Erythema Multiforme: Should Anyone Care About the Standards of Care?

THIS ISSUE of the Archives contains a thought-provoking article describing 13 patients who developed druginduced toxic epidermal necrolysis (TEN), while they were receiving systemic corticosteroids. After reviewing the data on these 13 patients culled from the records of 179 patients with TEN, the authors conclude that ''longterm steroid therapy may delay the onset of TEN but does not halt its progression.''¹ Most articles in the past 10 years confirm that steroids do not have any beneficial effect on TEN, yet the subject continues to be controversial. Since the more serious variants of erythema multiforme such as Stevens-Johnson syndrome (SJS) and TEN are among the most lifethreatening emergencies that a dermatologist is likely to see, a brief editorial on their treatment seems appropriate. Is there a standard of care? Should we be concerned about doing ''nothing''? What will produce the best results for our patients? To discuss therapy, we need