Erythema multiforme

BENZOIC ACID AND ERYTHEMA MULTIFORME

Erythema multiforme is an acute inflammatory disorder characterized by a variety of lesions on the skin and the mucous membranes of the mouth, eyes, and genitals. In typical cases, an initial episode is usually followed by recurrences of reduced severity, and known precipitating factors (drug therapy, recent infection, or systemic disease) can be identified. This report describes the results of investigations performed on seven patients attending the Oral Unit of the Glasgow Dental Hospital and School with unusual cases of erythema multiforme: all had recurrent episodes of equal severity, and none had a history of exposure to recognized causative factors. As part of an extensive search for possible precipitating agents, the patients were subjected to patch testing using a variety of substances including food additives. All seven were found to be sensitive to the preservative benzoic acid, and five were found to react to other substances as well. Benzoic acid is used in jam, salad cream, soft drinks, fruit pulp, and pickled produce; small amounts occur naturally in a variety of fruits and types of honey. Varying degrees of exacerbation of oral symptoms of erythema multiforme occurred during patch testing. All patients were placed on a diet free from benzoic acid and benzoates and advised on how to avoid the other substances to which they were sensitive. Four patients adhered conscientiously to the dietary restrictions; none suffered recurrences during 6-30 months of follow-up. The three patients who found it difficult to maintain the diet all suffered recurrences and associated these episodes with known exposure to benzoic acid or benzoates. The findings indicate that benzoic acid sensitivity, as well as other allergies, may be an important precipitating factor in some patients with recurrent erythema multiforme, and that patch testing is a useful diagnostic tool in such cases.

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