The photodistribution of erythema multiforme

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

“…Although the pathogenesis of EM is unknown, evidence is increasing for ati immunologie etiology. It has been suggested that this disease results from a hypersensitivity reaction with abnormal immune responses to a variety of antigens, including viruses, drugs, and systemic disease (1). Studies have examined the roie of cellular and humoral immunemediated mechanisms, and although consistent evidence remains controversial, immunoreactants have been demonstrated in most cases of EM (2)(3)(4)(5).…”

“…The use of these drugs in the treatment of EM major is advocated on the basis of a body of clinical experience. Current texts state that because of the potential seriousness of the disease, any measure that may lessen tissue damage should be employed; the use of systemic corticosteroids is justified if the patient is relatively early in the course of the dis-ease and skin and mucosal involvement are still progressing (1,25). Numerous critical reviews and case reports concerning EM major have reported using systemic corticosteroids, although most acknowledge that a controversy exists regarding their use.…”

“…When treating EM major, a crucial point for the clinician to bear in mind is that corticosteroid therapy should be initiated early, before significant tissue damage has occurred. The generally accepted dosage of prednisone or methylprednisolone is 1 to 2 mg/kg/day (1). After a clinical response is noted (i.e., the patient is afebrile and no new lesions have occurred for at least 72 hours) this can be tapered over two to three weeks.…”

Furazolidine Induced Erythema Multiforme

“…Cytokines released by activated mononuclear cells and keratinocytes may contribute to epidermal cell death and constitutional symptoms [6].…”

“…Glucocorticoids have no beneficial role in management, rather they may be permissive of HSV replication and make EM episodes more frequent or continuous. Prophylactic oral Acyclovir for 6 months may be effective in controlling recurrent episodes of HSV associated with EM [6].…”