Vol. 2 No. 1 (2019): Current Issue
Case Report

Differentiating Oral Erythema Multiforme from Steven Johnson Syndrome-Oral Dermatology Case Report

Pincelli T
Department of Dermatology, Mayo Clinic, Jacksonville, Florida, United States
Tolaymat LM
Department of Dermatology, Mayo Clinic, Jacksonville, Florida, United States
Bruce AJ
Department of Dermatology, Mayo Clinic, Jacksonville, Florida, United States
Published October 17, 2019
Keywords
  • Erythema Multiforme,
  • Steven Johnson Syndrome,
  • HSV

Abstract

Erythema Multiforme (EM) is an acute inflammatory immune-mediated disorder involving the skin and/or mucous membranes with typically an infectious trigger - particularly viral hypersensitivity. An evolving erythematous papular eruption with occasional systemic involvement is characteristic. Symmetrically distributed, targetoid and progressive lesions on the extremities are the hallmark. Depending on the presence or absence of mucosal involvement, EM may be sub-classified into EM minor (EMm) and EM major (EMM). EMm refers to cutaneous disease without affected mucosa, while EMM has both mucosal and cutaneous involvement. A third variant of EM has been proposed-oral EM-characterized by oral manifestations alone, and no skin involvement. This under-recognized form needs to be differentiated from other causes of acute ulcerative stomatitis, such as primary herpetic (HSV) gingivostomatitis, or Steven Johnson Syndrome (SJS). Recognition of EM by clinicians is essential in order to avoid alarm about other more severe entities such as SJS. Oral EM tends to be abenign and self-limited condition and morbidity and mortality are generally low.