Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

papular type (typical PLE) and plaque type with few small plaques

1st line – mild topical corticosteroids + emollients

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ACUTE
|
papular type (typical PLE) and plaque type with few small plaques
1st line – 

mild topical corticosteroids + emollients

All patients with a typical mild to moderate type of PLE will benefit from the anti-inflammatory effects of mild topical corticosteroids in combination with the moisturizing and cooling effects of emollients.[1][10][60]​​

Water-based emollients can be stored in the fridge for additional cooling effects.

Primary options

hydrocortisone topical: (1 to 2.5%) apply sparingly to the affected area(s) twice daily

or

prednicarbate topical: (0.1%) apply sparingly to the affected area(s) twice daily

-- AND --

emollient topical: apply to the affected area(s) two to three times daily

plaque type with widespread thick plaques + vesiculobullous variant

1st line – potent topical corticosteroids + emollients

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ACUTE
|
plaque type with widespread thick plaques + vesiculobullous variant
1st line – 

potent topical corticosteroids + emollients

More potent corticosteroid formulations are usually very effective in treating more pronounced skin lesions.[1][10]

Water-based emollients can be stored in the fridge for additional cooling effects.

Primary options

triamcinolone topical: (0.025 to 0.1%) apply sparingly to the affected area(s) twice daily

or

fluocinonide topical: (0.05%) apply sparingly to the affected area(s) twice daily for 7 days

or

clobetasol topical: (0.05%) apply sparingly to the affected area(s) twice daily for 7 days

-- AND --

emollient topical: apply to the affected area(s) two to three times daily

Consider – nonsteroidal anti-inflammatory drugs (NSAIDs)

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ACUTE
|
plaque type with widespread thick plaques + vesiculobullous variant
Consider – 

nonsteroidal anti-inflammatory drugs (NSAIDs)

Treatment recommended for SOME patients in selected patient group

NSAIDs may hasten the resolution of skin symptoms.

Primary options

ibuprofen: 200-400 mg orally every 6-8 hours when required, maximum 2400 mg/day

OR

naproxen: 250-500 mg orally twice daily when required, maximum 1250 mg/day

Consider – oral corticosteroids

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ACUTE
|
plaque type with widespread thick plaques + vesiculobullous variant
Consider – 

oral corticosteroids

Treatment recommended for SOME patients in selected patient group

Oral corticosteroids are reserved for more severe cases of PLE, such as the subtype of plaque and papular-vesicular type (erythema exudativum multiforme) or widespread bullae.

Primary options

prednisone: 0.5 to 1 mg/kg/day orally, taper dose by 50% every other day and cease treatment after 8 days

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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