Erythema Multiforme: A Retrospective Study of the Clinical Manifestations of Patients Attending an Oral Medicine Clinic in Nigeria

Abstract

Background: Erythema multiforme (EM) manifests on the skin and mucosa surfaces such as the oral mucosa and the genitals as ulcerative lesions. The spectrum of clinical presentation underscores the importance of describing the clinical features observed in patients presenting in an oral medicine clinic for treatment. Aim: To describe the epidemiology and the clinical features of patients presenting with erythema multiforme in the oral medicine clinic of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). Methodology: A retrospective study of cases diagnosed as EM in the Oral Medicine clinic of OAUTHC between August 2009 and August 2019. Patients’ hospital records were retrieved and reviewed. Information extracted included biodata, clinical findings, presence of co morbidity and treatment received. Diagnosis of EM was mostly clinical; some patients also had histopathologic and/or Direct Immunofluorescence (DIF) investigations. Data was analyzed using STATA 13 statistical software. Results: Out of the total number of 923 patients seen in the clinic during the study period, 19 (2.08%) patients had EM. Nine males and 10 females were affected. The age ranged from 9 years to 73 years with mean age of 35.53± 16.20 years.  EM minor was diagnosed in 17(89.47%) while EM major was diagnosed in 2(10.53%). The affected oral sites were upper and lower lips 16(84.21%), buccal mucosa 9(47.3%), hard and soft palate had 3(15.79%) and  tongue 2(10.52%). Seven patients (36.84%) presented with target skin lesions. Seventeen patients (89.47%) had recurrence. Sixteen (84.47%) patients had no identifiable causative factor while one patient each presented with ciprotab® (5.26%), septrin® (5.26%) and sulphonamide (5.26%) as the implicating triggers. Two (10.53%) of the patients presented with oral and genital ulcers. The 2 patients had histopathology and Direct Immunofluorescence investigation. Patients were treated with steroids and other supportive therapy. Conclusion: Erythema Multiforme appears to be an uncommon presentation in the oral medicine clinic, but may be associated with recurrent lesion in and around the oral tissue. The lips were the most common site of oral presentation. Drug reactions were identifiable etiological factor. Topical or systemic steroids were effective in patient management.