Treat any underlying diseases and avoid any known triggers (certain medications, for example). It is also important to avoid the sun when taking certain medications.
Your doctor will treat any underlying diseases, stop any drugs that may contribute to symptoms, and take steps to control your current symptoms. Mild cases may not require treatment. Bed rest and medication may be necessary for more severe cases.
- Antihistamines for itching
- Antibiotics, if you have an infection
- Antiviral medications such as acyclovir and valacyclovir, if you have a virus
- Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Burrow's compresses -- a solution used to soothe skin conditions, particularly blisters
- Corticosteroids -- applied to the skin (topically); corticosteroids may also be taken orally to reduce symptoms of erythema nodosum
- Intravenous immunoglobulin -- used experimentally for SJS and TEN
- Photomodulation therapy -- use of a light emitting diode to accelerate the resolution of erythema
Complementary and Alternative Therapies
To treat erythema, you must treat the underlying cause. It is important to get a proper diagnosis from your doctor before using any complementary and alternative therapies. Not all CAM therapies are appropriate for all people, and some may interact with conventional medicines or therapies, so you should use CAM therapies only under the guidance of a physician. Some CAM therapies may be used to:
- Reduce inflammation
- Boost the immune system
- Prevent infections
Antioxidants are molecules that scavenge free radicals (chemicals that can damage cells). Antioxidants also may protect skin against damage caused by ultraviolet (UV) sun rays. The following antioxidants have been shown to protect skin against damage in scientific studies:
- Beta-carotene and other carotenoids (up to 300 IU per day for beta-carotene) -- Beta-carotene is often used as a standard treatment for sun sensitivity, although studies have been mixed. In one trial, though, 20 healthy subjects received either carotenoids alone, mainly from beta-carotene, or carotenoids plus vitamin E. Both groups improved significantly, but vitamin E did not appear to add any benefits. Scientists think the protective effect of beta-carotene comes from its antioxidant effect, so it's possible other antioxidants may also help protect skin from damage.
- Vitamin B6 (100 mg per day for 3 months) -- Some case reports suggest that vitamin B6 can help reduce the reaction to sunlight. You should only take this high a dose of vitamin B6 under a doctor's supervision, because of the risk of side effects. Vitamin B6 can interfere with Amiodarone (Cordarone), Phenobarbital (Luminal), Phenytoin (Dilantin), and possibly Levodopa. Speak with your physician if you are taking any of these medications.
- Vitamin C (1 - 3 g per day, lower dose if diarrhea develops) -- Vitamin C is an antioxidant, so it may provide some protection against skin damage from sunlight. Vitamin C can negatively impact certain health conditions, and can interfere with some medications. Speak with your physician.
- Vitamin E -- Vitamin E is also an antioxidant, and a few studies have shown that it can offer protection from sun damage to skin when taken with vitamin C (but not alone). However, other studies have not found the same results. Vitamin E can interact with certain medications, including but not limited to, blood thinning medications, such as Warfarin (Coumadin). It may also have negative effects on people with bleeding disorders, head and neck cancers, Retinitis Pigmentosa and other conditions.
- Vitamin D -- In animal studies, vitamin D helped protect against damage from UVB rays. It is not clear yet whether vitamin D supplements may protect humans in the same way. Vitamin D can interact with some medications, including but not limited to, Digoxin and Verapamil. It may also have a negative impact on some health conditions. Speak with your physician.
- Melatonin -- Applying melatonin topically (either alone or in combination with vitamin E) seems to offer some protection against sunburn in healthy people, but it isn't known whether melatonin also lessens effects in people prone to erythema.
- Zinc -- Zinc is necessary for healthy skin and was used in a study along with other prescription medications as a treatment for a severe form of erythema multiforme similar to TEN. In the study, 5 out of 8 people treated with zinc showed a benefit. Because high doses of zinc can be dangerous, many doctors suggest doses below 50 mg per day. Talk to your doctor to determine which dose is right for you. Zinc can interact with certain antibiotics, Cisplatin, Amiloride, and Penicillamine (used for Wilson syndrome and Rheumatoid arthritis).
Flavonoids -- Some of these plant based antioxidants may protect skin from sun damage in healthy people. In one study, German researchers found that drinking high flavonol cocoa offered protection from the sun (the cocoa used was a special formulation that is not yet available commercially). In another study, pomegranate fruit extract helped protect skin cells in a test tube from UV light. It isn't yet known whether taking the extract would provide any benefit. However, adding a lot of fruits and vegetables to your diet in order to eat more flavonoids may help. You can also take these flavonoids in dried extract form; speak with your physician first, since certain flavonoids can interact with prescription medications:
- Catechin (25 - 150 mg 2 -3 times per day), quercetin (50 - 250 mg 2 -3 times per day), hesperidin (50 - 250 mg 2 - 3 times per day), and rutin (50 - 250 mg 2 - 3 times per day).
- Rose hips (Rosa canina) are also high in flavonoids and may be used as a tea. Drink 3 - 4 cups per day.
- Hesperidin methyl chalcone (HMC, 200 mg 2 - 3 times per day) is a water soluble form of quercetin that may act as an antihistamine.
Green tea (Camellia sinensis) may also protect against erythema caused by UV light because it contains antioxidants.
Herbs traditionally used topically to heal damaged skin, promote lymph circulation, and possibly treat the underlying cause of various skin conditions may be helpful. You should check with your doctor before using any of these remedies. Although these have not been tested for erythema specifically, some examples include:
- Aloe vera -- used topically for skin inflammation. One study found that aloe vera displayed anti-inflammatory effects superior to 1% hydrocortisone gel.
- Burdock root (Arctium lappa) -- used topically for skin inflammation and wound healing. Never apply to an open wound.
- Calendula (Calendula officinalis) -- used topically for burns, wounds, and other skin conditions. Never apply to an open wound.
- Goldenseal (Hydrastis canadensis) -- used for infections, including those causing skin lesions
- Lemon balm (Melissa officinalis) -- can be applied to HSV lesions as a cream or a wash
- Sage extract -- applied topically to reduce inflammation. In one study, sage extract significantly reduced the ultraviolet induced erythema to a similar extent as hydrocortisone.
- Slippery elm (Ulmus fulva) -- applied topically, in combination with goldenseal root. Never apply to an open wound.
- Yarrow (Achillea millefolium) -- applied topically for skin inflammation and wound healing. Never apply to an open wound.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of erythema based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for an individual.
- Apis mellifica -- for skin rashes that feel hot and dry and are sensitive to touch; may be accompanied by sore throat; symptoms are relieved by cool drinks and baths and worsened by heat and warm liquids; this remedy is most appropriate for individuals who often feel sad, disappointed, or even depressed; they tend to cry easily but may also be irritable and envious by nature; they're also distinctly not thirsty but may crave milk
- Calendula -- for burns and skin lesions that are fairly superficial; often used after the acute phase of the skin condition has subsided to aid in complete recovery
- Rhus toxicodendron -- used for blisters and vesicles accompanied by intense itching that worsens at night and improves with the application of heat; this remedy is most appropriate for individuals who are generally restless and unable to get comfortable at night
- Sulphur -- for skin disorders that are accompanied by fever and intense itching; this remedy is most appropriate for individuals who are thirsty, irritable while sick, lazy and messy under ordinary circumstances, and who describe a sensation of internal heat and burning; symptoms tend to improve with open, cold air and worsen with warmth
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