Introduction to Erythema Multiforme

Erythema Multiforme Minor
This condition is characterized by erythematous papules that evolve into target lesions with dusky centers. Some oral lesions may be present.
The most common precipitant is HSV infection. It may also be drug-induced.

Treatment

• Antihistamines provide symptomatic relief.
• Systemic steroids may be helpful if given early.
• Prophylactic acyclovir may be useful to prevent recurrent HSV-related disease.

Erythema Multiforme Major (Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)
In Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), marked erythema or target lesions rapidly progress to blistering and epidermal sloughing.

Treatment

• Discontinue all possible precipitating medications.
• Replace fluid losses and provide adequate nutrition.
• Administer local wound care. Débridement is not recommended.
• Give antibiotics as needed for superinfection. Avoid prophylactic antibiotics.
• Consider systemic steroids, which may be beneficial early in the course of the disease.
• Intravenous immune globulin has been shown to be beneficial in some cases of TEN.