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Key Features

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  • Erythema multiforme has sometimes been diagnosed in patients with severe mucous membrane involvement, but Stevens-Johnson syndrome is the diagnosis when severe involvement of conjunctiva, oral cavity, and genital mucosa also occur

  • Many causes are suspected, particularly concomitant herpes simplex virus (HSV); drugs, especially sulfonamides; and Mycoplasma infections

  • Recurrent erythema multiforme is usually associated with reactivation of HSV

  • In erythema multiforme, spontaneous healing occurs in 10–14 days, but Stevens-Johnson syndrome may last 6–8 weeks

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Clinical Findings

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  • Papules that later develop a dark center

  • Lesions with central bluish discoloration or blisters

  • Characteristic target lesions (iris lesions) that have three concentric circles of color change

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Diagnosis

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  • Clinical

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Treatment

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  • Treatment is symptomatic in uncomplicated erythema multiforme

  • Discontinue offending drugs

  • Oral antihistamines such as cetirizine 5–10 mg every morning and hydroxyzine 1 mg/kg/d at bedtime are useful

  • Cool compresses and wet dressings relieve pruritus

  • Corticosteroids have not been demonstrated to be effective

  • Long-term acyclovir therapy has been successful in decreasing attacks in patients with HSV-associated recurrent erythema multiforme

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