The first description of this pathology was by Ferdin in 1860. In literature has a relation with a herpes virus, the term multiforme is related to a characteristic of the diseases. Certain medications, autoimmune diseases, radiation, immunization, pregnancy, menstruation, and food or chemical additives [1],[2]. Another frequent occurrence, especially in children, is an association with the bacterium Mycoplasma pneumoniae.

Occurs mainly in young adults and without any predilection [1]. It is also pre-sized, which presents predominantly in the form of adults and mainly edematous distributed mainly in the extremities of the body and EM if larger and more multiform in the form of raised edematous papules, but distributed in the extremities of the body, but the involvement of one or more mucous membranes, less than the involvement of the total body surface area. The occurrence of Stevens-Johnson is related to detachment, in contrast to an index below [3].

EM does Erythema multiforme can be divided into mucosa multiforme EM which does not involve EM of the greater mucosa [4]. Clinically, EM presents erythematous plaques affecting mainly and oral, called target deficiencies, and may progress to vesiculobullous [4],[5],[6].

A female patient, 50-year-old, persistent by otorhinolaryngology for evaluation of lower lip consultation. The clinical presentation showed an ulcerated lesion that extended through the semimucosa and buccal mucosa (Figure 1). She referred an intense pain and can’t eat because of the mouth lesions. The patient had no injuries. With the diagnostic hypothesis of EM, we recommend performing an incisional biopsy that confirmed the clinical diagnosis of EM (Figure 2).

As treatment, topical use of 0.05% clobetasol propionate for 15 days was prescribed on the lesion. The patient returned within seven days with significant improvement in the area (Figure 3). We were decided to follow up and not intervene with systemic corticosteroid therapy. The patient is followed up for 15 months without recurrence of the lesion.

Histopathology

The histopathological analysis of this type of lesion is essential for the diagnosis of the lesion. In this case, the disease is mainly from foot and mouth in children to rule out diagnoses and pemphigus vulgaris. In the slide of the case in question, it was possible to observe and not observe spongiosis presence of intraepithelial cleft, in the tissue there may be an inflammatory infiltrate with the presence of neutrophils and plasma cells (Figure 4).

One of the characteristics that the type of lesion presents is neovascularization, which is present in the connective region just below the epithelium.

Erythema multiforme is a difficult pathology to diagnose and there are few reports in the literature about it. It is an acute inflammatory reaction, related to an immune system response, which can generate hypersensitivity, which is affected. In this case report, the lesion presents with clinical manifestations that affect the skin and mucosa, especially the perioral region. In the literature, this type of symptom can be announced as mild, moderate or severe, related to EM minor.

The mechanisms that describe the pathogenesis of EM have been linked in investigational studies to the herpes simplex virus (V) [2]. However, there are some specific cases in the literature that do not have a specific cause determined, that is, an association with and an association with specific conditions in the multiform literature [7].

Even though the pathogenesis is unknown, there is a tendency to consider minor and major EM as part of a spectrum that is most often identified by infection-John and separate epidermal necrosis most often provoked by drugs with EM major and SJS representing a bridge in the continuum of IN. There are significant differences between minor EM, major SJS EM, and about the severity of their clinical expression, but all variants of combination of two main characteristics in common, simple, or less typical formulas of target deficiency and satellite cell necrosis, mainly not epithelium [3].

As they usually occur in 3–5 days of resolution and disappear the lesions, in more severe cases, may occur in weeks [2],[8]. For some authors, complete and spontaneous resolution may take five weeks [8]. Recurrent episodes of disease may occur, on average, six times a year, lasting from six to ten years [8],[9]. Treatments for EM according to regions the degree of disease in each patient, as there is no specific therapeutic treatment [4].

The treatments used in this type of case vary between the profile of choice of Shah et al. [9] in mild cases, the use of mouthwash should be recommended, and the diet should be soft and liquid. In moderate or severe cases, Erythema multiforme (EM) can be treated with oral corticosteroids or in the form of a solution as a mouthwash in patients without contraindication for a short period, topically, orally, or intravenously [4],[9]. Immunosuppressive drugs such as Dapsone, Azathioprine is showing good results in the regression of the disease [9]. For pediatric patients with suspected herpes simplex, the prescription of Acyclovir is recommended. The use of systemic corticosteroids in the treatment of EM remains controversial, which is why there is still a debate about the administration of these drugs, despite the recommendation for severe cases [10],[11].

According to the histopathology of the established lesions being characterized by dermatitis of vacuolar interface with basocellular degeneration and epidermal dysceratosis. Another main characteristic independent of localization is the presence of superficial perivascular lymphocytic infiltrate with rare eosinophils or neutrophils. Therefore, the administration of corticosteroids is the most widely used drugs in the treatment containing the acute symptomatology of the case [1],[12],[13].

The present case report represents how important the histopathological analysis is necessary in more complex cases to conclude the diagnosis, because in this way the therapeutic approach will be effective. In patients with this type of diagnosis, clinical follow-up is extremely necessary, in order to verify if the cause of the injury was treated and properly solved.