It’s important to differentiate EM from life-threatening conditions like SJS and toxic epidermal necrolysis (TEN).5 EM is characterized by typical and atypical targetoid lesions with minimal mucosal involvement.6,7 SJS is characterized by flat atypical targetoid lesions, confluent purpuric macules, severe mucosal erosions, and <10% epidermal detachment.6,7 TEN is characterized by severe mucosal erosions and >30% epidermal detachment.6,7
Lesions resolve on their own, but topical steroids can provide relief
EM is a self-limiting disease; lesions resolve within about 2 weeks.3 Management begins by treating any suspected infection or discontinuing any suspected drugs.1 In patients with co-existing or recurrent HSV infection, early treatment with an oral antiviral (such as acyclovir) may lessen the number and duration of lesions.1,6 In addition, oral antihistamines and topical steroids may be used to provide symptomatic relief.1,6 Use of oral corticosteroids can be considered in severe mucosal disease, although such use is considered controversial due to a lack of evidence.1,6
Our patient remained hospitalized for 4 days. As noted earlier, his DVT and pulmonary embolism were treated with enoxaparin and the patient was sent home with a prescription for warfarin. Regarding the EM, his rash and itching improved significantly during the hospitalization (without any specific treatment) and was mostly resolved at a follow-up visit 6 days after discharge.
CORRESPONDENCE
Morteza Khodaee, MD, MPH, AFW Clinic, 3055 Roslyn Street, Denver, Colorado 80238; morteza.khodaee@ucdenver.edu.