What are the indications for referral to a dermatologist for a patient with erythema multiforme?

Indications for referral to a dermatologist for a patient presenting with erythema multiforme include:

• Recurrent erythema multiforme associated with herpes simplex infections, where specialist opinion is considered to evaluate the potential benefit of long-term suppressive antiviral treatment.
• Diagnostic uncertainty about the erythema multiforme presentation, especially if the clinical features are atypical or the diagnosis is unclear.
• Severe or extensive disease that is not responding to initial management in primary care.
• Cases where there is suspicion of underlying or associated conditions that require specialist assessment.

Referral is recommended to obtain specialist advice on diagnosis, management, and consideration of antiviral prophylaxis in recurrent cases.

This approach is based on expert opinion and review articles indicating that while prophylactic oral antivirals are not routinely recommended in primary care for recurrent erythema multiforme, referral for specialist assessment should be considered to reduce morbidity associated with recurrent episodes.

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