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Doctors' Answers to "Frequently Asked Questions" - Erythema Multiforme

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Erythema Multiforme [posted 8/13/98]
Question: Hello, my girlfriend has erythema multiforme and has had it for about 7 years. It is hsv (cold sore) induced, and she has several outbreaks a year, often with mucous membranes involved. She has tried prednisone with very little success. She was taking acyclovir 200 mg bid, and recently upped to 400 mg bid. In spring 1997 she had a particularly bad outbreak and at our suggestion was prescribed cyclosporin (Neoral). It stopped the outbreak within 2-3 days. Three times since then, she has taken neoral at the very first signs of an outbreak, (always 10 days to the day of a cold sore developing). As you know, cyclosporin is very expensive, about $240 cdn. per outbreak for her, who has had 6-7 a year in the past. Can you advise on the suggested drinking of grapefruit juice and halving the dose of neoral? We have heard of, but have very little information on the use of such drugs as Azathiopine, Dapsone and Thalidomide in treating this disease.

Answer: There are several drugs that we use in EM with steroid failure. None are approved for this use by the FDA. I would try to avoid toxic drugs since she doesn't seem to have systemic effects. I doubt you will find a good answer.

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