Brajon D, Bursztejn A-C, Goffinet L, Schmutz J-L, Barbaud A
Service de dermatologie-vénéréologie, pôle des spécialités médicales, hôpitaux de Brabois, CHU de Nancy, 6, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
Ann Dermatol Venereol. 2013 Apr;140(4):291-5. doi: 10.1016/j.annder.2013.01.435. Epub 2013 Feb 28.
Mucosal erosions in bullous diseases and leading to mucosal sequelae are widely described in toxic epidermal necrolysis (TEN). These complications cause disfigurement and functional impairment. They are more rarely reported in erythema multiforme (EM). We report a case of lip adhesion following EM induced by Mycoplasma pneumoniae.
A 12-year-old boy was hospitalized in a paediatric intensive care unit. He had a prominent target skin rash on the palms and soles. Mucosal injury was associated with conjunctivitis, balanitis without dysuria and hyperalgesic stomatitis. M. pneumoniae serology was positive with immunoglobulin M. We made a diagnosis of EM secondary to M. pneumoniae infection. Two months later, the skin lesions had completely disappeared but the patient's mouth opening was limited to 25 mm and he presented bilateral adhesions between the upper and lower lips of 5mm on the right and 8mm on the left resulting in aesthetic and functional damage.
Mucosal damage and its sequelae have been widely described in TEN. Ophthalmic sequelae are more frequent. A case of labial synechiae secondary to TEN has been reported. In EM, mucosal lesions occur in 100% of cases with a further mucosal problem being present in 50% of patients. Mucosal damage has been reported during EM flares but there are no studies of side-effects after the acute episode. Oral mucosal adhesions can cause cosmetic sequelae, but above all they hinder functional prognosis. These complications must be prevented by making gutters of vestibular deepening and lip movements with maximum mouth opening several times a day, starting as soon as possible. Appropriate pain management should be undertaken to ensure patient comfort and avoid the need for analgesics and restriction of movement.
Mucosal sequelae exist in EM. Whatever their cause, complications involving the mucosa must be prevented through early, tailored and multidisciplinary treatment. Adequate pain management must not be overlooked.
中毒性表皮坏死松解症（TEN）中广泛描述了大疱性疾病中的黏膜糜烂及其导致的黏膜后遗症。这些并发症会导致容貌毁损和功能障碍。在多形红斑（EM）中此类情况报道较少。我们报告一例由肺炎支原体引起的EM后唇部粘连的病例。
一名12岁男孩入住儿科重症监护病房。他手掌和脚底有明显的靶形皮疹。黏膜损伤伴有结膜炎、无痛性龟头炎和疼痛性口腔炎。肺炎支原体血清学检测免疫球蛋白M呈阳性。我们诊断为肺炎支原体感染继发的EM。两个月后，皮肤病变完全消失，但患者的开口度限制在25毫米，上下唇之间出现双侧粘连，右侧5毫米，左侧8毫米，导致美观和功能受损。
TEN中黏膜损伤及其后遗症已有广泛描述。眼部后遗症更为常见。曾有一例TEN继发唇粘连的报道。在EM中，100%的病例会出现黏膜病变，50%的患者还会出现进一步的黏膜问题。EM发作期间曾有黏膜损伤的报道，但尚无急性发作后副作用的研究。口腔黏膜粘连会导致美容后遗症，但最重要的是会妨碍功能预后。必须通过每天多次进行前庭加深沟和最大开口度的唇部运动来预防这些并发症，尽早开始。应进行适当的疼痛管理，以确保患者舒适，避免使用镇痛药和限制活动。
EM存在黏膜后遗症。无论其病因如何，必须通过早期、针对性和多学科治疗来预防涉及黏膜的并发症。充分的疼痛管理不容忽视。
