From the FDA Drug Label
4 Dermatologic Diseases Pemphigus Bullous dermatitis herpetiformis Severe erythema multiforme (Stevens-Johnson syndrome) Exfoliative dermatitis Mycosis fungoides Severe psoriasis Severe seborrheic dermatitis The management of severe erythema multiforme may include treatment with prednisone (PO), as it is indicated for Dermatologic Diseases, specifically severe erythema multiforme (Stevens-Johnson syndrome) 1.
- The use of prednisone for erythema multiforme is as an adjunctive therapy for short-term administration.
- Key words: severe erythema multiforme, prednisone, short-term administration.
From the Research
The management of erythema multiforme primarily focuses on identifying and removing the triggering factor, providing supportive care, and treating symptoms, with the most recent and highest quality study 2 guiding the approach to prioritize symptomatic treatment and addressing underlying causes. The first step in managing erythema multiforme is to discontinue any suspected causative medications and treat underlying infections, particularly herpes simplex virus with antivirals like acyclovir (400 mg orally three times daily for 5-10 days) if HSV is the suspected trigger, as supported by 3 and 2. For symptomatic relief, oral antihistamines such as diphenhydramine (25-50 mg every 4-6 hours) or cetirizine (10 mg daily) can help control itching, and topical corticosteroids like triamcinolone 0.1% cream applied twice daily to affected areas can reduce inflammation and discomfort, as mentioned in 3. Pain management with acetaminophen or NSAIDs is often necessary, and for severe cases, especially those with extensive mucosal involvement, short courses of systemic corticosteroids like prednisone (0.5-1 mg/kg/day for 7-10 days with a taper) may be considered, though their use remains controversial, as discussed in 4 and 2. Patients should maintain good oral hygiene with antiseptic mouthwashes if oral lesions are present and use bland emollients for skin comfort, as recommended in 2. Most cases of erythema multiforme are self-limiting and resolve within 2-4 weeks without scarring, but recurrent episodes, particularly those triggered by HSV, may benefit from prophylactic antiviral therapy, as suggested by 3 and 2. Key considerations in the management of erythema multiforme include:
- Identifying and removing the triggering factor
- Providing supportive care
- Treating symptoms
- Addressing underlying infections
- Maintaining good oral hygiene and skin comfort
- Considering prophylactic antiviral therapy for recurrent episodes, especially those triggered by HSV, as supported by the most recent study 2.