Erythema multiforme - Summary of recommended managements
- The treatment of acute Erythema multiforme varies according to the severity and recurrence.
- Most patients with EM can be managed with symptomatic therapy alone. For patients with cutaneous disease and/or mild oral mucosal involvement, treatment with topical corticosteroids, oral antihistamines, and/or an anesthetic mouthwash is sufficient.
- Severe oral mucosal involvement may be accompanied by intense pain and an inability to eat or drink. For patients with severe oral mucosal involvement, we suggest treatment with oral prednisone (40 to 60 mg/day) tapered over the course of two to four weeks . Patients with disabling symptoms may require hospitalization for nutrition and pain control.
- Ocular involvement rarely may lead to keratitis, conjunctival scarring, or visual impairment. Patients with ocular symptoms should be referred to an ophthalmologist.
- Some patients with EM develop recurrent disease. When feasible, the inciting agent should be identified and eliminated. For patients with HSV-induced or idiopathic EM that recurs ≥6 times per year, or who have fewer, but disabling episodes, A continuous antiviral therapy is recommended.
- Acyclovir — 400 mg twice daily. Low cost approach
- Valacyclovir — 500 mg twice daily. May be better than acyclovir in selected setting
- Famciclovir — 250 mg twice daily
- For patients with severe, recurrent EM who fail to respond to continuous systemic antiviral therapy, other options are mycophenolate mofetil, azathioprine, dapsone etc.
- In general, patients who respond to continuous antiviral therapy should be treated for 1–2 years before therapy is discontinued. When EM recurs after the discontinuation of therapy, medication should be restarted at the lowest effective dose and therapy ,cessation can be reattempted in 6–12 months.
References and suggested readings
Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol. 2012 Aug;51(8):889-902. doi: 10.1111/j.1365-4632.2011.05348.x. Review. PubMed PMID: 22788803.