Recurrent Erythema Multiforme Unresponsive to Acyclovir Prophylaxis and Responsive to Valacyclovir Continuous Therapy

Recurrent erythema multiforme: Clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007

“…The results of previous studies have shown the efficacy of corticosteroids in the treatment of recurrent oral EM, 22 but other investigators maintain that such therapy only partially suppresses disease and may lead to disease chronicity and prolonged duration of attacks. 6,8 Therapies other than corticosteroids that have been reported to be beneficial in recurrent EM include continuous antiviral medications, 1,8,23 dapsone, 1 azathioprine, 1,6 intramuscularly administered human immunoglobulin, 1,5 hydroxychloroquine, 1 cyclosporine, 24 mycophenolate mofetil, 25 thalidomide, 26,27 interferon alfa (in cases secondary to hepatitis C virus infection 14,15 ), and cimetidine. 28 Tatnall et al 8 performed a double-blind, placebocontrolled trial of continuous acyclovir therapy (6 months) in 20 patients with recurrent EM (15 had HSV-induced disease).…”

“…Other investigators have reported success with continuous valacyclovir therapy in patients who did not have a response to acyclovir therapy. 23 In a large series of 65 patients with recurrent EM, Schofield et al 1 treated 37 patients with continuous acyclovir therapy for 6 months and noted that 15 patients had complete suppression of disease (14 had HSV-associated disease); 14 patients did not have a response to treatment. On the basis of these results, the investigators proposed an algorithm for a 6-month course of orally administered acyclovir for those patients whose disease does not respond to intermittent antiviral therapy, even patients without HSV as an obvious precipitant.…”

Minocycline-Induced Lupus

“…Furthermore, as with other drug-induced syndromes with a highly varying clinical and laboratory presentation which can make a correct diagnosis often difficult [53], it is possible that some cases may have been missed by the literature search. Since classification of lupus-like reactions may also vary depending on the specialisation of the reporting physician (e.g.…”

Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management

“…72,187,188,193,282 Lack of response with acyclovir may be attributed to poor patient compliance or subtherapeutic tissue concentrations. 188,200,283 Oral steroid use partially ameliorates HAEM attacks but often prolongs recurrences. 194 Other empirical protocols for HAEM therapy include azathioprine, cyclosporine, antimalarials, and thalidomide.…”