1Department of Pediatrics B, Schneider Children's Medical Center of Israel 2Tel Aviv University, Sackler Faculty of Medicine
Background: Erythema multiforme minor is an acute, immune-mediated, self-limiting skin disease with distinctive targetoid lesions. Most cases are considered to be drug- or infection-related. This study reviewed the 10-year experience with erythema multiforme minor of a tertiary pediatric medical center with a focus on precipitating factors. Methods:The study group included all children hospitalized during the years 2001 to 2011, with the diagnosis of erythema multiforme minor. The medical files were reviewed for background data and potential precipitating factors. Results: One hundred eighteen patients met the inclusion criteria: 70 male and 48 female, mean age 3.2 years. At least one precipitating factor was recognized in 98 cases; the remainder were classified as idiopathic. The most common was drugs (35/118), particularly penicillin (20 patients), followed by infection with various pathogens (27/118): Epstein-Barr virus (7), Streptococcus A. or Mycoplasma pneumoniae (5 each), herpes simplex virus (4), varicella zoster virus (3), cytomegalovirus (2), and tonsillitis (1). In fifteen patients two possible causes of erythema multiforme minor were found- drugs and infections. An association with cow-milk allergy was found in 20 cases (17% of children). Analysis by age showed that infection was the most common precipitating factor in the 1-3-year age group, and cow-milk allergy in the 2.5 weeks-4months group. Conclusions: In the first month of life, cow milk allergy is the most common precipitating factor of erythema multiforme minor. Later in life erythema multiforme minor is associated with medications or infections.
