Oral Management of Herpes-Associated Erythema Multiforme in A Microcytic Anaemia Patient

Authors

  • Nurina Febriyanti Ayuningtyas Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga Surabaya, Indonesia
  • Rossy Sismiyanti Oral Medicine Specialist Study Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Fatma YasminMahdani Oral Medicine Specialist Study Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Gremita Kusuma Dewi Oral Medicine Specialist Study Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

DOI:

https://doi.org/10.46862/interdental.v21i2.10897

Keywords:

Erythema multiforme, herpes simplex virus, HAEM, oral medicine

Abstract

Introduction: One acute and self-limiting hypersensitivity reaction affecting the skin and/or other mucous membranes is known as Erythema Multiforme (EM). EM is considered to be associated with infections or medications. Infection with Herpes Simplex Virus types 1 and 2 (HSV-1 and HSV-2) is a well-known predisposing factor and the most prevalent cause of EM, also referred to as Herpes Associated Erythema Multiforme (HAEM).

Case: A 31-year-old female patient presented to RSGM Universitas Airlangga with red-black crusts, erosion, and bleeding on her lips, as well as erosion and sloughing of the oral mucosa. She had experienced fever and chills for a week, and three days later, lesions appeared on the lips and oral mucosa. The symptoms progressively worsened despite treatment.

Case Treatment: At the first visit, the patient was referred for serology tests, complete blood count, IgM and IgG Anti-HSV 1 and Anti-HSV 2, and total IgE. Positive serology for IgG Anti-HSV 1 confirmed the diagnosis, and microcytic anaemia was also detected. The patient was treated with steroid orabase and oral elixir, administered four times daily.

Discussions: The first line in treatment management is using antiviral therapy. Early treatment with oral antivirals may lessen the number and duration of lesions. Topical steroids can be given in dosage form, paste in orabase, ointment or elixir according to the involvement of the lesion area.

Conclusion: Management of HAEM must determine the etiology and symptoms. A prompt and correct diagnosis following by the right approach to oral management not only cure but also prevent recurrence and improve the quality of life.

Downloads

Download data is not yet available.

References

1. Thongprasom K. Treatment of a pregnant patient with herpes associated erythema multiforme (HAEM): A case report. Acta Stomatol Croat 2016; 50(3): 265–8. Doi: 10.15644/asc50/3/10

2. Mtiri A, Bouslama G, Messouad NS Ben, Abidi I, Youssef S Ben, Sriha B. Erythema multiforme attributable to herpes simplex virus: clinical aspects and treatment. Case Rep Dent 2021; 2021: 6692495. Doi: : 10.1155/2021/6692495

3. Soares A, Sokumbi O. Recent updates in the treatment of erythema multiforme. Vol. 57, Medicina (Lithuania). Medicina 2021; 57(9): 921. Doi: 10.3390/medicina57090921

4. Kamala K, Ashok L, Annigeri R. Herpes associated erythema multiforme. Contemp Clin Dent 2011; 2(4): 372. Doi: 10.4103/0976-237X.91807

5. Ganesha R, Kartika Sari R. Treatment of herpes associated erythema multifome (HAEM). Interdental Jurnal Kedokteran Gigi (IJKG) 2023; 19(1): 11–6. Doi: 10.46862/interdental.v19i1.6350

6. Rochmah YS, Mujayanto R. Herpes associated erythema multifome (haem) on the psychosomatic patient: A case report. Medali Jurnal. 2021; 3(1) Doi: 10.30659/medali.v3i1.17390

7. Staikuniene J, Staneviciute J. Long-term valacyclovir treatment and immune modulation for Herpes associated erythema multiforme. Central European Journal of Immunology. Termedia Publishing House Ltd.; 2015; 40(3): 387–90. Doi: 10.5114/ceji.2015.54604

8. Glick M, Greenberg MS, Lockhart PB, Challacombe SJ. Burket’s Oral Medicine. 13th Edition. Michael Glick, Martin S. Greenberg, Peter B. Lockhart, Stephen J. Challacombe, editors. Hoboken, NJ, USA: John Wiley & Sons, Inc; 2021.

9. Prabhu SR. Handbook of Oral Pathology and Oral Medicine. USA:John Wiley & Sons Ltd; 2022. p.279-280.

10. Lucchese A. From HSV infection to erythema multiforme through autoimmune cross reactivity. Autoimmunity Reviews. Elsevier B.V 2018; 17(6): p. 576–81. Doi: 10.1016/j.autrev.2017.12.009.

11. Magri F, Chello C, Pranteda G, Pranteda G. Erythema multiforme: differences between HSV-1 and HSV-2 and management of the disease—A case report and mini review. Dermatol Ther 2019; 32(3): e12847. Doi: 10.1111/dth.12847

12. Du Y, Wang F, Liu T, Jin X, Zhao H, Chen Q, Zeng X. Recurrent oral erythema multiforme: a case series report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129(4): e224–9. Doi: 10.1016/j.oooo.2019.11.013

13. Soares A, Sokumbi O. Recent updates in the treatment of erythema multiforme. Medicina (Lithuania) 2021; 57(9): 921. Doi: 10.3390/medicina57090921

14. Grünwald P, Mockenhaupt M, Panzer R, Emmert S. Erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis – diagnosis and treatment. JDDG - Journal of the German Society of Dermatology 2020; 18(6): 547– 53. Doi: 10.1111/ddg.14118

15. Trayes K, Love G, Studdiford JS. Erythema multiforme: recognition and management. Am Fam Physician 2019; 100(2): 82–8.

16. Widagdo AK, Herawati D, Syaify A. Aplikasi chlorine dioxide gel pada periodontitis kronis paska kuretase (kajian pada pocket depth, clinical attachment level dan bleeding on probing). J Ked Gi 2015; 6(3): 265-270.

17. Cascio MJ, DeLoughery TG. Anemia: evaluation and diagnostic tests. Medical Clinics of North America 2017;101(2): 263–84. Doi: 10.1016/j.mcna.2016.09.003

18. Lanier J, Park JJ, Callahan RC. Anemia in older adults. Am Fam Physician 2018; 98(7): 437-42

19. Hoffbrand AVictor, Moss PAH. Hoffbrand’s Essential Haematology. Seventh Edition. USA:Wiley Blackwell; 2016.

20. Ronald Hoffman, Ronald Hoffman, Edward J. Benz, Leslie E. Silberstein, Helen E. Heslop, Jeffrey I. Weitz, et al. Hematology: Basic Principles and Practice. Seventh Ed. London:Elsevier; 2013.

21. Fairman JE, Wang M. Iron deficiency and other types of anemia in infants and children. Am Fam Physician [Internet]. 2016;93(4): 270-8. Available from: www.aafp.org/afp.

22. Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2nd edn. Switzerland:Springer International Publishing; 2017. p.66-67.

23. Langlais RP, Miller CS, Gehrig JS. Color Atlas of Common Oral Diseases. 5th edn. Philadelphia:Wolters Kluwer; 2017. p.190-191.

24. Talahatu LB, Kaban BE, Ayuningtyas NF, Brilyanti IN, Parmadiati AE, Radithia D, Pratiwi AS. Management of patients with aphthous-like ulcers related to aplastic anaemia in the COVID-19 pandemic era through teledentistry: A case report. Dental Journal 2020, 55(1): 49–55. Doi: 10.20473/j.djmkg.v55.i1.p.49-55

Downloads

Published

2025-08-05

How to Cite

1.
Ayuningtyas NF, Sismiyanti R, YasminMahdani F, Dewi GK. Oral Management of Herpes-Associated Erythema Multiforme in A Microcytic Anaemia Patient. interdental [Internet]. 2025 Aug. 5 [cited 2025 Aug. 8];21(2):335-40. Available from: https://e-journal.unmas.ac.id/index.php/interdental/article/view/10897