Topical Treatment for Erythema Multiforme
For erythema multiforme, topical high-potency corticosteroids are the recommended first-line topical treatment to reduce inflammation and provide symptomatic relief. 1, 2
First-Line Topical Treatments
Topical corticosteroids:
- High-potency corticosteroids for skin lesions
- Apply 2-3 times daily to affected areas
- Should be used for a minimum of 7 days (as EM lesions typically persist for at least this duration)
- Taper gradually once control is achieved 3
For painful lesions:
- Lidocaine-containing preparations (creams, ointments, or patches)
- Lidocaine patches (4% OTC or 5% prescription) are particularly effective for larger areas
- Can be worn for up to 12-24 hours 4
Second-Line Topical Options
For pain management:
- Compounded amitriptyline-ketamine mixture
- Diclofenac 1% gel (over-the-counter)
- Compounded gabapentin 6% ointment 4
For cooling/soothing effect:
- Over-the-counter preparations containing camphor or menthol in combination with methyl salicylate (e.g., Ultra Strength Bengay Cream, Icy Hot) 4
- Limit application to 3-4 times daily to prevent skin irritation
For Mucosal Involvement
- Antiseptic or anesthetic solutions for oral lesions 2
- Viscous lidocaine for pain relief before meals
- Antiseptic mouthwashes to prevent secondary infection
Treatment Duration and Monitoring
- Topical treatments should be tried for at least 4 weeks to assess efficacy 4
- Monitor for signs of secondary infection (yellow crusting, pustules) and treat with appropriate antibiotics if present 3
- Reassess after 2 weeks to adjust corticosteroid potency if necessary 3
Important Considerations
- Avoid prolonged use of topical antibiotics due to risk of bacterial resistance 3
- Children may be more vulnerable to systemic effects of topical corticosteroids due to greater percutaneous absorption 3
- Elderly patients require special attention due to age-related physiological changes and higher risk of adverse drug reactions 3
When to Consider Systemic Therapy
- If topical treatments alone are not effective
- For severe or widespread lesions
- For recurrent EM, especially if associated with herpes simplex virus (consider antiviral prophylaxis) 1, 2
- For severe mucosal involvement causing difficulty with oral intake (may require hospitalization) 1
Remember that erythema multiforme is typically self-limiting, and topical treatments are primarily for symptomatic relief while the condition resolves. If the underlying cause is identified (such as herpes simplex virus or medication), addressing this is essential for complete resolution.