title: Erythema multiforme major secondary to a cosmetic facial cream: first case report.
abstract: BACKGROUND
  Oral erythema multiforme (EM) major is an acute immune-mediated disorder typically involving the oral mucosa, triggered by a hypersensitivity reaction to an antigen.
  
  
  METHODS
  A 59-year-old woman presented to an oral medicine clinic with a chief complaint of "mystery disease" of 1 year's duration. The condition was described as repeated episodes of severe, painful, asymmetric oral lesions that responded to systemic steroid therapy. A previous oral biopsy described fibrinoid necrosis, mixed inflammation, and granulation tissue. A regimen of descending-dose prednisone was administered, and 3 weeks later the tissues appeared to be partially healed. Direct immunofluorescence staining of a biopsied oral mucosal lesion was negative. To rule out a drug causation, the patient discontinued hydrochlorothiazide and escitalopram oxalate. However, on steroid tapering, episodic lesions recurred. The patient was placed on combination systemic prednisone and azathioprine. The oral lesions resolved again, but new episodes occurred immediately after tapering. The patient's daily facial cosmetics were evaluated, and she was asked to stop using cosmetics with the active ingredient octocrylene. After eliminating the use of facial cosmetics containing octocrylene, the episodes no longer recurred.
  
  
  CONCLUSIONS
  We report a case of cosmetic-induced EM major and suggest that the triggering allergen is octocrylene.
authors.affiliation: Associate Professor, Department of Comprehensive Dentistry, Howard University College of Dentistry, Washington, DC, USA.
authors.forename: Andre A
authors.initials: AA
authors.lastname: Farquharson
authors.affiliation: Associate Professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Stoopler
authors.affiliation: Chief Resident, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Houston
authors.affiliation: Professor, Department of Comprehensive Dentistry, Howard University College of Dentistry; Clinical Associate Professor, Department of Otolarynogology, Georgetown University Medical Center, Washington, DC, USA. Electronic address: rbrown@howard.edu.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Brown
mesh_terms: D000179:Acrylates / Q000009:adverse effects*; D001706:Biopsy; D003358:Cosmetics / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004892:Erythema Multiforme / Q000139:chemically induced* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008875:Middle Aged; D009059:Mouth Diseases / Q000139:chemically induced* / Q000517:prevention & control; D013473:Sunscreening Agents / Q000009:adverse effects*
chemical_list: D000179:Acrylates; D003358:Cosmetics; D013473:Sunscreening Agents; C088673:octocrylene