Erythema multiforme in children: the steroid debate.

QUESTION: In my office I occasionally see children who have rashes with "target lesions" and who are diagnosed with erythema multiforme (EM). When should these children receive steroids, and when should the illness be allowed to follow its natural course without steroid treatment?

ANSWER: Erythema multiforme is relatively common in children. Current recommendations suggest not to treat EM minor with systemic steroids and that topical steroids might be of benefit. The use of systemic steroids for EM major remains controversial, as there is evidence both for and against treatment, and no randomized controlled trials have been done. Further studies need to address the benefit of steroids, and in the interim, physicians should decide on a treatment based on the severity of EM and in consultation with a dermatologist, if available.