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Erythema multiforme - Treatment

Alternative Names

Lyell's syndrome; Stevens-Johnson syndrome; Erythema multiforme minor; Erythema multiforme major

Treatment:

Treatment goals include:

  • Controlling the illness that is causing the condition
  • Preventing infection
  • Treating the symptoms

Stop taking any suspected medications, with your doctor's approval.

Treatment of mild symptoms may include:

  • Medications such as antihistamines to control itching
  • Moist compresses applied to the skin
  • Oral antiviral medication if it is caused by herpes simplex
  • Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort
  • Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking

Treatment of severe symptoms may include:

  • Antibiotics to control any skin infections
  • Corticosteroids to control inflammation
  • Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
  • Intravenous immunoglobulins (IVIG) to stop the disease process

Practicing good hygiene and staying away from other people may help prevent secondary infections.

Skin grafting may be helpful in cases in which large areas of the body are affected.

Expectations (prognosis):

Mild forms of erythema multiforme usually get better in 2 - 6 weeks, but they may return. More severe forms may be difficult to treat. Stevens-Johnson syndrome and toxic epidermal necrolysis have high death rates.

Complications:

  • Body-wide infection, sepsis
  • Loss of body fluids, shock
  • Occasionally, lesions on internal organs causing:
    • Heart inflammation (myocarditis)
    • Lung inflammation (pneumonitis)
    • Kidney inflammation (nephritis)
    • Liver inflammation (hepatitis)
  • Permanent skin damage and scarring
  • Skin infection (cellulitis)

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of erythema multiforme. If a large area of the body is involved, it is an emergency situation.

  • Reviewed last on: 10/10/2010
  • Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:pp 710-714.

Weber DJ, Cohen MS, Morrell DS, Rutala WA. The acutely ill patient with fever and rash. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 52.

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