Management

Treatment depends on the underlying cause. Initial management includes treatment of the suspected infectious disease or to discontinue the causal drug (1).

Some general principles are outlined below:

• secondary infection and dehydration should be prevented - especially if the patient has Stevens-Johnson syndrome or toxic epidermal necrolysis
• itch may be a prominent feature - a combination of a potent topical steroid and an antihistamine may help to relieve this (2)
• oral acyclovir for patients with coexisting or recent HSV infection to reduce the number and duration of cutaneous lesions (1).
• the condition may take up to three weeks to resolve (2)
• recurrent episodes of erythema multiforme are often due to herpes simplex an may respond to long-term treatment with aciclovir. These patients should also be referred to a dermatologist for further treatment (1)
• the role of oral steroids is controversial in this condition

Reference:

• (1) Lamoreux MR et al. Erythema Multiforme. AFP 2006;74(11)
• (2) The Practitioner (2001), 345, 937-41