Different clinical and histopathological variants of erythema multiforme

Abstract EN

Erythema multi formed (EM) is a frequently encountered problem in daily practice.

The data on EM from the Iraqi patients sparse.

This study was undertaken to evaluate the different clinical pathological aspects of this problem among Iraqi patients.

Jn the outpatient descriptive study, 126 patients were assessed in the outpatient clinic of the Department of Dermatology and Venereology ' Baghdad Teaching Hospital during the period from October of 1999 to July of 2001.

The diagnosis was mainy clinical and tk patients had full clinical examination and evaluation.

Skin biopsies were obtained from 22 patients.

The patients' ages ranged between 1-56 years with a mean age of 27.5 + 11.1 years.

There were 69 males (54.76 %) and56 females (45.24 %) in a ratio of 1.2 : 1.

The study showed that the disease had a universal distribution of age of incidence with a predilection for adolescent's andyoum adults (76.3 %).

The periods between the identifiable inciting factor and eruption oj EM rash were: herpes simplex virus (HSV) infection (3-14 days), or infection (14-24 days), drugs (3-13 days), upper respiratory tract (URT) infection (5-10 days), contactants (2-4 days).

The recognisable aetiological factors were : HSV infection (64.2 %), orf infection (8.7 %), URT infection (3.17 % pregnancy (3.9 %), -and drugs (7.14 %), contact reactions (3.17 %), idiopathic (6.34 %).

The distribution of the rash was on-extremities (89.68 %), face (54.7 %), upper trunk (20.63 %), external genitalia (1.58 %), elbow and knees (3.96 %).

Mucosal lesions were present in (46.03 %), almost exclusively limited to the oral cavity.

Morphological variants of EM were: target lesions (73.8 %), atypical target lesions and macuolopapules (77.78 %), vesiculobullous (2.38 %), annular (2.38 %), purpuric (0.79 %), Histopathological findings of 22 specimens with EM were: normal stratum corneum, exocytosis (81.82 %), spongiosis (54.5 %), satellite cell necrosis (50 %), upper dermalinflammatory infiltrate (45.45 %), basal layer liquefaction degeneration (22.72 %), and melanophages (18.18 %).

In conclusion, EM seems to be a common disease among Iraqi patients.

There is a predilection for adolescent's andyoung adults.

HSV infection represented the major aetiological factor in the recurrent and nonrecurrent forms of EM.

Orff infection showed the longest lag period.

Pregnancy-induced EM was of annular type and seen only in the 2 "1 and 3" 1 trimesters.