Letter to the Editor
Open Access
Isolated palmar located postherpetic Erythema
multiforme: unique pathognomonic clinical presentation!
Ivanka Temelkova1,Georgi Tchernev1*
1Onkoderma- Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606 Sofia.
*Corresponding author: Prof Dr. Georgi Tchernev, Onkoderma- Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev
26, 1606 Sofia;
E-mail:@
E-mail:
Received: October 08, 2019; Accepted: October 08, 2019; Published: October 11, 2019
Citation: Temelkova I, Tchernev G (2019) Isolated palmar located postherpetic Erythema multiforme: unique pathognomonic
clinical presentation!. Clin Res Dermatol Open Access 6(5): 1-2. DOI: 10.15226/2378-1726/6/5/001102
We present a 37-year-old woman complaining of recurrent
herpes simplex infections in the genital area. Episodes of herpes
recurrence have been observed within the last 2-3 years. The
patient treated the viral infection in the past with acyclovir
3x400mg / day with a temporary improvement. At the time
of the clinical examination, the complaints were about the
appearance of oval red lesions on the palms and fingers (Fig.
1a-b) with a duration of several weeks. In the course of the
dermatological examination, we detected disease progression
as well as the presence of polymorphic rash units with the
appearance of erythemo-edematous cockades-concentric circles
with a peripheral erythematous ring and central clearing in the
area of the palms and fingers (Fig. 1a-c). Based on a clear clinical
picture and histological finding, a palmar form of erythema
multiforme was diagnosed as a result of recurrent infection with
herpes simplex virus in the genital area. There was no evidence
of a general disorder as well as mucosal involvement within the
erythema multiforme. Systemic therapy with methylprednisolone
60 mg was started under a regimen initially followed by 40 mg
/ day p.o. in reduction sheme for one month. Esomeprazole
40 mg once daily for the duration of corticosteroid intake, as
well as desloratidine 5mg/day, and topical administration of
methylprednisolone aceponate cream 0.1% x 2 per day.
Figure. 1a-c: polymorphic rash units with the appearance of concentric circles with a peripheral erythematous ring and central clearing in the area of the palms and fingers. Photos 4 weeks before hospitalization.
Figure. 1d-e: erythema multiforme picture - clinical status after worsening of the condition.
Figure. 1d-e: erythema multiforme picture - clinical status after worsening of the condition.
In outpatient treatment, prophylaxis for recurrent herpes
infections with acyclovir 2x400mg was initiated for a period of
6 months.
HSV infection is considered to be one of the major etiologic causes of acute or sequellar EM lesions [1]. Usually, the predisposing factors are unknown, with the condition being considered an immune-mediated reaction, which is more common in HSV-1 compared to HSV-2 in the context of herpes infection [2]. Although it is generally accepted that EM has a self-limited course of development in some cases timely adequate treatment of erythema multiforme remain a major challenge, especially within recurrent herpes-associated erythema multiforme (HAEM), as in the patient described by us [2,3].
HSV infection is considered to be one of the major etiologic causes of acute or sequellar EM lesions [1]. Usually, the predisposing factors are unknown, with the condition being considered an immune-mediated reaction, which is more common in HSV-1 compared to HSV-2 in the context of herpes infection [2]. Although it is generally accepted that EM has a self-limited course of development in some cases timely adequate treatment of erythema multiforme remain a major challenge, especially within recurrent herpes-associated erythema multiforme (HAEM), as in the patient described by us [2,3].
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