Clinical presentation of erythema multiforme. (A) Shows erythema multiforme on the legs, combined with signs of eczema caused by phototoxicity to doxycycline. (B) and (C) Close-up photos of erythema multiforme lesions
Declarations
Acknowledgements
I express my sincere gratitude to those who contributed to this case report. First and foremost, we extend our heartfelt thanks to the patient for consenting to the publication of this report and for their cooperation throughout the process. My appreciation goes to the Special Hospital for Pulmonary Diseases, Zagreb, Croatia, specifically to the staff of the allergy unit, for providing the necessary facilities and support that made this case study possible. I thank everyone who, directly or indirectly, played a role in the successful completion of this case report.
Author contributions
VVL: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. The author read and approved the submitted version.
Conflicts of interest
The author declares that she has no conflicts of interest.
Ethical approval
According to the policy of our hospital—Special Hospital for Pulmonary Diseases, ethical committee approval is not required for case reports, provided that written informed consent is obtained from the patients.
Consent to participate
Informed consent to participate in the study was obtained from all participants.
Consent to publication
Informed consent to publication was obtained from relevant participants.
Availability of data and materials
All data for this study are included in the manuscript. For further discussion regarding this report, please contact the corresponding author.
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References
Nigen S, Knowles SR, Shear NH. Drug eruptions: approaching the diagnosis of drug-induced skin diseases.J Drugs Dermatol. 2003;2:278–99. [PubMed]
Soares A, Sokumbi O. Recent Updates in the Treatment of Erythema Multiforme.Medicina (Kaunas). 2021;57:921. [DOI] [PubMed] [PMC]
Samim F, Auluck A, Zed C, Williams PM. Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment.Dent Clin North Am. 2013;57:583–96. [DOI] [PubMed]
Watanabe R, Watanabe H, Sotozono C, Kokaze A, Iijima M. Critical factors differentiating erythema multiforme majus from Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).Eur J Dermatol. 2011;21:889–94. [DOI] [PubMed]
Kutlubay Z, Sevim A, Engin B, Tüzün Y. Photodermatoses, including phototoxic and photoallergic reactions (internal and external).Clin Dermatol. 2014;32:73–9. [DOI] [PubMed]
Monteiro AF, Rato M, Martins C. Drug-induced photosensitivity: Photoallergic and phototoxic reactions.Clin Dermatol. 2016;34:571–81. [DOI] [PubMed]
Brockow K, Ardern-Jones MR, Mockenhaupt M, Aberer W, Barbaud A, Caubet J, et al. EAACI position paper on how to classify cutaneous manifestations of drug hypersensitivity.Allergy. 2019;74:14–27. [DOI] [PubMed]
Rodríguez-Pazos L, Gómez-Bernal S, Montero I, Rodríguez-Granados M, Toribio J. Erythema multiforme photoinduced by paroxetine and herpes simplex virus.Photodermatol Photoimmunol Photomed. 2011;27:219–21. [DOI] [PubMed]
Huff C, Weston WL. The photodistribution of erythema multiforme.Arch Dermatol. 1980;116:477. [PubMed]
Fitzpatrick JE, Thompson PB, Aeling JL, Huff C. Photosensitive recurrent erythema multiforme.J Am Acad Dermatol. 1983;9:419–23. [DOI] [PubMed]
Sethy M, Padhan P, Abirami C, Maikap D. Rowell’s Syndrome: A Case Report and Literature Overview.Indian Dermatol Online J. 2021;12:608–10. [DOI] [PubMed] [PMC]
Adelman MJ, Messenger G, Farshchian M, Moossavi M. Toxic epidermal necrolysis induced by doxycycline.Int J Dermatol. 2021;60:e398–400. [DOI] [PubMed]
Lockhart SP, Rushworth A, Azmy AA, Raine PA. Topical silver sulphadiazine: side effects and urinary excretion.Burns Incl Therm Inj. 1983;10:9–12. [DOI] [PubMed]
Woodruff CM, Botto N. The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications.Clin Rev Allergy Immunol. 2022;62:548–61. [DOI] [PubMed] [PMC]
Novack DE, Braskett M, Worswick SD, Adler BL. Drug patch testing in Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review.Ann Allergy Asthma Immunol. 2023;130:628–36. [DOI] [PubMed]
Degreef H, Dooms-Goossens A. Patch testing with silver sulfadiazine cream.Contact Dermatitis. 1985;12:33–7. [DOI] [PubMed]
Binet O, Bruley C, Robin J. Photo-patch testing and patch testing with silver sulfadiazine cream.Photodermatol. 1987;4:102–3. [PubMed]
Fraser-Moodie A. Sensitivity to silver in a patient treated with silver sulphadiazine (Flamazine).Burns. 1992;18:74–5. [DOI] [PubMed]
Sawada Y. Adverse reaction to sulphonamides in a burned patient--a case report.Burns Incl Therm Inj. 1985;12:127–31. [DOI] [PubMed]
Hamilton LA, Guarascio AJ. Tetracycline Allergy.Pharmacy (Basel). 2019;7:104. [DOI] [PubMed] [PMC]
Parish LC, Witkowski JA. Pulsating fixed drug eruption due to tetracycline.Acta Derm Venereol. 1978;58:545–7. [PubMed]
Honari G. Photoallergy.Rev Environ Health. 2014;29:233–42. [DOI] [PubMed]
Layton AM, Cunliffe WJ. Phototoxic eruptions due to doxycycline--a dose-related phenomenon.Clin Exp Dermatol. 1993;18:425–7. [DOI] [PubMed]
Goetze S, Hiernickel C, Elsner P. Phototoxicity of Doxycycline: A Systematic Review on Clinical Manifestations, Frequency, Cofactors, and Prevention.Skin Pharmacol Physiol. 2017;30:76–80. [DOI] [PubMed]
Ramien ML. Reactive infectious mucocutaneous eruption: Mycoplasma pneumoniae-induced rash and mucositis and other parainfectious eruptions.Clin Exp Dermatol. 2021;46:420–9. [DOI] [PubMed]
Roca B. Mycoplasma infections.Rev Clin Esp. 2006;206:239–42. Spanish. [DOI] [PubMed]
Aurelian L, Ono F, Burnett J. Herpes simplex virus (HSV)-associated erythema multiforme (HAEM): a viral disease with an autoimmune component.Dermatol Online J. 2003;9:1. [PubMed]
Ono F, Sharma BK, Smith CC, Burnett JW, Aurelian L. CD34+ cells in the peripheral blood transport herpes simplex virus DNA fragments to the skin of patients with erythema multiforme (HAEM).J Invest Dermatol. 2005;124:1215–24. [DOI] [PubMed]
Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, et al. International Consensus on drug allergy.Allergy. 2014;69:420–37. [DOI] [PubMed]
Sassolas B, Haddad C, Mockenhaupt M, Dunant A, Liss Y, Bork K, et al. ALDEN, an algorithm for assessment of drug causality in Stevens-Johnson Syndrome and toxic epidermal necrolysis: comparison with case-control analysis.Clin Pharmacol Ther. 2010;88:60–8. [DOI] [PubMed]
Lazarević VV. Diagnosis, Investigation and Management of Non-immediate (Type IV) Cutaneous Adverse Drug Reactions.Acta Dermatovenerol Croat. 2024;32:88–95. [PubMed]
Koo G, Stollings JL, Lindsell C, Dear ML, Kripalani S, Nelson GE, et al.; Vanderbilt University Medical Center Learning Healthcare System. Low-risk penicillin allergy delabeling through a direct oral challenge in immunocompromised and/or multiple drug allergy labeled patients in a critical care setting.J Allergy Clin Immunol Pract. 2022;10:1660–3.e2. [DOI] [PubMed] [PMC]
Redmond M, Scherzer R, Hardy C, Macias C, Samora J, Stukus D. In-Office Amoxicillin to Increase Graded-Dose Challenges at Initial Evaluation for Penicillin Allergy.J Allergy Clin Immunol Pract. 2023;11:2190–5. [DOI] [PubMed]