Hello,

I have suffered for quite some time with erythema multiforme (EM) minor
of the oral mucosa. My symptoms are text-book but my condition only
affects my lips, which can be quite terrible. Mt first attack caused
most of the skin on my lips to peel off, which later grew back but
never the same. Subsequent attacks, occuring nearly every 2 months,
cause peeling, yellow sores, and shallow ulcerations all over my inner
lips.

Recent literature now shows that anyhwere from 70-85% of all recurrent
EM minor cases are caused by the body's hypersensitive reaction to the
Herpes Type I or II virus. It's a rare reaction that most people with
Herpes do not have, effects men more than women, and is predominant in
the years between 20-40. Essentially, your own body somehow becomes
allergic to HSV causing this reaction. EM is not a disease, but rather
a hypersensitive reaction of the body.

EM minor can be caused by other factors, namely certain bacterial and
viral infections, certain drugs (antibiotics- particularly Sulfa based,
anti-convulsants), and vaccinations. These causes are much rarer but
should be looked into with the first diagnosis of the disease. EM major
is a much more serious, sometimes life-threatening condition that is
more often caused from an allergic reaction to medication rather than
HSV.

Newer studies are showing how easy it can be for most to control
outbreaks of EM from even happening. By suppressing the herpes virus in
the body, EM has trouble developing. EM can occur even with a
sub-clinical Herpes infection (i.e. no visible cold sore) so a course
of anti-virals is warranted in almost every case of recurring EM.
Valtrex (500 mgs 2x a day) and Famvir (250mgs 2 x a day) are excellent
at suppressing HSV and preventing EM from developing. A course of these
virals should be run for at least 4 months (pills taken every day) and
then the patient should be re-evaluated.

We now know how safe antivirals like Famvir and Valtrex are and how few
side-effects they can pose. Both have been cleared by the FDA for
long-term suppression (up to 5 years) for herpes suppression.

Usually, with a well developed case of EM the only medication that can
help is oral steriods such as Prednisone. Usually moderate doses (40mgs
daily 1 week, 20mgs daily 1 week) can suppress the inflammation, reduce
the severity of the sores, and reduce any pain you might have. However,
the outbreak of EM still needs to run its course, 2-6 weeks, but the
Prednisone can make things a little more comfortable.

The best way to treat this condition is to stop it before it even
starts by using daily antivital therapy. For the rare, recalcitrant
cases of EM minor that fail to respond to this therapy, do not give up.
There are other medications such as dapsone, thalidomide, cyclosporin,
and some anti-malarial drugs that can be tried in the tougher cases.

Herpes sores suck but EM is much worse. Hang in there.

Buckeye