Erythema Multiforme Major caused by topical Imiquimod

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Alexandra Edelman
Mark Jackson
Alfred Knable


Erythema Multiforme, Drug reaction


Erythema multiforme (EM) is an acute, self-limited inflammatory skin disease that is associated with an immune reaction to various triggers, such as herpes simplex virus, Mycoplasma pneumoniae, and medications. Topically applied medications are a rare cause of EM or EM-like eruptions. We report one patient with EM major from imiquimod 5% topical cream. After reviewing the relevant literature, we found eight cases of erythema multiforme induced by topical imiquimod. Of the eight cases of Imiquimod-induced EM, seven patients had a significant local reaction that subsequently led to the more distant cutaneous manifestations of erythema multiforme. Because Imiquimod is a commonly used topical treatment for a variety of dermatologic conditions, clinicians must be aware of this rare but serious complication. Furthermore, patients with an exuberant local reaction to imiquimod may be at higher risk of developing EM. 


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