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Clinical observations of erythema multiforme in children
1Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Childhood Erythema Multiforme (EM) is often triggered by infections like Mycoplasma and anticonvulsant medications. While EM major may benefit from corticosteroids, EM minor typically resolves with supportive care alone.
Area of Science:
- Pediatrics
- Dermatology
- Infectious Diseases
Background:
- Erythema multiforme (EM) is a mucocutaneous disorder primarily affecting young adults.
- Understanding childhood EM's triggers, course, and treatment is crucial for effective management.
Purpose of the Study:
- To retrospectively evaluate precipitating factors, clinical courses, and treatment outcomes of Erythema Multiforme in children.
- To assess the efficacy of systemic corticosteroids in childhood EM, differentiating between minor and major types.
Main Methods:
- Retrospective analysis of 30 pediatric EM cases (1 month to 15 years) from Jan 1988 to Aug 1998.
- Categorization into EM minor (23 cases) and EM major (7 cases, including Stevens-Johnson syndrome).
- Identification of potential triggers (infections, medications) and comparison of treatment outcomes (supportive care vs. systemic corticosteroids).
Main Results:
- Mycoplasma infection was a significant trigger in EM minor.
- Anticonvulsant medications were associated with EM major and some EM minor cases.
- EM minor resolved within 2 weeks, while EM major took up to 6 weeks; no mortality or sequelae were observed.
- Systemic corticosteroids showed potential benefit in EM major but were not significantly different from supportive care in EM minor regarding disease course and hospitalization.
Conclusions:
- Infections (especially Mycoplasma) and anticonvulsants are key factors in childhood EM.
- Systemic corticosteroids may be beneficial for EM major, but are likely unnecessary for EM minor.
- Prompt diagnosis and appropriate supportive care are essential for managing childhood EM.
Abstract:
Erythema multiforme (EM), a cutaneous or mucocutaneous disorder, occurs primarily in young adults. To evaluate the precipitating factors, clinical courses, and treatment of this disease in children, 30 cases aged from 1 month old to 15 years of age were studied retrospectively from Jan 1988 to Aug 1998. Twenty-three cases were diagnosed as minor type; the other 7 were of major type (Stevens-Johnson syndrome). Mycoplasma infection was identified in 4 patients, and adenovirus in one patient with EM minor. Cytomegalovirus was found in one EM major patient. Anticonvulsant administration before the skin lesions were recorded in 5 EM major patients and 2 EM minor patients. All cases received supportive treatment during admission. Besides, 6 of 7 patients with EM major, and 11 of 23 EM minor (Group A) received systemic corticosteroid at a dose equal to prednisolone 1-2 mg/kg/day for 3-14 days. One EM major patient and 11 patients with EM minor (Group B) received supportive care only. One EM minor patient with acute idiopathic thrombocytopenia purpura was treated with intravenous immunoglobulin. The mean duration of course of EM minor was 11.8 +/- 2.9 days, and it was 25.1 +/- 9.8 days for EM major. No mortality and no sequelae were noted. The average disease course and hospitalization time were not significantly different between Group A and B: (11.4 +/- 3.1 days vs 12.4 +/- 2.9 days, p = 0.45); (5.4 +/- 2.0 days vs 6.3 +/- 3.1 days, p = 0.47). This study demonstrated that infections, especially mycoplasma, and anticonvulsants play important roles in childhood EM. The skin lesions of EM minor subsided within 2 weeks, and EM major recovered completely within 6 weeks. Systemic corticosteroid may be beneficial to EM major, but probably is unnecessary for patients with EM minor.