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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 6  |  Page : 559-560

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


Department of Ophthalmology, SS Medical College, Rewa - 486 001, Madhya Pradesh, India

Date of Web Publication16-Oct-2010

Correspondence Address:
Shashi Jain
Anupam Nursing Home, Behind PK School, Rewa - 486 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.71701

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How to cite this article:
Jain S, Rathore M K, Dwivedi P C, Tirkey E. Corneal lesions in erythema multiforme minor - Are systemic steroids indicated?. Indian J Ophthalmol 2010;58:559-60

How to cite this URL:
Jain S, Rathore M K, Dwivedi P C, Tirkey E. Corneal lesions in erythema multiforme minor - Are systemic steroids indicated?. Indian J Ophthalmol [serial online] 2010 [cited 2020 Jun 4];58:559-60. Available from: http://www.ijo.in/text.asp?2010/58/6/559/71701

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. [1] We appreciate that the authors have drawn attention to this relatively uncommon finding. 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. It is characterized by skin eruption with or without mucosal involvement and may present with a wide spectrum of severity. Ocular involvement in EM minor is usually mild and may manifest as red conjunctivae, chemosis and lacrimation. We also recently came across a case of simultaneous presentation of bilateral coin-shaped discrete and few coalesced epithelial lesions with EM minor.

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 [Figure 1]a 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 [Figure 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/mm 3 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 [Figure 3]a and b.
Figure 1: (a) Slit-lamp photograph of the cornea in diffuse illumination showing coin-shaped discrete and coalesced lesions with central clearing in some lesions. (b) Slit-lamp photograph in slit illumination showing discrete and coalesced coin-shaped epithelial lesions

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Figure 2: Photograph of the face showing papular skin lesions

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Figure 3: (a) Slit-lamp photograph showing disappearance of corneal
lesions (diffuse illumination). (b) Slit illumination showing disappearance
of corneal lesions


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In the literature (Medline search), [2],[3],[4] 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.

 
  References Top

1.
Babu K, Murthy VR, Akki VP, Prabhakaran VC, Murthy KR. Coin - shaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings. Indian J Ophthalmol 2010;58:64-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Power WJ, Ghoraishi M, Merayo-Lloves J, Neves RA, Foster CS. Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens- Johnson syndrome/ toxic epidermal necrolysis disease spectrum. Ophthalmology 1995;102:1669-76.  Back to cited text no. 2
[PUBMED]    
3.
Chang YS, Huang FC, Tseng SH, Hsu CK, HoCL, Sheu HM. Erythema multiforme, Stevens- Johnson syndrome and toxic epidermal necrolysis: Acute ocular manifestations, causes and management. Cornea 2007;26:123-9.  Back to cited text no. 3
    
4.
Farthing P, Began JV, Scully C. Mucosal disease series. Number IV. Erythema multiforme. Oral Dis 2005;11:261-7.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Reply: Coin-shaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings
Babu, K., Murthy, V.R., Akki, V.P., Prabhakaran, V.C., Murthy, K.R.
Indian Journal of Ophthalmology. 2011; 59(2): 167
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