições associadas como infecção, gravidez, uso de drogas e malignidades. OBJETIVOS: Avaliar as alterações clínicas e histopatológicas da síndrome, relacionando-a a outras condições. MÉTODO: Estudo retrospectivo de 73 casos com avaliação microscópica de lesões cutâneas, dados clínicos e laboratoriais. RESULTADOS: Houve predomínio de mulheres (83,0%), brancas (49,2%), entre a quarta e a sexta décadas de vida (73,8%). Placas eritematosas (76,9%), pápulas (43,0%), pseudovesiculação (PV) (38,4%) e lesões em alvo (18,5%) foram as principais alterações. Entre as condições associadas, infecções de vias aéreas (15,4%) e uso de drogas (10,8%) foram as mais frequentes. Outras associações, representadas por um caso cada, foram: linfoma de Hodgkin, gravidez, colite ulcerativa, policitemia vera e lúpus eritematoso em paciente com Aids. Neutrófilos com leucocitoclasia (98,6%), degeneração do colágeno (87,7%), edema (74,0%) e PV (38,4%) foram os principais achados microscópicos. Eosinófilos estiveram presentes (41,1%) de raros a abundantes e, em geral, não relacionados ao uso de drogas. O infiltrado inflamatório atingiu a derme profunda em 47,9% das vezes e encontrou-se paniculite em 80,0% dos casos nos quais a hipoderme estava representada (10 casos). CONCLUSÕES: Os achados, de modo geral, coincidem com os da literatura, destacando-se: frequente participação de eosinófilos sem correlação com a ingestão de medicamentos, paniculite e rara associação com linfoma de Hodgkin, sendo este o quinto relato de tal ocorrência, segundo o conhecimento dos autores.BACKGROUND: Sweet's syndrome refers to a set of cutaneous, systemic and histopathological alterations that occur in response to different stimuli, in a similar way to that occurring in erythema nodosum, erythema multiforme and leukocytoclastic vasculitis. The syndrome has been described in association with conditions such as infections, pregnancy, the use of certain medications and malignancy. OBJECTIVES: To evaluate the clinical and histopathological alterations occurring in this syndrome and to assess the association between these alterations and other conditions. METHODS: A retrospective study of 73 cases was conducted, evaluating data on the microscopic examination of skin lesions, as well as clinical and laboratory data. RESULTS: The majority of the patients were female (83.0%), white (49.2%) and between 30 and 60 years of age (73.8%). The principal alterations found were: erythymatous plaques (76.9%), papules (43.0%), pseudo-vesiculation (PV) (38.4%) and target lesions (18.5%). With respect to the associated conditions, upper respiratory tract infections (15.4%) and the use of medication (10.8%) were the most common. Other associations, albeit represented by only one case each, were: Hodgkin's lymphoma, pregnancy, ulcerative colitis, polycythemia vera and lupus erythematosus in a patient with acquired immune deficiency syndrome (AIDS). The principal microscopic findings were: neutrophils with leukocytoclasia (98.6%), collagen degeneration (87.7%), edema (74.0%) and PV (38.4%). The presence of eosinophils (41.1%) ranged from rare to abundant and was usually unrelated to the use of medication. Inflammatory infiltrate reached the deep epidermal layer in 47.9% of cases and panniculitis was found in 80.0% of cases in which the hypodermis was affected (10 cases). CONCLUSIONS: In general, these findings are in agreement with results published in the literature, emphasizing the frequent finding of eosinophils unrelated to drug use, panniculitis and the rare association with Hodgkin's lymphoma. This is the fifth report of an association between Sweet's syndrome and Hodgkin's disease.

El eritema multiforme, aparece como una enfermedad sistémica con la participación de la piel y las membranas mucosas en relación con varios factores como las infecciones bacterianas o virales, y en particular la administración de drogas, analgésicos y antibióticos en general. Se presenta un paciente masculino de 29 años de edad con eritema multiforme mayor desencadenado por antimicrobianos con la aparición de lesiones vesiculares-bulloso-ulcerosas en las regiones de los labios, encías, la lengua y la mucosa genital en tratamiento de una infección del tracto urinario con norfloxacino 400 mg por una semana. Fue realizado un tratamiento de soporte con el uso de colutorios para la higienización bucal y pomada a base de corticoide para protección de las úlceras, antihistamínicos y orientación nutricional de dieta líquida hipercalórica e hiperproteica. Este síndrome está caracterizado como un proceso eruptivo buloso agudo que compromete la calidad de vida del paciente y no hay pruebas de laboratorio específicas por lo que su diagnóstico debe estar basado en la revisión minuciosa de la anamnesis y en los hallazgos clínicos.The multiform erythema appears as a systemic disease where skin and the mucous membranes have participation in relation to some factors such as bacterial or viral infections and in particular the drugs administration, analgesics and antibiotics in general. The aim of present paper was the presentation of case of big multiform erythema triggering by antimicrobials. Authors present the case of a male patient aged 29 with appearance of ulcerous bullous-vesicular lesions in lips, gums, tongue and genital mucosa under treatment with 400 mg norfloxacin due to urinary tract infection for a week. We made support treatment using mouthwashes for oral hygiene and corticoids ointment for ulcer protection, antihistaminics and nutritional guiding of a hypercaloric and hyperprotein liquid diet. This syndrome is characterized as an acute bullous eruptive process involving the patient's quality of life and there are not specific laboratory tests thus its diagnosis must to be based on a highly detailed review of anamnesis and the clinical findings.

FUNDAMENTOS: A coccidioidomicose é micose sistêmica usualmente manifesta como infecção benigna de resolução espontânea; porém, uma pequena proporção dos infectados desenvolve quadros progressivos potencialmente fatais, podendo atingir a pele com lesões pleomórficas disseminadas. OBJETIVOS: Identificar e descrever as manifestações cutâneo-mucosas da coccidioidomicose, as ocupações de risco relacionadas à doença e o quadro clínico associado. MÉTODOS: Estudo realizado entre os anos 2003 e 2006 em 30 pacientes portadores de coccidioidomicose provenientes dos estados do Piauí e Maranhão e diagnosticados por exame microscópico direto, cultivo do escarro ou sorologia de triagem de imunodifusão dupla em gel de ágar, aliados à anamnese e exame físico. RESULTADOS: Identificaram-se lesões extrapulmonares em 13 casos (43,3%), com predomínio de manifestações dermatológicas de hipersensibilidade: eritema nodoso (26,6%), exantema com lesões eritemato-escamosas (26,6%) e eritema multiforme (23,3%), além de úlceras de língua (13,3%) e lábio (6,6%) e abscesso subcutâneo (3,3%). Tais manifestações foram observadas na fase aguda da doença. CONCLUSÕES: As manifestações cutâneas associadas à infecção respiratória aguda fortalecem a hipótese diagnóstica desta doença, especialmente, em caçadores de tatus ou pessoas expostas à escavação do solo.BACKGROUND: Coccidioidomycosis is a systemic mycosis that usually presents as a benign infection. Patients generally recover spontaneously; however, a small proportion of infected individuals develop progressive complications that may affect the skin in the form of disseminated pleomorphic lesions and may become fatal. OBJECTIVES: To identify and describe skin and mucous membrane manifestations of coccidioidomycosis, to identify occupational hazards associated with the disease and to determine its associated clinical presentation. METHODS: A study conducted between 2003 and 2006 involving 30 patients from the Brazilian states of Piauí and Maranhão with coccidioidomycosis diagnosed by direct microscopy, sputum culture or screening serology using agar gel double immunodiffusion, in association with anamnesis and physical examination. RESULTS: Extrapulmonary lesions were found in 13 cases (43.3%), consisting predominantly of dermatological manifestations of hypersensitivity: erythema nodosum (26.6%), exanthema with erythematosquamous lesions (26.6%) and erythema multiforme (23.3%), as well as ulcerations of the tongue (13.3%), lip ulcers (6.6%) and subcutaneous abscess (3.3%). These manifestations were seen during the acute phase of the disease. CONCLUSIONS: Skin manifestations associated with an acute respiratory infection reinforce the hypothesis of a diagnosis of coccidioidomycosis, particularly in individuals who hunt armadillos or in those exposed to soil excavation.

Among the severe reactions to medications, immune-mediated Mucocutaneous Disorders are widely represented. Steven-Johnson’s syndrome, or great multiform erythema, appears as a systemic disturbance, involving the skin and mucous membranes, and is related to several factors, such as, viral or bacterial infections and particularly the administration of medicines, in general painkillers and antibiotics. The objective of this article is report the onset of ulcerative vesicle –blister lesions in the regions of the lips, gums, tongue and genital mucosa membrane in a 26 year-old patient, a leukoderm man, being treated with sulfamethoxazole trimethoprim for a respiratory infection, after being diagnosed as having the Steven-Johnson syndrome. SSJ1 558187121279.

El síndrome de Stevens-Johnson (SSJ) es una variante severa del eritema multiforme, consistente en una reacción de hipersensibilización que afecta piel y mucosa, además de otros órganos internos, y que se manifiesta con lesiones en zonas genitales, bucales y cutáneas, es idiopático en el 50% de los casos, generalmente producido por alergia a medicamentos. La muerte sobreviene en el 5-15% de los casos sin tratar. El riesgo de recurrencia es del 37% o más. Al Hospital Pediátrico Provincial Docente “Mártires de Las Tunas” fue traído un niño de seis años de edad, que tras el uso del Sulfaprín comenzó con lesiones que afectaban la piel y todas las mucosas, además de toma del estado general. Inmediatamente fue admitido en la Unidad de Cuidados Intensivos Pediátricos, donde fueron tomadas medidas que incluyeron supresión del agente causal, corticoterapia endovenosa, antibioticoterapia endovenosa, tratamiento de las lesiones, vigilancia del balance hidromineral y atención oftalmológica, respondiendo favorablemente. Se presenta el caso, por ser una enfermedad poco frecuente y de muy mal pronóstico.

Erythema multiforme or polymorph EM) may occur as an adverse reaction to medication or due to infection by various agents. It is a self-limiting skin disease that lasts four to six weeks, sometimes recurring, characterized by target lesions mainly distributed in extremities and face, but can also compromise torso. It may compromise one or more mucous in a high percentage of cases. classically, eM has been subdivided into two types of clinical presentation: minor and a major, the latter with more extensive lesions and greater general compromise. We present the case of a preschooler boy with eM and a review of the most important clinical aspects with special emphasis on target lesions. [ABSTRACT FROM AUTHOR]

Erythema multiforme (EM) is a hypersensitivity reaction that affects the skin and/or mucous membranes, in response to infections, drugs, or other comorbidities. Presentation of EM can be Minor (Mild EM, characterized for presenting target lesions) or Major (Severe EM, that occurs also with mucous membranes involvement). The case of a 36 year old male patient presenting to emergency of HNAL with fever, malaise, itching and painful ulcer type lesions in oral cavity, multiple target lesions in upper and lower limbs, penis, and perianal region is reported. The diagnosis was EM Major. Ulcerous lesions in oral cavity and target lesions in hands were the most salient. [ABSTRACT FROM AUTHOR]

As reações cutâneas graves adversas a droga (RCGAD) são as que geralmente necessitam de internação hospitalar, por vezes em unidade de terapia intensiva ou de queimados, com observação minuciosa dos sinais vitais e da função de órgãos internos. O objetivo é descrever essas reações, facilitando seu reconhecimento e tratamento. Fazem parte desse grupo a anafilaxia, a síndrome de Stevens-Johnson (SSJ), a necrólise epidérmica tóxica (NET) e, dependendo do envolvimento sistêmico, as eritrodermias. Neste artigo, são abordados as características clínicas e o tratamento de algumas reações adversas a droga: anafilaxia, as eritrodermias, a síndrome de Stevens-Johnson (SSJ) e a necrólise epidérmica tóxica (NET).Severe Cutaneous Adverse Reactions to drugs (SCARD) generally require hospitalization, and at times in the intensive therapy or burn care unit for observation of the vital signs and the viscera function. The aim of this study is to describe these reactions in order to facilitate recognition and treatment. This group of drug reactions includes anaphylaxis, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and, depending on the systemic involvement, erythroderma. In this article we approach the characteristics and treatment of some adverse reactions to drugs: anaphylaxis, erythroderma, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

A síndrome de Rowell é descrita como associação entre lúpus (discóide ou sistêmico) e eritema multiforme. Por apresentar lesões bolhosas, implica em diagnóstico diferencial das lesões bolhosas do próprio lúpus e de outras patologias bolhosas que podem se superimpor. Os autores descrevem um caso de síndrome de Rowell e revêem alguns aspectos desta entidade clínica.

O eritema exsudativo multiforme é uma erupção aguda, autolimitada, frequentemente associada a infecções (geralmente virais), doenças sistêmicas e fármacos. Apresenta-se o caso de uma mulher de 39 anos, com o diagnóstico de lúpus eritematoso sistêmico, que recorreu à Urgência com quadro de eritema exsudativo multiforme, com início 10 dias após tomar amoxicilina e ácido clavulânico por amigdalite e, quase simultaneamente, receber a vacina antipneumocócica. Colocou-se também a hipótese de síndrome de Rowell. Efetuaram-se testes epicutâneos de contacto com bateria básica (portuguesa) e princípios ativos dos fármacos suspeitos (Chemotechnique®). Encontrou-se hipersensibilidade à amoxicilina 10% vas (++), à ampicilina 10% vas (++) e à penicilina G potássica 10% vas (+), atribuindo-se à amoxicilina a causa mais provável do eritema exsudativo multiformeExudative erythema multiforme is an acute self-limited skin disease often associated with infections (usually viral), and also with systemic diseases and drugs. We report the case of a 39-year-old woman diagnosed with systemic lupus erythematosus, who presented at the emergency clinic with exudative erythema multiforme which started 10 days after taking amoxicillin and clavulanic acid for tonsillitis together (almost simultaneously) with the pneumococcal vaccine. Rowell's syndrome was also considered to be a possibility. Skin patch tests were carried with the standard battery of patches (GPEDC) and the active ingredients of the suspected drugs (Chemotechnique ®), with readings at D2 and D3. The tests were positive for amoxicillin 10% pet (++), ampicillin 10% pet (+ +) and penicillin G potassium 10% pet (+). We accepted the diagnosis of erythema multiforme due to amoxicillin, confirmed by patch testing

O eritema multiforme é uma alteração cutânea de etiologia e fisiopatologia mal conhecidas, mas tem sido descrito em associação a múltiplas patologias infecciosas e inflamatórias. A Ricketsia conori é um agente bem conhecido e descrito na literatura, podendo apresentar um leque variado de manifestações clínicas. A associação entre este agente infeccioso e o eritema multiforme, apesar de referida em algumas revisões na literatura, é extremamente rara e mal conhecida. Neste artigo, descrevemos um caso clínico de infecção a Ricketsia Conori, com confirmação laboratorial numa criança de 9 anos que se apresentou com síndrome febril e eritema multiforme.

O eritema exsudativo multiforme representa uma síndroma mucocutânea, imuno-mediada, resultante de mecanismos de hipersensibilidade associados a causas infecciosas ou farmacológicas. Nas primeiras verifica-se um predomínio da infecção pelo vírus herpes simples. A associação com a infecção por Mycobaterium tuberculosis é menos frequente. Os autores descrevem o caso de um doente de 35 anos, internado por eritema exsudativo multiforme possivelmente associado a infecção pulmonar por Mycobacterium tuberculosis, com favorável evolução clínica após o início de terapêutica com isoniazida, rifampicina, pirazinamida e etambutol.

Mycoplasma pneumoniae, one of the most frequent agents of community-acquired pneumonia worldwide, can affect different organs besides the lung, causing skin lesions in 25% of patients. The spectrum of dermatological features include macules, papules, purpura, target lesions and even well stablished conditions as erythema multiforme, Stevens- Johnson's Syndrome and toxical epidermal necrolysis. We present 3 pediatric patients with erythema multiforme and toxical epidermal necrolysis in which Mycoplasma pneumoniae was considered as the etiological agent. [ABSTRACT FROM AUTHOR]

Urticaria multiforme is a rare clinical and morphological subtype of acute urticaria in childhood. Clinical features include acute onset of blanchable, annular, polycyclic, erythematous wheals with dusky or ecchymotic centers (target lesion-like). Pruritus in nearly all and edema on the face, hand and foot are seen in majority of cases. Urticaria multiforme, known as a cutaneous hypersensitivity reaction, can often be misdiagnosed as erythema multiforme and serum-sickness-like reaction. Although the majority of cases have been related with viral or bacterial infections and drug use, the exact etiopathogenesis of the disease is yet unclear. The association between Mycoplasma pneumoniae infection and urticaria multiforme has been reported in only two cases in the literature. In this article, a total of four cases diagnosed with urticaria multiforme two of whom had clinical and serological proof of Mycoplasma pneumoniae infection have been presented, and diagnostic criteria, differential diagnosis, etiopathogenesis and treatment of urticaria multiforme have been reviewed. (Turkderm 2015; 49: 157-63) [ABSTRACT FROM AUTHOR]

O ensino da dermatologia é pouco valorizado no currículo médico, e as doenças sexualmente transmissíveis, em geral, são apresentadas de forma não sistematizada. Em estudo sobre o ensino da dermatologia, de 83 médicos que participaram do projeto apenas 10 acertaram uma questão sobre sorologia de lues. Mais pesquisas sobre o ensino das doenças sexualmente transmissíveis são necessárias no Brasil, e os dermatologistas devem aproveitar a oportunidade, trazida pelas reformas curriculares, para reassumir a responsabilidade do ensino dessas doenças.Teaching of Dermatology is little valorized in medical courses, and sexually transmitted diseases are generally presented to the students in a non-systematized way. In a study about the teaching of Dermatology, only ten out of 83 medical doctors taking part in the project correctly answered a question about syphilis serology. More research regarding the teaching of the sexually transmitted diseases is needed in our country. Moreover, dermatologists should take the opportunity brought about by the current discussion on the re-elaboration of medical course curricula to retake the responsibility on teaching about these diseases.

The clinical course of leprosy is often interrupted by reactions, which are acute inflammatory episodes that can be classified as type I or type II. Type II reactions may occur as skin lesions resembling erythema multiforme (EM), which conventionally has been associated mainly with existing drug allergies or viral infections. However, differential diagnostic criteria of the different causal agents of multiform erythema remain controversial. We present an unusual case of a male patient whose first manifestation of leprosy has been a type II reaction, multiform erythema support. [ABSTRACT FROM AUTHOR]

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