Erythema Multiforme Bullosum (Stevens-Johnson Syndrome)

Controversy: Are Systemic Steroids Indicated in the Treatment of Erythema Multiforme?

“…Over the ensuing several years, numerous reports were published advocating the use of ACTH or corticosteroids in the treatment of EM major in children, adolescents, and adults (12)(13)(14)(15)(16). In 1954, Weeks and Lehmann (17) observed a dramatic therapeutic response to the compounds in the treatment of four patients 'with EM major and subsequently stated, "This study shows that ACTH or cortisone is the treatment of choice in erythema multiforme extidativum and should be used as soon as the diagnosis is made," After this series of case reports the treatment of EM with systemic corticosteroids became established by convention.…”

Controversy in the Use of High-Dose Systemic Steroids in the Acute Care of Patients With Stevens-Johnson Syndrome

“…66,67 Over the next few years, small numbers of reports were published advocating the use of ACTH or corticosteroids in the treatment of SJS in children, adolescents, and adults. 68,69 After the series of case reports by Weeks and Lehmann, 70 which showed dramatic positive response in patients with SJS to ACTH or corticosteroids, the treatment of SJS with systemic corticosteroids became an established convention.…”

Erythema Multiforme Bullosa (Stevens-Johnson Syndrome)

“…Chlortetracycline has some effect in pemphigus vulgaris (Bettley, 195I), but no consistent effect in Stevens-Johnson Syndrome has been recorded. This applies, too, to other antibiotics and sulphonamides, which may even precipitate the condition (Agostas et al, 1952). Chlortetracycline was without effect in Case No.…”

“…irregular fine scarring were evidentlymphocytes, neutrophils, eosinophils and lipidcontaining macrophages lay between the trabeculae. Agostas et al (1952) noted perivascular lymphocyte infiltration of the corium, while Goldfarb (I946) described non-specific inflammatory changes, and noted the presence of eosinophilia. No eosinophilia, however, occurred in the present series.…”