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Herpes simplex virus-associated erythema multiforme in prepubertal children
1Department of Dermatology, University of Colorado School of Medicine, Denver, USA. william.weston@UCHSC.edu
Insights
Herpes simplex virus-associated erythema multiforme (EM) in children often recurs and may not respond to standard treatments. Prophylactic acyclovir can prevent frequent EM recurrences.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases
- Viral Infections
Background:
- Erythema multiforme (EM) is an acute, self-limiting hypersensitivity reaction.
- Herpes simplex virus (HSV) is a common trigger for EM, particularly in children.
- Understanding the clinical course and treatment response in prepubertal children is crucial.
Purpose of the Study:
- To investigate the clinical associations of HSV-associated EM in children younger than 13 years.
- To analyze the condition's evolution, recurrence patterns, and treatment outcomes.
- To evaluate the efficacy of acyclovir in treating and preventing EM episodes.
Main Methods:
- Retrospective case series of 12 children under 13 years with EM.
- Evaluation of clinical data including age of onset, preceding illness, and episode duration.
- Assessment of treatment responses to topical/oral acyclovir and prophylactic acyclovir.
Main Results:
- HSV-associated EM occurred in 12 children, with a mean onset age of 8.1 years.
- EM episodes lasted a mean of 10.6 days and were recurrent in 9 children (2.6 episodes/year).
- Oral acyclovir (25 mg/kg/day) did not reduce individual episode duration, but prophylaxis (20 mg/kg/day) prevented recurrences in 3 children.
Conclusions:
- Childhood HSV-associated EM is recurrent, potentially triggered by sun exposure, and does not progress to Stevens-Johnson syndrome.
- Standard acyclovir treatment may be ineffective for individual EM episodes.
- Prophylactic acyclovir can effectively prevent frequent recurrences of EM in susceptible children.
Objective:
To examine clinical associations, evolution of the condition, and response to treatment of erythema multiforme (EM) in prepubertal children.
Design:
A retrospective case series evaluation of children younger than 13 years with EM.
Setting:
Ambulatory care university hospital.
Patients:
Referral patients from pediatricians serving a population of 3.2 million.
Interventions:
Results of treatment of each EM episode with topical acyclovir or oral acyclovir at a dose of 25 mg/kg per day and 6-month prophylaxis with oral acyclovir at a dose of 20 mg/kg per day were evaluated.
Outcomes:
Age at EM onset, preceding illness, and number and duration of episodes during a 3-year period were recorded.
Results:
Twelve children (7 boys and 5 girls) in whom herpes simplex virus (HSV)-associated EM developed were evaluated. Preceding lesions were herpes labialis in 8 children and herpes facialis in 2 children. Two children had no obvious HSV lesion. The mean age at onset of disease was 8.1 years, and the mean time from the preceding HSV to the onset of skin lesions was 3.9 days (range, 0-11 days). Episodes of EM lasted a mean of 10.6 days. In 9 children, the EM was recurrent, with a mean of 2.6 episodes per year. All 12 children, including those with negative viral cultures for HSV or no HSV history had HSV detected in their target lesions by polymerase chain reaction amplification of DNA obtained from skin biopsy specimens. Six of 12 children were treated with oral acyclovir at a dose of 25 mg/kg per day for 1 or more individual episodes, without reduction in the episode. Three children underwent 6-month prophylaxis with oral acyclovir at a dose of 20 mg/kg per day and remained disease free during treatment. After discontinuation of the prophylactic treatment with acyclovir, 1 child relapsed at 4 months. The other 2 children had no further episodes during a 3-year period.
Conclusions:
The HSV-associated EM is a recurrent disease that can be precipitated by sun exposure and does not progress to Stevens-Johnson syndrome. Childhood HSV-associated EM may be unresponsive to treatment with oral steroids or oral or topical acyclovir. Frequent recurrences of EM may be abrogated by prophylactic treatment with acyclovir.
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