title: Long-term valacyclovir treatment and immune modulation for Herpes-associated erythema multiforme.
abstract: OBJECTIVE
  Erythema multiforme (EM) is an immune-mediated condition characterized by the appearance of target-like lesions on the skin and often accompanied by erosions or bullae involving the oral, genital, and/or ocular mucosae. 70% of recurrent EM cases are associated with HSV reactivation and it is labelled as herpes-associated erythema multiforme (HAE M). Recurrences are seen in approximately 20-25% of EM cases and managing these conditions are challenging for both the patient and the doctor. The effectiveness of antiviral drugs is proven for Herpes simplex infection, however most patients use a multiplicity of alternative and complementary therapies.
  
  
  METHODS
  We present clinical data of 3 patients with recurrent HAE M managed by long-term valacyclovir therapy and immunostimulation with Echinacea or replacement immunoglobulin therapy in the case of IgG1 subclass deficiency. The presented cases have demonstrated that immune mechanisms are relevant for HAEM recurrences.
  
  
  CONCLUSIONS
  The immune abnormalities, such as antibody deficiency, in the patients with HSV-associated EM can lead to frequent relapses of disease and should be evaluated. Long-term antiviral therapy with immunomodulation can control the relapses of HAEM.
authors.affiliation: Department of Pulmonology and Immunology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Jurate
authors.initials: J
authors.lastname: Staikuniene
authors.affiliation: Department of Histology and Embryology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Jurate
authors.initials: J
authors.lastname: Staneviciute
keywords: HAEM; HSV infection; erythema multiforme; herpes-associated erythema multiforme