Recent Updates in the Treatment of Erythema Multiforme.

Alexa Soares,Olayemi Sokumbi

doi:10.3390/medicina57090921

Abstract

Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. EM can be confused with other more serious conditions like Stevens–Johnson syndrome (SJS); however, clinical research has provided significant evidence to classify EM and SJS as separate disorders. Treatment of EM is highly variable, depending on the etiology, the involvement of mucosal sites, and the chronicity (acute vs. recurring) of the disease. If the etiology or causal medication/infection is identified, then the medication is stopped and/or the infection is treated prior to initiating symptomatic treatment. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials

Highlights

Erythema multiforme (EM) is a cutaneous, and sometimes mucocutaneous condition that is typically precipitated by viral infections, most commonly herpes simplex virus (HSV), and the use of specific medications [1,2,3,4]
Treatment for acute or isolated cases of EM typically do not need intervention, but in cases where patients are experiencing uncomfortable symptoms, topical steroids, antiseptics, and oral antihistamines are recommended
Little evidence has been published regarding the treatment of EM

Summary

Introduction

Erythema multiforme (EM) is a cutaneous, and sometimes mucocutaneous condition that is typically precipitated by viral infections, most commonly herpes simplex virus (HSV), and the use of specific medications [1,2,3,4]. Clinical literature over the past decade has provided significant evidence that supports EM major as a completely separate condition from SJS that share similar mucosal lesions but distinctly different cutaneous lesions [6,7]. Complex apthosis, and a high dietary intake of benzoic acid (a food preservative) [1,4,11] It is unclear how many cases of EM that are initially determined to be idiopathic have an underlying or subclinical infection with HSV [12,13,14]. For non-responsive EM, another antiviral medication may be substituted, or the dose of the current antiviral doubled

Acute EM

Mucosal EM

Recurrent EM

Findings

Summary