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General lnternal Medicine DO]T'T BE TRICKED r Never select systemic glucocorticoids for the treatment of psoriasis. TETilYOURSEIF A 28-year-old woman has a chronic extensive skin rash consisting of multiple small and large plaques with an adherent, thick, silvery scale. ANSWER: For diagnosis, select psoriasis. Erythema Multiforme Diagnosis Look for target-like lesions with outer rings around a violaceous or dark center, blister, or erosion. Mucosal erosions may also be found. Recurrent HSV infection is the most common inciting factor. Drug allergz (most often to sulfonamides, penicillin, and phe- nytoin) is another common cause. Treatment Treat EM by removing the offending agent and providing supportive care. If EM is caused by an active Mycoplosma infection, antibacterial drugs may be helpful. Recurrent episodes of EM may be managed with antiviral suppressive therapy for HSV infection. DOil'T BETRICKED r Do not confuse EM with erythema migrans, the rash of Lyme disease (red macule with central clearing as the macule expands). . Do not treat acute EM-associated HSV with antivirals. TESTYOURSETF A 24-year-old man is evaluated for target lesions on his hands and arms, which he says he has had twice before in recent years. ANSWER: For diagnosis, select recurrent EM caused by HSV Erythema tlultlforme: These images show the targetoid lesions of EM. 189