Erythema multiforme, also known as Stevens-Johnson Syndrome (SJS), is an acute, self-limiting condition with characteristic red skin lesions covering up to 10% of the surface area of the body. The lesions remain in a fixed location for at least 7 days and then begin to heal, but usually tend to recur. A more severe involvement of the body surface area (more than 30%) is termed as Toxic Epidermal Necrolysis (TEN). Mortality increases as the percentage of involved body surface increases. A disturbed immunity is believed to be responsible for this condition. Most patients also have mucous membrane involvement along with the skin lesions.

The Ayurvedic treatment of SJS is aimed at treating the skin and mucous membrane lesions, reducing the severity and intensity of generalized symptoms and preventing recurrence. Medicines useful in this condition are: Arogya-Vardhini, Gandhak-Rasayan, Maha-Manjishthadi-Qadha, Kamdudha-Ras, Sutshekar-Ras, Chandrakala-Ras, Manjishtha (Rubia cordifolia), Usheer (Vetiveria zizanioidis), Gokshur (Tribulus terrestris), Amalaki (Emblica officinalis), Haridra (Curcuma longa) and Guduchi (Tinospora cordifolia). Medicines which act on the ‘Ras’ and ‘Rakta’ dhatus (tissues) of the body are useful in this condition. These medicines include Indrayav (Holharrhina antidysentrica), Patol (Tricosanthe dioica), Kutki (Picrorrhiza kurroa), Saariva (Hemidesmus indicus), Patha ( Cissampelos pareira) and Musta (Cyperus rotundus). If there is severe mucous membrane involvement, medicines which act on the ‘Mansa’ dhatu also need to be used in this condition. These medicines include, in addition to the above mentioned medicines, Triphala (Three fruits) and Nimba (Azadirachta indica).

Medicines are also used to improve immune dysfunction, which is usually responsible for this condition. These medicines include Ashwagandha (Withania somnifera), Tulsi (Ocimum sanctum), Bhrungraj (Eclipta alba), Shatavari (Asparagus racemosus), Suvarna-Sutshekhar-Ras and Suvarna-Bhasma. Maha-Manjishthadi-Qadha and Saarivasav are given on a long term basis to prevent recurrence.

A large number of medicines can precipitate SJS. It is important to immediately discontinue the offending medication. An acute onset of SJS can cause rapid severe dehydration and circulatory collapse, which may even lead to death. Hospitalization in the acute stage is therefore, very important. Ayurvedic medicines may be added to the therapy once the acute phase has stabilized, in order to control generalized symptoms of the condition and to prevent recurrence.