ORAL LESIONS OF DRUG INDUCED ERYTHEMA MULTIFORME - REPORT OF THREE CASES

Öz

Abstract: Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition considered to be a hypersensitivity reaction associated with certain infections and medications. A range of medications can trigger the EM. Non-steroidal anti-inflammatory drugs (NSAIDS) which are most commonly prescribed for pain relief can also produce rare adverse reactions such as EM. EM is clinically characterized by a ''minor'' form and a ''major'' form. Only few reports have stated about oral EM as the third variant of EM. However it is unclear whether EM involving only oral mucosa is a separate entity or is a part of minor form of EM. In this report three cases of EM are discussed , in which two cases involved exclusively oral mucosal lesions and in one case skin manifestations along with oral mucosa was observed. Also the uncommon adverse effects of NSAIDS is highlighted in this report along with its management.

Anahtar Kelimeler

• Erythema multiforme, drugs, oral mucosa

İlacın İndüklediği Eritema Multiformenin Oral Lezyonları- Üç Olgunun Sunusu

Öz

Eritema Multiforme (EM) belirli enfeksiyon ve ilaçlarla ilişkili bir hipersensitivite reaksiyonu olarak Kabul edilen, ani, kendini sınırlayan ve bazen tekrarlayan cilt bulgularıno olması durumudur. Geniş bir ilaç grubu EM'yi tetikleyebilir. Ağrı kesici olarak en sık reçete edilen ilaçlardan olan non steroid antiinflamatuvar ilaçlar EM gibi yan etkilere de yol açabilir. EM'nin klinik olarak major ve minor formları vardır. EM'nin üçüncü bir varyantı olarak oral EM bir kaç raporda sunulmuştur. Bubunla birlikte oral mukozayı tutan EM'nin ayrı bir antite mi yoksa minör EM formunun bir parçası mı olduğu hale açık değildir. Bu olgu sunusunda üç EM olgusu tartışılmıştır, ikisinde yalnız oral mukozal lezyonlar, diğerinde ise deri belirtileri ile oral mukoza lezyonları gözlenmiştir. Ayrıca bu sunuda NSAID'lerin nadir yan etilerive bu durumu yönetimi ile birlikte vurgulanmıştır.

Anahtar Kelimeler

• eritema multiforme, ilaç, oral mukoza

Kaynakça

1. 1. Shetty SR, Chatra L, Shenai P , Rao PK . Stevens-Johnson syndrome: a case report. J Oral Sci 2010; 52: 343-346.
2. 2. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral & maxillofacial pathology. 3rd ed. Phila
3. 3. Goncalves LM , Jose Ribamar Sabino Bezerra Junior , Maria Carmen Fontoura Nogueira da Cruz. Clinical evaluation of oral lesions associated with dermatologic diseases. An Bras Dermatol. 2009;84(6):585-92.
4. 4. Lamoreux MR, Sternbach MR, Hsu WT. Erythema Multiforme. Am Fam Physician 2006;74: 1883- 8.
5. 5. Al-Johani KA, Fedele S, Porter SR. Erythema multiforme and related disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:642-54.
6. 6. Scully C, Bagan J. Oral mucosal diseases: Erythema multiforme. British Journal of Oral and Maxillofacial Surgery 2008; 46 : 90–95.
7. 7. Huang YF, Yang HW, Yang JH. Erythema multiforme case report. J Dent Sci, 1(2)：94-97, 2006
8. 8. Joseph TI, Vargheese G, George D, Sathyan P. Drug induced oral erythema multiforme: A rare and less recognized variant of erythema multiforme. J Oral Maxillofac Pathol 2012;16:145-8.

9. 9. Osterne RL, de Matos Brito RG, Pacheco IA, Alves AP, Sousa FB. Management of erythema multiformeentat associated with recurrent herpes infection: A case report. J Can Dent Assoc. 2009;75:597– 601
10. 10. Michaels B, Del Rosso JQ. The Role of Systemic Corticosteroid Therapy in Erythema Multiforme Major and Stevens-Johnson Syndrome A Review of Past and Current Opinions.Journal of clinical and aesthetic dermatology 2009 ; 2 ( 3): 51-55.
11. 11. Mockenhaupt M, Kelly JP, Kaufman D, Stern RS. The Risk of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Associated with Nonsteroidal Antiinflammatory Drugs: A Multinational Perspective. J Rheumatol 2003; 30:2234-40.
12. 12. Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, Auquier A, Bastuji-Garin S, Correia O, Locati F, et al. Medication use and the risk of StevensJohnson syndrome or toxic epidermal necrolysis. N Engl J Med. 1995 ;333(24):1600-7.
13. 13. Bruton L, Lazo J, Parker K. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11th Ed. McGraw-Hill 2005.
14. 14. Kohli PS, Kaur J. Erythema Multiforme-Oral Variant: Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2011; 63:S9–S12.