Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Department of Dermatology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
Medicina (Kaunas). 2021 Sep 1;57(9):921. doi: 10.3390/medicina57090921.
Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. EM can be confused with other more serious conditions like Stevens-Johnson syndrome (SJS); however, clinical research has provided significant evidence to classify EM and SJS as separate disorders. Treatment of EM is highly variable, depending on the etiology, the involvement of mucosal sites, and the chronicity (acute vs. recurring) of the disease. If the etiology or causal medication/infection is identified, then the medication is stopped and/or the infection is treated prior to initiating symptomatic treatment. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials.
多形红斑（EM）是一种免疫介导的疾病，其特征为离散的靶形病变，可累及黏膜和皮肤部位。EM 通常由病毒感染引起，尤其是单纯疱疹病毒（HSV），以及某些药物，但很大一部分病例的病因仍无法确定。EM 可能与其他更严重的疾病如史蒂文斯-约翰逊综合征（SJS）相混淆；然而，临床研究已经提供了充分的证据，将 EM 和 SJS 分类为两种不同的疾病。EM 的治疗方法多种多样，取决于病因、黏膜受累情况以及疾病的慢性程度（急性或复发性）。如果确定了病因或致病药物/感染，那么在开始对症治疗之前，应停止用药和/或治疗感染。急性 EM 的治疗重点是缓解症状，可使用局部类固醇或抗组胺药。针对复发性 EM 的治疗在针对个体患者时最有效。复发性 EM 的一线治疗包括全身和局部治疗。全身治疗包括皮质类固醇治疗和抗病毒预防。局部治疗包括高浓度皮质类固醇，以及针对黏膜受累的防腐或麻醉溶液。对于对抗病毒药物无反应的患者，二线治疗包括免疫抑制剂、抗生素、驱虫药和抗疟药。
