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How to Treat Erythema Multiforme?


Things to note:
Principles of management
  • The foundation of management is supportive, good nursing, and dehydration and sepsis prevention.
  • Stop all medicines.
  • Patients usually require care in a high or intensive care unit with dedicated nursing.
Monitoring
  • Monitor vital organ function.
  • Examine daily for infection and swab infected lesions. If septicaemic, do blood cultures.
Dressings
  • Skin hygiene, daily cleansing and bland, non-adherent dressings as needed.
  • Do not use silver sulfadiazine if condition is thought to be due to cotrimoxazole or other sulphonamide.
Mucous membranes:
  • Regular supervised oral, genital and eye care to prevent adhesions and scarring.
  • Two-hourly mouth washes with bland mouth wash, e.g. glycothymol.
  • Examine daily for ocular lesions and treat 2-hourly with eye care and lubricants and break down adhesions.
  • Treat genitalia 6 hourly with Sitz baths and encourage movement of against eroded surfaces to prevent adhesions.
Fluids:
  • Oral rehydration is preferred but intravenous fluid therapy may be required in significant dehydration.
  • Encourage oral fluids to prevent pharyngeal adhesions.
  • If unable to eat, provide soft, lukewarm food or nasogastric feeds.
Note:
  • All the patients should wear a notification bracelet / necklace.

Medical Treatment:
Corticosteroids:
  • There is no evidence to support the practice of using systemic corticosteroids and is therefore not recommended.
Antibiotic therapy:
  • Systemic antibiotics may be indicated, depending on results of appropriate cultures.
Analgesia:
  • Appropriate and adequate analgesia for the pain associated with dressing changes, given at least half an hour before dressing change.