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Corneal lesions in erythema multiforme minor--are systemic steroids indicated?

Jain S, Rathore MK, Dwivedi PC, Tirkey E - Indian J Ophthalmol (2010 Nov-Dec)

View Article: PubMed Central - PubMed

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Dear Editor, We have read with interest the brief communication “Coin-shaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings” by Babu et al... Regarding the treatment of erythema multiforme (EM) minor, we would like to present few points... EM is an acute and a self-limiting mucocutaneous hypersensitivity reaction associated with certain infections, medications, and other various triggers... EM minor is considered the mildest form of EM... Ocular involvement in EM minor is usually mild and may manifest as red conjunctivae, chemosis and lacrimation... Corneal lesions resolved within a week... Visual acuity improved to 20/20 and slit-lamp examination showed normal corneal epithelium [Fig. 3a and b]... In the literature (Medline search), it is described that for all forms of EM, no specific treatment is available but the most important treatment is usually symptomatic supportive care, with the identification and removal of the trigger factor... Systemic corticosteroid therapy is controversial and has no effect on the severity of ocular manifestations and prognosis... Some believe it may predispose to complications... EM minor is typically asymptomatic and the lesions may clear up themselves within 2–3 weeks even without treatment... We report this case to highlight that epithelial lesions associated with EM minor have responded well to topical steroid drops and completely resolved in a week’s time.

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Photograph of the face showing papular skin lesions
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Figure 0002: Photograph of the face showing papular skin lesions

Mentions: A 17-year- old female presented with sudden diminution of vision in both eyes since 5 hrs. She had watering and irritation in both eyes along with a history of cold and cough for 3 days. There was no history of any drug intake. On ophthalmic examination, her best-corrected visual acuity was 20/40 in both eyes. Slit-lamp examination in both eyes revealed multiple coin-shaped epithelial lesions, few coalesced and some showing central clearing [Fig. 1a and b]. There was no involvement of stroma. Corneal sensation and the rest of anterior segment and posterior segment were normal. On general inspection, she had multiple papular rashes on face, arms, and legs [Fig. 2] for which she was advised to consult a dermatologist, who diagnosed EM minor, and advised symptomatic treatment. The erythrocyte sedimentation rate was 45 mm/h and total white blood count was 11,000 cells/mm3 with predominant neutrophils (70%). For corneal lesions, she was prescribed topical steroid drops four times a day along with lubricant drops and acyclovir eye ointment 3% three times a day. Corneal lesions resolved within a week. Visual acuity improved to 20/20 and slit-lamp examination showed normal corneal epithelium [Fig. 3a and b].Figure 1


Corneal lesions in erythema multiforme minor--are systemic steroids indicated?

Jain S, Rathore MK, Dwivedi PC, Tirkey E - Indian J Ophthalmol (2010 Nov-Dec)

Photograph of the face showing papular skin lesions
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2994010&req=5

Figure 0002: Photograph of the face showing papular skin lesions
Mentions: A 17-year- old female presented with sudden diminution of vision in both eyes since 5 hrs. She had watering and irritation in both eyes along with a history of cold and cough for 3 days. There was no history of any drug intake. On ophthalmic examination, her best-corrected visual acuity was 20/40 in both eyes. Slit-lamp examination in both eyes revealed multiple coin-shaped epithelial lesions, few coalesced and some showing central clearing [Fig. 1a and b]. There was no involvement of stroma. Corneal sensation and the rest of anterior segment and posterior segment were normal. On general inspection, she had multiple papular rashes on face, arms, and legs [Fig. 2] for which she was advised to consult a dermatologist, who diagnosed EM minor, and advised symptomatic treatment. The erythrocyte sedimentation rate was 45 mm/h and total white blood count was 11,000 cells/mm3 with predominant neutrophils (70%). For corneal lesions, she was prescribed topical steroid drops four times a day along with lubricant drops and acyclovir eye ointment 3% three times a day. Corneal lesions resolved within a week. Visual acuity improved to 20/20 and slit-lamp examination showed normal corneal epithelium [Fig. 3a and b].Figure 1

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, We have read with interest the brief communication “Coin-shaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings” by Babu et al... Regarding the treatment of erythema multiforme (EM) minor, we would like to present few points... EM is an acute and a self-limiting mucocutaneous hypersensitivity reaction associated with certain infections, medications, and other various triggers... EM minor is considered the mildest form of EM... Ocular involvement in EM minor is usually mild and may manifest as red conjunctivae, chemosis and lacrimation... Corneal lesions resolved within a week... Visual acuity improved to 20/20 and slit-lamp examination showed normal corneal epithelium [Fig. 3a and b]... In the literature (Medline search), it is described that for all forms of EM, no specific treatment is available but the most important treatment is usually symptomatic supportive care, with the identification and removal of the trigger factor... Systemic corticosteroid therapy is controversial and has no effect on the severity of ocular manifestations and prognosis... Some believe it may predispose to complications... EM minor is typically asymptomatic and the lesions may clear up themselves within 2–3 weeks even without treatment... We report this case to highlight that epithelial lesions associated with EM minor have responded well to topical steroid drops and completely resolved in a week’s time.

Show MeSH
Related in: MedlinePlus