28 However, most patients with HSV infection do not develop erythema multiforme. 27 These results ref lect the seroprevalence of HSV-1 and -2 in the United States. 19 In another study, researchers determined the genotype of HSV in cutaneous lesions of patients with herpes-associated erythema multiforme 66.7 percent of cases were attributed to HSV-1, 27.8 percent to HSV-2, and 5.6 percent to HSV-1 and -2 coinfection. 10 In a study involving 63 patients with erythema multiforme, HSV DNA was detected (by polymerase chain reaction in skin biopsy specimens) in 60 percent of patients with clinically diagnosed recurrent herpes-associated erythema multiforme and in 50 percent of patients with recurrent idiopathic erythema multiforme (defined as erythema multiforme with no clinical history of HSV infection or drug ingestion). Recurrent erythema multiforme often is secondary to HSV-1 and -2 reactivation, although the HSV may be clinically silent. The remainder of this article will focus on erythema multiforme. 5 Although SJS and TEN may represent the same process with differing severity, 6 erythema multiforme, with its minimal mucous membrane involvement and less than 10 percent epidermal detachment, now is accepted as a distinct condition. 4 An often-cited study from 1993 proposed a useful clinical classification of erythema multiforme, SJS, and TEN based on the pattern of individual skin lesions and the estimation of body surface area with detachment of the epidermis (i.e., blisters, denuded areas, or erosions) at the worst stage of the disease ( Table 2 1, 2, 5, 6). 2, 3 Previously, the condition was thought to be part of a clinical spectrum of disease that included erythema minor, erythema major (often equated with Stevens-Johnson syndrome ), and toxic epidermal necrolysis (TEN), with erythema minor being the most mild and TEN the most severe. Erythema multiforme is an acute, self-limited, and sometimes recurring skin condition considered to be a hypersensitivity reaction associated with certain infections and medications ( Table 1 1, 2).
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