An Unusual Complication of Erythema Multiforme and Its Treatment

Abstract

A 16‐year‐old boy came to our polyclinic complaining of an eruption on the face and limbs. His history showed that, initially, a blistering eruption developed on the side of his nose, which was followed about 10 days later by mildly painful red lesions that showed a pale center (targetoid lesions) on the face, lips, hands, arms, and feet. The patient stated that he had a similar attack about a year ago, when lesions that developed on his lips crusted after the attack and lip adhesions followed. Dermatological examination showed a large number of papules of 0.5–1 cm diameter with an erythematous periphery and a pale erythematous center on the face, ears, forearm, back of the hand, and palm. Some of the papules had purpuric “targetoid” lesions at the center. Lesions on the lips were papulovesicles and vesicles. In addition, there were adhesions on the commissures of both lips, which limited mouth opening to 25 mm. Clustered erosions with a dry surface were seen on the side of his right nostril (Figure 1). Histopathological investigation of the excisional biopsy taken from the forearm revealed necrotic keratinocytes in the epidermis, vacuolization in basal keratinocytes, and subepidermal blistering. The patient was clinically and histopathologically diagnosed as erythema multiforme. Symptomatic treatment was started and oral acyclovir prophylaxis was given to prevent recurrent nasolabial herpes simplex virus infections. The lesions completely resolved in 2 weeks. After 3 weeks, the patient returned for bilateral labial adhesion surgery. Local anesthesia was induced in upper and lower edges of the lips with lidocaine HCl. Adhesions were separated by a lancet, spare tissues were excised, and both sites were sutured by catgut (Figure 2). Total recovery was achieved, and no adhesion recurrence was observed at 1‐month follow‐up. A large number of papules with an erythematous periphery and a pale erythematous center; adhesion on the edges of both lips image After treatment image