Materiały źródłowe

• #1 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. […] 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.

• #1

  https://111.wales.nhs.uk/erythemamultiforme/

  Erythema multiforme usually gets better on its own in 2 to 4 weeks. […] Sometimes, you may need: moisturisers or steroid creams to speed up recovery and help ease symptoms like itching […] treatment for the infection that’s causing it, such as antiviral medicine for a virus.

• #1 Erythema Multiforme Treatment & Management: Approach Considerations, Medical Care, Hospitalization

  https://emedicine.medscape.com/article/1122915-treatment

  Mild cases of erythema multiforme (EM) require only symptomatic treatment in the emergency department (ED), which may include analgesics or nonsteroidal inflammatory drugs (NSAIDs); cold compresses with saline or Burrow solution; topical steroids; and soothing oral treatments (eg, saline gargles, viscous lidocaine, and diphenhydramine elixir). […] In the severe cases of EM major, aggressive monitoring and replacement of fluids and electrolytes as necessary are of paramount importance. Supportive respiratory care, including suctioning and postural drainage, should be provided as necessary. […] The cause of EM should be identified, if possible. If a drug is suspected, it must be withdrawn as soon as possible. This includes all medications begun during the preceding 2 months. All unnecessary medications should be discontinued.

• #1 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Treatment is often not needed as episodes are typically self-limiting with no ongoing complications. However, ocular involvement should always prompt ophthalmology referral given the risk for more serious sequelae. […] Treatment of symptomatic mild cases: Itch oral antihistamines and/or topical steroids for itch or discomfort associated with cutaneous lesions; Pain for mild mucosal involvement, oral washes containing antiseptic or local anaesthetic. […] Other treatments are dependent on cause: Precipitating infections treat appropriately (note treatment of HSV does not significantly alter the course of single episode erythema multiforme); Offending medications cease and avoid in future. […] Severe mucosal disease: May require hospital admission for support of oral intake; Although evidence is limited, prednisone has been suggested to reduce the severity and duration of symptoms in these cases.

• #1 Management of Erythema Multiforme in the Urgent Care Setting – Journal of Urgent Care Medicine

  https://www.jucm.com/management-of-erythema-multiforme-in-the-urgent-care-setting/

  In mild cases, cold compresses and topical steroids can be used. Severe skin lesions should be treated as heat burns; 5% aluminum subacetate (Domeboro) solutions should be used and nonadherent dressings should be applied. […] Viscous lidocaine or lidocaine gel can be used for pain relief in oral lesions. Diphenhydramine elixir may also be useful for oral lesions. Antibiotics may be necessary if secondary infections are suspected. A bland liquid diet may be necessary if eating and drinking are compromised by pain. […] Systemic corticosteroids may be considered in severe cases, though their use remains controversial. A one- to three-week course of prednisone is usually used. Prednisone (40 mg/day to 80 mg/day) is continued until control is achieved and is then tapered rapidly over a week. Treatment with prednisone may be successful in aborting a recurrence.

• #1 Recent Updates in the Treatment of Erythema Multiforme

  https://www.mdpi.com/1648-9144/57/9/921

  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. […] In severe disease with extensive mucosal involvement, hospitalization is generally recommended due to limited oral intake. Administration of intravenous fluids and electrolyte replacement are recommended. Additionally, systemic glucocorticoid therapy may be used, most commonly, prednisone 40–60 mg/d, tapered over 2–4 weeks. […] In both HSV-associated EM and idiopathic EM, the first-line treatment is antiviral prophylaxis. Current recommendations include acyclovir, 400 mg, twice daily, valacyclovir, 500 mg, twice daily, or famciclovir, 250 mg, twice daily. […] Patients with recurrent EM that are unresponsive to antiviral therapy can try other antiviral drugs or double the dosage of the current drug. Additionally, other systemic agents may be used.

• #1 Erythema Multiforme Treatment & Management: Approach Considerations, Medical Care, Hospitalization

  https://emedicine.medscape.com/article/1122915-treatment

  Infections should be appropriately treated after cultures or serologic tests have been performed. The use of liquid antiseptics (eg, 0.05% chlorhexidine) during bathing helps prevent superinfection. Topical treatment, including that for genital involvement, may be performed with a gauze dressing or a hydrocolloid. […] Local supportive care for eye involvement is important and includes topical lubricants for dry eyes, sweeping of conjunctival fornices, and removal of fresh adhesions. […] Suppression of herpes simplex virus (HSV) can prevent HSV-associated EM, but antiviral treatment started after the eruption of EM has no effect on the course of EM. […] Analgesics should be administered as needed to control pain, which may be severe. Topical corticosteroids are useful for outpatient treatment of patients with limited disease. Systemic corticosteroid therapy is controversial in EM, and some believe it may predispose to complications. If given, the course should be limited to 10 days to 2 weeks.

• #1 Erythema Multiforme: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0715/p82.html

  Recurrent HSV-associated erythema multiforme can be treated with continuous prophylactic antiviral therapy. […] Options include acyclovir (400 mg twice per day), valacyclovir (Valtrex; 500 mg twice per day), or famciclovir (250 mg twice per day), but there are insufficient studies to determine the recommended duration of treatment. […] For patients who do not respond to antiviral medications, a variety of other treatment options include immunosuppressives, antimalarials, corticosteroids, and others. […] A small study indicated thalidomide as a treatment for reducing the duration of erythema multiforme flare-ups, but further research is encouraged.

• #1 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Recurrent disease: At least 6 months of continuous oral antiviral therapy (typically acyclovir/aciclovir), even if a clear cause has not been identified; Remission can be difficult to achieve; may require trial of more prolonged therapy or alternative antiviral; Other systemic agents used (with variable evidence) for antiviral-resistant cases include azathioprine, dapsone, mycophenolate mofetil, and antimalarials.

• #1 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  Recurrent EM is the most difficult type of EM to treat due to its refractory nature. In both HSV-associated EM and idiopathic EM, the first-line treatment is antiviral prophylaxis. Current recommendations include acyclovir, 400 mg, twice daily, valacyclovir, 500 mg, twice daily, or famciclovir, 250 mg, twice daily. These medications can be administered orally in either a continuous or intermittent fashion. […] Patients with recurrent EM that are unresponsive to antiviral therapy can try other antiviral drugs or double the dosage of the current drug. Additionally, other systemic agents may be used. […] There are no randomized controlled trials to support the efficacy of the treatments described above. Most of these recommendations are derived from case series and expert opinion. Treatment options must be carefully weighed, considering the various adverse effects that are possible with each therapy and their variable efficacies.

• #1 Erythema Multiforme: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24475-erythema-multiforme

  Treatment for erythema multiforme isn’t always necessary, as symptoms can resolve on their own. If you need treatment, it could include: […] Using topical corticosteroids or oral antihistamines for itching. […] Using eye drops if symptoms affect your eyes. […] Applying topical anesthetics or oral numbing medicine for pain. […] Eating a soft or liquid diet if lesions in your mouth make eating difficult. […] Rinsing your mouth with a warm saltwater solution. […] Taking antibiotics or antiviral medications if you have an infection. […] Stopping a medication that causes erythema multiforme. […] Medications can help treat recurring symptoms of erythema multiforme, especially if symptoms arise after a herpes flare. Common medicines to treat erythema multiforme include: […] Acyclovir. […] Valacyclovir. […] Famciclovir. […] Follow your provider’s treatment plan to reduce your symptoms. […] To prevent itching, use a topical cream or ointment to soothe your skin. […] If you have frequent flare-ups, talk to your provider about ways to reduce the frequency of your flares.

• #1 Erythema multiforme – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/erythema-multiforme/

  Recurrent attacks may be a problem. If they always follow a cold sore and come up several times a year, then it may be worth taking a small twice daily dose of a drug called aciclovir which is designed to suppress the herpes simplex virus (the virus responsible for cold sores) for several months. […] Secondary bacterial infections may occur in the site of rash, which can be treated with appropriate antibiotics. […] Scarring around mouth may cause restriction to mouth movements. To prevent this, if the rash involves the mouth, regular mouth opening exercises can be beneficial. […] If you have had one attack of EM, remember there is a risk that you will have another. […] If a medication was suspected to be the cause, it is vital that this is avoided in the future. […] If your attacks follow cold sores, you may want to ask your doctor about taking antiviral tablets long-term. […] Sun exposure can trigger herpes simplex virus (cold sore). To reduce the risk of reactivation it is advised to regularly apply sunscreen. This helps shield your skin from the sun, which can decrease the number of flare-ups.

• #1 Erythema Multiforme: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0715/p82.html

  Continuous prophylactic antiviral treatment is recommended for recurrent herpes simplex virus-associated erythema multiforme. […] When a recent infection or drug is the cause of the erythema multiforme eruption, treat the infection or discontinue the medication. Manage acute, uncomplicated erythema multiforme with symptomatic treatment using topical steroids or antihistamines. […] If HSV is the cause, expert opinion recommends early administration of oral acyclovir to reduce the severity and duration of the erythema multiforme eruption. […] Mucosal erythema multiforme may be very painful. Based on expert opinion and case series, treatment options include high-potency topical corticosteroid gel and oral antiseptic or anesthetic solutions. […] Month-long prednisone tapers can be initiated for patients with severe symptoms, but no controlled studies have supported this treatment.

• #1 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  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. In acute HSV-induced EM, antiviral suppressive therapy can be used, however, several studies have suggested that the administration of antiviral therapy in this context does not alter the clinical course of the disease. […] Treatment for EM with mucosal involvement largely depends on the degree of severity. In mild or moderate disease, high-potency topical corticosteroid gel is used along with oral antiseptic washes and oral anesthetic solutions. In severe disease with extensive mucosal involvement, hospitalization is generally recommended due to limited oral intake. Administration of intravenous fluids and electrolyte replacement are recommended. Additionally, systemic glucocorticoid therapy may be used, most commonly, prednisone 40-60 mg/d, tapered over 24 weeks.

• #1 Recent Updates in the Treatment of Erythema Multiforme

  https://www.mdpi.com/1648-9144/57/9/921

  Antibiotics, azithromycin, and dapsone specifically, have both produced clinical improvement in patients with recurrent EM. […] A small case series reported complete response to thalidomide in 6 out of 7 enrolled patients who had been diagnosed with persistent EM major and were resistant to treatment with acyclovir and corticosteroids. […] Immunosuppressants such as adalimumab and rituximab have garnered more interest recently due to their promising success in some case series. […] High-quality evidence is needed to create a more structured and reliable framework for treating EM.

• #1 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  Treatment modalities differ for acute and recurrent disease. In acute disease, treatment is rarely needed as the lesions will typically regress over the course of several weeks, and supportive treatment is focused on improving symptoms. In recurrent EM, treatment focuses on addressing the etiology through systemic antiviral prophylactic therapy. Refractory or resistant disease is more difficult to treat, generally relying on systemic immunosuppression. […] Most of the treatment recommendations for EM are based on small case series or expert opinion. There have been few clinical trials. Prior to treatment, the etiology should be determined. If there is evidence of a recent infection, then treating the infection is the first step in management. Similarly, if there is evidence that the EM is caused by a medication, discontinuing the medication is the initial step. Once the etiology has been addressed, acute EM can be managed with topical steroids or antihistamines, if needed to improve symptoms. In the case of HSV-induced EM, some experts recommend early intervention with oral acyclovir to reduce disease duration and symptomaticity.

• #1 Erythema Multiforme Treatment & Management: Approach Considerations, Medical Care, Hospitalization

  https://emedicine.medscape.com/article/1122915-treatment

  EM major may warrant hospitalization for the treatment of complications and sequelae (eg, in cases of severe mucous membrane involvement, impaired oral intake, dehydration, or secondary infection) and to manage the patient’s fluid and electrolytes. […] Proper skin care is essential during the healing process, which usually takes about 2 weeks. […] During the healing process, which usually takes about 2 weeks, proper skin care is essential. […] Once the patient has stabilized in the ICU or burn unit, the peak of disease progression has passed, and reepithelialization has begun, transfer to a regular surgical ward may be appropriate. […] After the acute period of illness has passed and the patient has survived, mucous membrane sequelae may warrant surgical intervention. […] If the patient was hospitalized, the medical professional(s) who provided treatment during that time should see the patient regularly and provide symptomatic relief as needed. […] Once EM due to a drug has been diagnosed, the patient should never be rechallenged with the same drug or any other drug of the same class or similar chemical structure.

• #2 Recent Updates in the Treatment of Erythema Multiforme

  https://www.mdpi.com/1648-9144/57/9/921

  Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. […] 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.

• #2 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470259/

  Erythema multiforme is a self-limiting condition that usually resolves without significant complications; however, a limited number of cases become persistent. Treatment focuses on managing symptoms and preventing recurrence, often through antiviral therapy for recurrent herpes-related cases. […] The first step in managing erythema multiforme is to remove the underlying cause, eg, discontinuing the medication that could have triggered the reaction. Etiological treatment must be instituted when a cause is identified. Mycoplasma pneumoniae infection should be treated with antibiotics without waiting for the results of the bacteriological examinations, especially if a cough or radiological evidence is present. Some studies suggest treating herpes with acyclovir or valacyclovir if it is suspected.

• #2 Erythema Multiforme: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24475-erythema-multiforme

  Treatment for erythema multiforme isn’t always necessary, as symptoms can resolve on their own. If you need treatment, it could include: […] Using topical corticosteroids or oral antihistamines for itching. […] Using eye drops if symptoms affect your eyes. […] Applying topical anesthetics or oral numbing medicine for pain. […] Eating a soft or liquid diet if lesions in your mouth make eating difficult. […] Rinsing your mouth with a warm saltwater solution. […] Taking antibiotics or antiviral medications if you have an infection. […] Stopping a medication that causes erythema multiforme. […] Medications can help treat recurring symptoms of erythema multiforme, especially if symptoms arise after a herpes flare. Common medicines to treat erythema multiforme include: […] Acyclovir. […] Valacyclovir. […] Famciclovir. […] Follow your provider’s treatment plan to reduce your symptoms. […] To prevent itching, use a topical cream or ointment to soothe your skin. […] If you have frequent flare-ups, talk to your provider about ways to reduce the frequency of your flares.

• #2 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  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. In acute HSV-induced EM, antiviral suppressive therapy can be used, however, several studies have suggested that the administration of antiviral therapy in this context does not alter the clinical course of the disease. […] Treatment for EM with mucosal involvement largely depends on the degree of severity. In mild or moderate disease, high-potency topical corticosteroid gel is used along with oral antiseptic washes and oral anesthetic solutions. In severe disease with extensive mucosal involvement, hospitalization is generally recommended due to limited oral intake. Administration of intravenous fluids and electrolyte replacement are recommended. Additionally, systemic glucocorticoid therapy may be used, most commonly, prednisone 40-60 mg/d, tapered over 24 weeks.

• #2 Erythema multiforme: Pictures, causes, treatment, and more

  https://www.medicalnewstoday.com/articles/323801

  Erythema multiforme minor usually resolves by itself, but treatment is sometimes necessary. A doctor might prescribe topical steroids if symptoms persist. […] Erythema multiforme major requires treatment. People with oozing lesions will need bandages and pain relief medications. […] If a person is losing a lot of fluid from the blisters, they need to rehydrate. If drinking is painful due to mouth lesions, they may need to receive intravenous fluids through an IV line possibly in a hospital setting if the lesions are extensive. Doctors might also prescribe steroids, mouthwashes with topical anesthetic, and eye drops. […] If HSV causes the skin reaction, some doctors suggest using an oral antiviral medication called acyclovir. Acyclovir can be particularly beneficial as a preventive method for recurrent cases of erythema multiforme resulting from HSV. […] If M. pneumoniae infection is responsible for the rash, doctors may prescribe antibiotics such as a macrolide, tetracycline, or azithromycin.

• #2 Erythema multiforme

  https://www.pcds.org.uk/clinical-guidance/erythema-multiforme

  EM is self-limiting, usually resolving without complications, and is now regarded as distinct from Stevens-Johnson syndrome and toxic epidermal necrolysis. […] Supportive treatment is all that is required for the majority. […] Usually requires the early help of an ophthalmologist. […] Recurrent cases of moderate-severe mucosal lesions – provide a mouth wash, and for those already on prophylactic aciclovir, consider prednisolone starting at 40 mg OD and reducing down over 10-14 days. […] In more severe cases, eg EM major, hospital admission is usually required for intensive nursing care. The role of systemic steroids remains controversial. […] Recurrent EM secondary to herpes simplex should be treated with prophylactic oral aciclovir. The standard adult dose is 400 mg BD, in children the dose is 10 mg/kg/day in divided doses. Even in patients where herpes simplex appears absent, if attacks are multiple consider prophylactic aciclovir as some cases of herpes simplex are believed to be subclinical. Patients may require prophylactic treatment for 1-2 years or longer. […] If EM is felt to be secondary to a drug, then it should be withdrawn.

• #2 Erythema Multiforme Treatment & Management: Approach Considerations, Medical Care, Hospitalization

  https://emedicine.medscape.com/article/1122915-treatment

  Prophylaxis for recurrence of herpes-associated EM (HAEM) should be considered in patients with more than five attacks per year. Oral acyclovir in a dosage of 200 mg qd to 400 mg bid can be effective for recurrence of HAEM, even in subclinical herpes simplex virus (HSV) infection. […] Alternative treatments for erythema multiforme include dapsone, antimalarials, azathioprine, cimetidine, and thalidomide. Beneficial effects with hemodialysis, plasmapheresis, cyclosporin, immunoglobulin, levamisole, thalidomide, dapsone, apremilast, adalimumab, and cyclophosphamide have been documented in case reports. […] Empiric antibiotics are indicated if clinical evidence of secondary infection exists. Prophylactic antibiotics are not recommended, because of the increased likelihood of selecting out resistant strains.

• #2 Erythema multiforme – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/erythema-multiforme/

  Recurrent attacks may be a problem. If they always follow a cold sore and come up several times a year, then it may be worth taking a small twice daily dose of a drug called aciclovir which is designed to suppress the herpes simplex virus (the virus responsible for cold sores) for several months. […] Secondary bacterial infections may occur in the site of rash, which can be treated with appropriate antibiotics. […] Scarring around mouth may cause restriction to mouth movements. To prevent this, if the rash involves the mouth, regular mouth opening exercises can be beneficial. […] If you have had one attack of EM, remember there is a risk that you will have another. […] If a medication was suspected to be the cause, it is vital that this is avoided in the future. […] If your attacks follow cold sores, you may want to ask your doctor about taking antiviral tablets long-term. […] Sun exposure can trigger herpes simplex virus (cold sore). To reduce the risk of reactivation it is advised to regularly apply sunscreen. This helps shield your skin from the sun, which can decrease the number of flare-ups.

• #2 Recent Updates in the Treatment of Erythema Multiforme

  https://www.mdpi.com/1648-9144/57/9/921

  Antibiotics, azithromycin, and dapsone specifically, have both produced clinical improvement in patients with recurrent EM. […] A small case series reported complete response to thalidomide in 6 out of 7 enrolled patients who had been diagnosed with persistent EM major and were resistant to treatment with acyclovir and corticosteroids. […] Immunosuppressants such as adalimumab and rituximab have garnered more interest recently due to their promising success in some case series. […] High-quality evidence is needed to create a more structured and reliable framework for treating EM.

• #2 Erythema Multiforme: Symptoms and Treatment | Doctor

  https://patient.info/doctor/erythema-multiforme-pro

  If a drug is thought to be responsible, it must be withdrawn. If an infection is suspected, it should be treated. […] In recurrent disease due to HSV, antiviral therapy is beneficial. […] Symptomatic treatment may include analgesics, mouthwash and local skin care. Steroid creams may be used. […] It may be helpful to emphasise to patients or parents that, although an underlying infection may be contagious, EM itself is not. […] If the mouth is very sore, attention may have to be given to hydration and nutrition. […] Dilute antiseptics, such as chlorhexidine, may help to prevent secondary infection. Lubricating drops for the eyes may be required. […] Where erythema multiforme is severe and refractory, biologic agents such as thalidomide, anti-TNF, apremilast, rituximab, and JAK inhibitors have been shown to have some benefit.

• #2 Erythema Multiforme Treatment & Management: Approach Considerations, Medical Care, Hospitalization

  https://emedicine.medscape.com/article/1122915-treatment

  Infections should be appropriately treated after cultures or serologic tests have been performed. The use of liquid antiseptics (eg, 0.05% chlorhexidine) during bathing helps prevent superinfection. Topical treatment, including that for genital involvement, may be performed with a gauze dressing or a hydrocolloid. […] Local supportive care for eye involvement is important and includes topical lubricants for dry eyes, sweeping of conjunctival fornices, and removal of fresh adhesions. […] Suppression of herpes simplex virus (HSV) can prevent HSV-associated EM, but antiviral treatment started after the eruption of EM has no effect on the course of EM. […] Analgesics should be administered as needed to control pain, which may be severe. Topical corticosteroids are useful for outpatient treatment of patients with limited disease. Systemic corticosteroid therapy is controversial in EM, and some believe it may predispose to complications. If given, the course should be limited to 10 days to 2 weeks.

• #2 Erythema Multiforme — Advanced Dermatology

  https://www.advanced-dermatology.com.au/erythema-multiforme

  To prevent erythema multiforme, good hygiene will be needed. This will help to prevent any secondary infections. Use sunscreen to prevent hyperpigmentation. A Zinc sulfate solution can also be applied to the site of the herpes simplex to prevent any relapse from happening. A daily dose of prescribed oral antiviral medication may be needed to prevent and manage erythema multiforme.

• #2 Erythema Multiforme – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-multiforme

  Erythema multiforme is an inflammatory reaction, characterized by target or iris skin lesions. […] Suppressive antiviral therapy may be indicated for patients with frequent or symptomatic recurrence due to herpes simplex virus. […] Erythema multiforme spontaneously resolves, so treatment is usually unnecessary. Topical corticosteroids and anesthetics and oral antihistamines may ameliorate symptoms and reassure patients, but sometimes antivirals are needed. […] Recurrences are common, and empiric oral maintenance therapy with antiherpetic medications such as acyclovir 400 mg orally every 12 hours, famciclovir 250 mg orally every 12 hours, or valacyclovir 1000 mg orally every 24 hours can be attempted if symptoms recur more than 5 times/year and HSV association is suspected or if recurrent erythema multiforme is consistently preceded by herpes flares. […] Treat erythema multiforme supportively and consider prophylactic antiviral medications if HSV is the suspected cause and recurrences are frequent.

• #2 Management of Erythema Multiforme in the Urgent Care Setting – Journal of Urgent Care Medicine

  https://www.jucm.com/management-of-erythema-multiforme-in-the-urgent-care-setting/

  In mild cases, cold compresses and topical steroids can be used. Severe skin lesions should be treated as heat burns; 5% aluminum subacetate (Domeboro) solutions should be used and nonadherent dressings should be applied. […] Viscous lidocaine or lidocaine gel can be used for pain relief in oral lesions. Diphenhydramine elixir may also be useful for oral lesions. Antibiotics may be necessary if secondary infections are suspected. A bland liquid diet may be necessary if eating and drinking are compromised by pain. […] Systemic corticosteroids may be considered in severe cases, though their use remains controversial. A one- to three-week course of prednisone is usually used. Prednisone (40 mg/day to 80 mg/day) is continued until control is achieved and is then tapered rapidly over a week. Treatment with prednisone may be successful in aborting a recurrence.

• #2 Erythema Multiforme – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/erythema-multiforme/

  Treatment depends on the form of EM. Considering the self-limiting nature of the condition and unidentifiable aetiology in many, specific treatment is available for few patients. Systemic antiinflammatory/immunoregulating agents seems to be the most effective treatment to control oral EM. In particular, prednisone is the most frequently used drug, sometimes associated with azathioprine. Frequently the shortness of the therapy (a full dose of prednisone for 3 days only and then taper the dose) does not require additional azathioprine. In the case of oral EM, topical corticosteroids (fluocinonide or clobetasol in adhesive base) can be useful. However, given the frequent wide extent of the oral lesions and the high prevalence of extra-oral lesions, systemic drugs are often used. […] Anti-viral drugs are justified in cases of proved HSV involvement. In SJS and TEN it is mandatory to identify and withdraw the suspected drug. Systemic corticosteroids may be used for the treatment of the SJS. TEN must be treated in a hospital able to manage scalded patients. There is no agreement on the usefulness of high doses of systemic corticosteroids or the effectiveness of other treatment, such as plasmapheresis, hyperbaric oxygen therapy or other immunomodulating drugs such as azathioprine, cyclophosphamide, ciclosporin or high-dose intravenous immunoglobulins.

• #2 Erythema Multiforme: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0715/p82.html

  Erythema multiforme can be differentiated from urticaria by the duration of individual lesions. Erythema multiforme lesions are typically fixed for a minimum of seven days, whereas individual urticarial lesions often resolve within one day. […] The management of erythema multiforme involves symptomatic treatment with topical steroids or antihistamines and treating the underlying etiology, if known. […] Recurrent erythema multiforme associated with the herpes simplex virus should be treated with prophylactic antiviral therapy. […] Severe mucosal erythema multiforme can require hospitalization for intravenous fluids and repletion of electrolytes. […] Symptomatic treatment with topical steroids or antihistamines is recommended for acute episodes of uncomplicated erythema multiforme. […] Oral anesthetics may be helpful in decreasing the pain of oral erythema multiforme lesions.

• #2 Recent Updates in the Treatment of Erythema Multiforme

  https://www.mdpi.com/1648-9144/57/9/921

  In recurrent EM, treatment focuses on addressing the etiology through systemic antiviral prophylactic therapy. Refractory or resistant disease is more difficult to treat, generally relying on systemic immunosuppression. […] Most of the treatment recommendations for EM are based on small case series or expert opinion. There have been few clinical trials. Prior to treatment, the etiology should be determined. If there is evidence of a recent infection, then treating the infection is the first step in management. Similarly, if there is evidence that the EM is caused by a medication, discontinuing the medication is the initial step. Once the etiology has been addressed, acute EM can be managed with topical steroids or antihistamines, if needed to improve symptoms. […] In the case of HSV-induced EM, some experts recommend early intervention with oral acyclovir to reduce disease duration and symptomaticity.

• #2 Erythema Multiforme – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470259/

  Topical treatment for erythema multiforme includes antiseptics for bullous lesions, antiseptic mouthwashes, and anesthetic agents for pain relief. Vaseline for the lips and vitamin A ointment for the eyes support healing, particularly for mucosal involvement. […] While systemic corticosteroids and intravenous immunoglobulins have been explored, limited evidence supports their effectiveness. […] Herpes is the most common cause of recurrent erythema multiforme. Even if specimens have not established the evidence, long-term treatment with acyclovir or valacyclovir should be proposed. […] In nonresponsive cases, immunomodulation may be required with medications including mycophenolate mofetil, dapsone, or azathioprine. […] Severe cases of erythema multiforme will require hospital admission to manage complications, dehydration, and infection, which are best handled in an intensive care facility.

• #2 Management of Erythema Multiforme in the Urgent Care Setting – Journal of Urgent Care Medicine

  https://www.jucm.com/management-of-erythema-multiforme-in-the-urgent-care-setting/

  Treatment for EM minor and EM major is basically similar. However, oral and ocular care may be an additional necessity if mucous membranes are involved in EM major. An emergency dermatologic consultation is indicated if it is unclear whether a patient has TEN, SJS, or EM. A dermatologic consultation, and possibly a subsequent skin biopsy, may also be necessary. The underlying cause, if identified, should be treated. If a medication is suspected, then it should be discontinued. Generally, mild cases are not treated. Symptomatic treatment involving oral antihistamines and analgesics is usually effective. Patients with mild symptoms are usually treated as outpatients. […] Patients with severe cases should be admitted to a burn unit. Dehydration may also be severe. The clinician should be vigilant in monitoring electrolyte imbalances. Antibiotics may be necessary if secondary infection of lesions is suspected.

• #2 Erythema Multiforme Treatment & Management: Approach Considerations, Medical Care, Hospitalization

  https://emedicine.medscape.com/article/1122915-treatment

  EM major may warrant hospitalization for the treatment of complications and sequelae (eg, in cases of severe mucous membrane involvement, impaired oral intake, dehydration, or secondary infection) and to manage the patient’s fluid and electrolytes. […] Proper skin care is essential during the healing process, which usually takes about 2 weeks. […] During the healing process, which usually takes about 2 weeks, proper skin care is essential. […] Once the patient has stabilized in the ICU or burn unit, the peak of disease progression has passed, and reepithelialization has begun, transfer to a regular surgical ward may be appropriate. […] After the acute period of illness has passed and the patient has survived, mucous membrane sequelae may warrant surgical intervention. […] If the patient was hospitalized, the medical professional(s) who provided treatment during that time should see the patient regularly and provide symptomatic relief as needed. […] Once EM due to a drug has been diagnosed, the patient should never be rechallenged with the same drug or any other drug of the same class or similar chemical structure.

• #2 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  Treatment modalities differ for acute and recurrent disease. In acute disease, treatment is rarely needed as the lesions will typically regress over the course of several weeks, and supportive treatment is focused on improving symptoms. In recurrent EM, treatment focuses on addressing the etiology through systemic antiviral prophylactic therapy. Refractory or resistant disease is more difficult to treat, generally relying on systemic immunosuppression. […] Most of the treatment recommendations for EM are based on small case series or expert opinion. There have been few clinical trials. Prior to treatment, the etiology should be determined. If there is evidence of a recent infection, then treating the infection is the first step in management. Similarly, if there is evidence that the EM is caused by a medication, discontinuing the medication is the initial step. Once the etiology has been addressed, acute EM can be managed with topical steroids or antihistamines, if needed to improve symptoms. In the case of HSV-induced EM, some experts recommend early intervention with oral acyclovir to reduce disease duration and symptomaticity.

• #2 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Recurrent disease: At least 6 months of continuous oral antiviral therapy (typically acyclovir/aciclovir), even if a clear cause has not been identified; Remission can be difficult to achieve; may require trial of more prolonged therapy or alternative antiviral; Other systemic agents used (with variable evidence) for antiviral-resistant cases include azathioprine, dapsone, mycophenolate mofetil, and antimalarials.

• #3 Erythema multiforme – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/erythema-multiforme/

  Erythema multiforme is usually self-limited and resolves spontaneously within a month; symptomatic treatment with antihistamines, and topical steroids is usually sufficient. […] Patients with erythema multiforme major may require systemic glucocorticoids and, in severe cases, IV fluid therapy and specialized nutritional support. […] Treatment is primarily symptomatic. […] Discontinue any offending medications. […] Consider treating any underlying infection (e.g., treatment of HSV infection, antibiotic therapy for M. pneumonie). […] Consider systemic glucocorticoid therapy. […] For patients with erythema multiforme major with severe mucosal involvement, consider: IV fluid therapy and electrolyte repletion (management is similar to that of extensive burns), specialized nutrition support, antibiotic therapy for SSTIs, specialist consultation (e.g., ICU, dermatology, ophthalmology).

• #3 Erythema Multiforme: Recognition and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0715/p82.html

  Erythema multiforme can be differentiated from urticaria by the duration of individual lesions. Erythema multiforme lesions are typically fixed for a minimum of seven days, whereas individual urticarial lesions often resolve within one day. […] The management of erythema multiforme involves symptomatic treatment with topical steroids or antihistamines and treating the underlying etiology, if known. […] Recurrent erythema multiforme associated with the herpes simplex virus should be treated with prophylactic antiviral therapy. […] Severe mucosal erythema multiforme can require hospitalization for intravenous fluids and repletion of electrolytes. […] Symptomatic treatment with topical steroids or antihistamines is recommended for acute episodes of uncomplicated erythema multiforme. […] Oral anesthetics may be helpful in decreasing the pain of oral erythema multiforme lesions.

• #3 Clinical features, diagnosis, and treatment of erythema multiforme

  https://ostrowonline.usc.edu/clinical-features-diagnosis-and-treatment-of-erythema-multiforme/

  Management […] Review the medical history to identify the cause is crucial. If a drug is suspected, contact the prescriber physician after approval, discontinue the medication. If an infection is suspected, consider a consultation with the patients primary physician or infectious disease specialist for appropriate treatment of the infection.[…] When skin is involved, always consider a dermatology consultation.[…] The pharmacological management will depend on the severity and recurrence of the condition:[…] Limited oral mucosal involvement: For alleviating the pain, a mouthwash containing equal parts of viscous lidocaine 2%, diphenhydramine (12.5 mg/5 mL), and aluminum hydroxide and magnesium hydroxide mixture (e.g., Maalox) as a swish-and-spit, can be used as needed, up to four times per day. Dexamethasone (0.5 mg/5 mL) oral elixir 4 times/day swish-and-spit can be used for diffused ulcers. If the ulcers are limited to a small area, fluocinonide 0.05% gel is applied two to three times per day.[…] Extensive oral mucosal involvement: Severe oral mucous membrane involvement that prevents sufficient oral intake consider hospitalization. If hospitalization is not needed, In the first-line treatment is systemic glucocorticoids. Dosage and tapering will depend on the severity of the case and response to the treatment. Azathioprine and dapsone have been reported helpful in several cases.[…] An antiviral suppersion therapy, such as Acyclovir 400mg twice a day, should be considered in recurrent EM associated with HSV.[…] All the above medications have contraindications which the clinician has to be aware of before prescription.

• #3 Recent Updates in the Treatment of Erythema Multiforme

  https://www.mdpi.com/1648-9144/57/9/921

  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. […] In severe disease with extensive mucosal involvement, hospitalization is generally recommended due to limited oral intake. Administration of intravenous fluids and electrolyte replacement are recommended. Additionally, systemic glucocorticoid therapy may be used, most commonly, prednisone 40–60 mg/d, tapered over 2–4 weeks. […] In both HSV-associated EM and idiopathic EM, the first-line treatment is antiviral prophylaxis. Current recommendations include acyclovir, 400 mg, twice daily, valacyclovir, 500 mg, twice daily, or famciclovir, 250 mg, twice daily. […] Patients with recurrent EM that are unresponsive to antiviral therapy can try other antiviral drugs or double the dosage of the current drug. Additionally, other systemic agents may be used.

• #3 Erythema Multiforme – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-multiforme

  Erythema multiforme is an inflammatory reaction, characterized by target or iris skin lesions. […] Suppressive antiviral therapy may be indicated for patients with frequent or symptomatic recurrence due to herpes simplex virus. […] Erythema multiforme spontaneously resolves, so treatment is usually unnecessary. Topical corticosteroids and anesthetics and oral antihistamines may ameliorate symptoms and reassure patients, but sometimes antivirals are needed. […] Recurrences are common, and empiric oral maintenance therapy with antiherpetic medications such as acyclovir 400 mg orally every 12 hours, famciclovir 250 mg orally every 12 hours, or valacyclovir 1000 mg orally every 24 hours can be attempted if symptoms recur more than 5 times/year and HSV association is suspected or if recurrent erythema multiforme is consistently preceded by herpes flares. […] Treat erythema multiforme supportively and consider prophylactic antiviral medications if HSV is the suspected cause and recurrences are frequent.

• #3 Management of Erythema Multiforme in the Urgent Care Setting – Journal of Urgent Care Medicine

  https://www.jucm.com/management-of-erythema-multiforme-in-the-urgent-care-setting/

  Acyclovir may be considered for prophylaxis for patients with more than five episodes per year. Doses are 400 mg twice a day, usually for six months. In children, a dose of 10 mg/kg/day is used. Herpes-associated EM is not prevented if oral acyclovir is administered after a herpes simplex recurrence is evident, and it is of no value after EM has occurred. Famciclovir and valacyclovir may be considered in patients resistant to acyclovir. […] If all the above treatments fail, thalidomide (100 mg/day), cyclosporine, immunoglobulins (0.75 g/kg/d for four days), azathioprine (100 to 150 mg/day), dapsone (100 to 150 mg/day), or interferon alpha can be tried.

• #3 Erythema multiforme – DermNet

  https://dermnetnz.org/topics/erythema-multiforme

  Treatment is often not needed as episodes are typically self-limiting with no ongoing complications. However, ocular involvement should always prompt ophthalmology referral given the risk for more serious sequelae. […] Treatment of symptomatic mild cases: Itch oral antihistamines and/or topical steroids for itch or discomfort associated with cutaneous lesions; Pain for mild mucosal involvement, oral washes containing antiseptic or local anaesthetic. […] Other treatments are dependent on cause: Precipitating infections treat appropriately (note treatment of HSV does not significantly alter the course of single episode erythema multiforme); Offending medications cease and avoid in future. […] Severe mucosal disease: May require hospital admission for support of oral intake; Although evidence is limited, prednisone has been suggested to reduce the severity and duration of symptoms in these cases.

• #3 Erythema multiforme Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/erythema-multiforme

  Erythema multiforme (EM) is an acute skin reaction that comes from an infection or another trigger. EM is a self-limiting condition. This means it usually resolves on its own without treatment. […] EM usually goes away on its own with or without treatment. Your provider will have you stop taking any medicines that may be causing the problem. But, don’t stop taking medicines on your own without talking to your provider first. Treatment may include: […] Medicines, such as antihistamines, to control itching […] Moist compresses applied to the skin […] Pain medicines to reduce fever and discomfort […] Mouthwashes to ease discomfort of mouth sores that interferes with eating and drinking […] Antibiotics for skin infections […] Corticosteroids to control inflammation […] Medicines for eye symptoms. Good hygiene may help prevent secondary infections (infections that occur from treating the first infection). Use of sunscreen, protective clothing, and avoiding excessive exposure to sun may prevent the recurrence of EM.

• #3 Recent Updates in the Treatment of Erythema Multiforme

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8467974/

  Recurrent EM is the most difficult type of EM to treat due to its refractory nature. In both HSV-associated EM and idiopathic EM, the first-line treatment is antiviral prophylaxis. Current recommendations include acyclovir, 400 mg, twice daily, valacyclovir, 500 mg, twice daily, or famciclovir, 250 mg, twice daily. These medications can be administered orally in either a continuous or intermittent fashion. […] Patients with recurrent EM that are unresponsive to antiviral therapy can try other antiviral drugs or double the dosage of the current drug. Additionally, other systemic agents may be used. […] There are no randomized controlled trials to support the efficacy of the treatments described above. Most of these recommendations are derived from case series and expert opinion. Treatment options must be carefully weighed, considering the various adverse effects that are possible with each therapy and their variable efficacies.

• #3 Erythema Multiforme Treatment & Management: Approach Considerations, Medical Care, Hospitalization

  https://emedicine.medscape.com/article/1122915-treatment

  Prophylaxis for recurrence of herpes-associated EM (HAEM) should be considered in patients with more than five attacks per year. Oral acyclovir in a dosage of 200 mg qd to 400 mg bid can be effective for recurrence of HAEM, even in subclinical herpes simplex virus (HSV) infection. […] Alternative treatments for erythema multiforme include dapsone, antimalarials, azathioprine, cimetidine, and thalidomide. Beneficial effects with hemodialysis, plasmapheresis, cyclosporin, immunoglobulin, levamisole, thalidomide, dapsone, apremilast, adalimumab, and cyclophosphamide have been documented in case reports. […] Empiric antibiotics are indicated if clinical evidence of secondary infection exists. Prophylactic antibiotics are not recommended, because of the increased likelihood of selecting out resistant strains.

• #3 Erythema multiforme – Skin Deep

  https://dftbskindeep.com/all-diagnoses/erythema-multiforme/

  Consider hospitalisation if EM occurs with oral lesions severe enough to impair feeding, when a diagnosis of SJS is suspected, or when constitutional symptoms are present. […] General management involves symptomatic treatment with topical steroids, antihistamines and treating the underlying cause. Recurrent EM associated with HSV should be treated with prophylactic antiviral therapy.

• #3 Erythema multiforme: What we know

  https://www.dvm360.com/view/erythema-multiforme-what-we-know

  Every case should be treated on an individual basis (i.e. medication doses can be lowered at different rates). In some patients, medications can be stopped after several months, whereas in others lifelong immunosuppressive therapy may be needed to maintain remission. […] Additional supportive therapy includes prevention and treatment of secondary infection. Bathing once a week with an antimicrobial shampoo can help lower surface bacteria. Oral antimicrobials may be needed if secondary infection is already present; these medications need to be chosen carefully, based on previous antibiotic history, along with results of culture and sensitivity testing. […] The prognosis for patients with EM is variable. If the underlying trigger can be identified and removed, there is a better chance of resolution. In patients with severe cases or those with idiopathic disease, lifelong therapy is more likely to be necessary. Relapse of disease likewise is more common in these patients.

• #3 Recent Updates in the Treatment of Erythema Multiforme

  https://www.mdpi.com/1648-9144/57/9/921

  In recurrent EM, treatment focuses on addressing the etiology through systemic antiviral prophylactic therapy. Refractory or resistant disease is more difficult to treat, generally relying on systemic immunosuppression. […] Most of the treatment recommendations for EM are based on small case series or expert opinion. There have been few clinical trials. Prior to treatment, the etiology should be determined. If there is evidence of a recent infection, then treating the infection is the first step in management. Similarly, if there is evidence that the EM is caused by a medication, discontinuing the medication is the initial step. Once the etiology has been addressed, acute EM can be managed with topical steroids or antihistamines, if needed to improve symptoms. […] In the case of HSV-induced EM, some experts recommend early intervention with oral acyclovir to reduce disease duration and symptomaticity.

• #4 Erythema multiforme

  https://www.pcds.org.uk/clinical-guidance/erythema-multiforme

  EM is self-limiting, usually resolving without complications, and is now regarded as distinct from Stevens-Johnson syndrome and toxic epidermal necrolysis. […] Supportive treatment is all that is required for the majority. […] Usually requires the early help of an ophthalmologist. […] Recurrent cases of moderate-severe mucosal lesions – provide a mouth wash, and for those already on prophylactic aciclovir, consider prednisolone starting at 40 mg OD and reducing down over 10-14 days. […] In more severe cases, eg EM major, hospital admission is usually required for intensive nursing care. The role of systemic steroids remains controversial. […] Recurrent EM secondary to herpes simplex should be treated with prophylactic oral aciclovir. The standard adult dose is 400 mg BD, in children the dose is 10 mg/kg/day in divided doses. Even in patients where herpes simplex appears absent, if attacks are multiple consider prophylactic aciclovir as some cases of herpes simplex are believed to be subclinical. Patients may require prophylactic treatment for 1-2 years or longer. […] If EM is felt to be secondary to a drug, then it should be withdrawn.

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