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 approach for erythema multiforme includes the use of prednisone for severe cases, as indicated in the drug label 1.
- The drug label specifies severe erythema multiforme (Stevens-Johnson syndrome) as one of the conditions for which prednisone is indicated.
- Prednisone is used as part of the management approach for this condition.
From the Research
The management of erythema multiforme primarily focuses on identifying and removing the trigger, providing supportive care, and treating symptoms, with a recent study suggesting that recurrent erythema multiforme presents a good response to acyclovir in monotherapy or in combined therapy with dapsone or thalidomide in the majority of patients 2.
Management Approach
The approach to managing erythema multiforme involves several key steps:
- 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) for HSV-associated cases.
- For symptomatic relief, use oral antihistamines such as diphenhydramine (25-50 mg every 4-6 hours) or cetirizine (10 mg daily) to reduce itching, and acetaminophen (500-1000 mg every 6 hours) or NSAIDs like ibuprofen (400-600 mg every 6-8 hours) for pain and fever.
- Topical corticosteroids (triamcinolone 0.1% cream applied twice daily) can help with localized skin inflammation.
- For oral lesions, use lidocaine rinses or gels for pain relief.
- In severe cases, especially those approaching Stevens-Johnson syndrome, systemic corticosteroids like prednisone (0.5-1 mg/kg/day for 7-10 days with taper) may be considered, though their use remains controversial, as noted in a case report 3.
Supportive Care
Maintain good skin care with gentle cleansing and moisturizing, and ensure adequate hydration and nutrition. Most mild cases resolve within 2-3 weeks without scarring, but recurrence is common in HSV-triggered cases, which may benefit from prophylactic antiviral therapy, as suggested by a study on recurrent erythema multiforme 2.
Treatment of Underlying Conditions
Treatments targeting Mycoplasma pneumoniae and HSV-1 were initiated in a case report, while lab results were pending, and the treatment regimen of corticosteroids for inflammation, acyclovir for HSV-1, and azithromycin for Mycoplasma pneumoniae was continued 3.
Recurrent Erythema Multiforme
Recurrent erythema multiforme may require a long-term therapeutic protocol to enable disease remission, with acyclovir treatment used in the majority of patients, and combined treatment with dapsone or thalidomide in refractory cases, as proposed in a therapeutic proposal for a chronic disease 2.