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Erythema multiforme (EM) is a skin disease that is characterized by redness, inflammation, and the presence of papules or vesicles underlying the skin. Generally it occurs on the hands and forearms. EM can be caused by allergies, drug sensitivity, or it may be seasonal. Also, infection with herpes simplex virus (HSV) has been associated with recurrent EM. HSV antigens have been found in the serum and in the skin of patients with EM. To investigate further the relationship between EM and HSV infection, the polymerase chain reaction was used to screen skin biopsy samples for the presence of HSV. The polymerase chain reaction is a highly sensitive technique that amplifies the amount of DNA present in a tissue sample. This allows the identification of DNA present in very small amounts in the original sample. Using this technique, the skin lesions of patients with EM were examined for the presence of HSV. Eleven out of 31 skin lesion biopsy samples tested positive for the presence of HSV DNA. In six other biopsy samples, very low levels of HSV DNA were detected, considered to be an inconclusive result. As a positive control, seven skin samples showing signs of HSV infection were tested for the presence of HSV DNA using the polymerase chain reaction; all seven skin samples were positive for HSV DNA. As a negative control, skin samples from patients without HSV infection were tested for HSV DNA. The polymerase chain reaction did not detect HSV DNA in any of the normal skin samples. These studies indicate a role for HSV in the pathogenesis of some forms of EM. Also, these results indicate that the polymerase chain reaction is a suitable method for the detection of HSV DNA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Erythema multiforme is a rash consisting of dark red papules, which are solid, round skin lesions, or tubercles, which are node-like lesions. The rash usually develops on the extremities, and can appear in various patterns, including ring shapes, patches, and figures. Erythema multiforme may be associated with allergic contact dermatitis, the inflammation of the skin due to contact with an allergen. A case is described of a 46-year-old woman who developed erythema multiforme as a result of contact with an epoxy sealant. The woman developed an itching rash consisting of papules on her upper arm after she repaired and repainted a swimming pool. Her skin had been in contact with a swimming pool sealant, which consisted of 55 percent epoxy resin and an epoxy hardener. The patient did not have a history of allergy. The rash consisted of reddened skin, papules, fluid-filled skin lesions, and blisters. She was diagnosed with allergic contact dermatitis from epoxy exposure, and was treated with Burow's solution compresses and betamethasone valerate 0.05 percent cream. The rash healed, but another outbreak resembling erythema multiforme developed on the forearms and hands nine days after the development of dermatitis. The erythema multiforme resolved without treatment and did not recur. In this case, erythema multiforme may be a delayed type of hypersensitivity reaction. Allergic responses to epoxy-containing substances can be prevented or reduced by use of protective clothing, careful washing after use of epoxy materials, and the use of a different type of epoxy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Treatment with lithium for mood disorders such as manic depression has been reported to cause skin-related side effects, such as acne and psoriasis. A case is described of a 52-year-old woman who was treated with lithium and developed erythema multiforme. (Erythema multiforme lesions usually occur in the extremities with red, solid, circular areas of swelling and develop in a series of rashes of short duration.) The patient was being treated with lithium when the skin reaction occurred. Treatment was discontinued for a brief period, but was then resumed, resulting in itching and fever. Immune factors were considered as the possible underlying mechanism. A dose-related toxic effect of lithium on the skin was unlikely, since lithium was used in the recommended amount. The patient had been treated with lithium for a long period and did not appear to show abnormal metabolism of the drug. In addition, the lithium preparation did not contain coloring agents or other substances that might have activated the immune system. This suggests that lithium could have caused the skin reaction. (Consumer Summary produced by Reliance Medical Information, Inc.)