Benefits and harms

Sixteen children with EM major were included in a prospective RCT within 3 days of the onset of rash. Ten received bolus infusions of methylprednisolone, 4 mg/kg/day, while six had supportive treatment only. Corticosteroids reduced the period of fever (4-0 versus 9-5

days), reduced the period of acute eruption (7-0 versus 9-8 days) and signs of prostration were milder. Complications were minimal in both groups. The authors suggest that an early short course of corticosteroids favourably influences the course of EM major in children.1

In an RCT including nine adults with mild, uncomplicated EM major, four received prednisolone, 30 mg daily, reduced by 5 mg each day, and five received placebo. The mean length of stay in hospital was longer in the corticosteroid group (9-5 versus 8 days). Diagnoses were not clear: histology was consistent with EM; a drug-induced reaction was suspected in five cases; no information about HSV was given.2

In a retrospective study, Rasmussen compared 17 children with EM treated with systemic corticosteroids with 15 children who received supportive care only. Both groups were comparable in age, sex, length of prodrome, exposure to drugs, initial fever, extent of oral and cutaneous involvement and frequency of isolation of pathogens. The group treated with corticosteroids had a shorter fever period (1-8 versus 5-5 days) but a longer mean length of hospitalisation (21 versus 13 days) because of more frequent complications (53% versus 0%).3

In a series of 51 children, corticosteroids were claimed to worsen the prognosis: 74% of patients treated with corticosteroids had complications, versus 28% of the patients who did not receive corticosteroids.4

In a series of 25 patients with EM minor, corticosteroids allowed no clinical improvement except a shorter duration of fever (2-7 versus 5-6 days).5

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