BaniHani A, Nazzal H, Webb L, Toumba K J, Fabbroni G
Leeds Dental Institute, University of Leeds, Leeds, LS2 9LU, UK,
Eur Arch Paediatr Dent. 2015 Jun;16(3):297-302. doi: 10.1007/s40368-015-0181-0. Epub 2015 Apr 8.
Erythema multiforme (EM) is an acute, vesiculobullous disease of skin and mucous membranes with symptoms ranging from mild to severe. A complex interaction of different factors has been implicated the condition; the majority with a preceding herpes simplex infection. This report describes an unusual presentation of erythema multiforme affecting the lips and oral mucosa of a healthy 7-year-old boy in the form of lip adherence.
Two weeks following eruption of oral ulcerations, a 7-year-old healthy boy developed severe erosive ulceration of both lips, causing complete lip adherence. This was accompanied by marked bilateral submandibular and cervical lymphadenopathy, tremor and sweating. Clinical and laboratory investigations led to a diagnosis of erythema multiforme. The patient was treated initially with gentle application of Vaseline between the lips using cotton buds in an attempt to release lip adhesion, followed by surgical release of the lips under general anaesthesia. Analgesics and topical steroid mouthwash were provided.
FOLLOW-UP: Seven months later, the patient presented with a recurrence of his EM which included lesions on the skin. The patient was treated with antivirals, topical and systematic steroids to suppress the recurrent attacks of EM. Eighteen months following the initial presentation the patient and parent reported considerable decrease in the frequency, severity and duration of the occurrence of intra-oral ulcers, with no major episode of target lesions on the skin.
Erythema multiforme is rare in children, however it should be considered in the differential diagnosis of recurrent erosive oral ulcerative lesions especially when the oral lesions resemble those of primary herpetic gingivostomatitis.
多形红斑（EM）是一种皮肤和黏膜的急性水疱性疾病，症状从轻度到重度不等。多种因素之间复杂的相互作用与该病有关；大多数患者之前有单纯疱疹感染。本报告描述了一名健康7岁男孩以唇部粘连的形式出现的多形红斑的不寻常表现，累及唇部和口腔黏膜。
口腔溃疡发作两周后，一名7岁健康男孩双侧唇部出现严重糜烂性溃疡，导致完全唇部粘连。同时伴有明显的双侧颌下和颈部淋巴结肿大、震颤和出汗。临床和实验室检查确诊为多形红斑。患者最初先用棉签在唇部轻柔涂抹凡士林以试图松解唇部粘连，随后在全身麻醉下进行唇部手术松解。给予了镇痛药和局部用类固醇漱口水。
七个月后，患者多形红斑复发，包括皮肤出现病变。患者接受了抗病毒药物、局部和全身用类固醇治疗以抑制多形红斑的复发。首次发病18个月后，患者及其家长报告口腔内溃疡发作的频率、严重程度和持续时间显著降低，皮肤未出现主要的靶形病变发作。
多形红斑在儿童中罕见，但在复发性糜烂性口腔溃疡性病变的鉴别诊断中应予以考虑，尤其是当口腔病变类似于原发性疱疹性龈口炎时。
