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Abstract

Erythema multiforme is a sudden, immune-mediated condition identified by unique target-like lesions on the skin. A common cause of this condition includes herpes simplex virus. Erythema dyschromicum perstans, or ashy dermatosis, is a hyperpigmentation disorder characterized by discolored cutaneous patches of bluish-grey hues, typically of unknown causes. This case presents a 56-year-old female with several years of recurrent skin lesions and discolored patches, who was ultimately diagnosed with concurrent erythema multiforme and erythema dyschromicum perstans. Her history included frequent travel to Africa, oral herpes simplex virus, and irregular periods. The patient underwent several diagnostic tests to confirm her diagnoses, including multiple punch biopsies, bone marrow pathology, and a leukemia/lymphoma evaluation. The treatment approach included suppressive oral valacyclovir for erythema multiforme and various drug regimens for erythema dyschromicum perstans, ultimately opting for daily doses of oral tetracycline and the antihistamine levocetirizine. This case highlights the challenges in diagnosing and managing both conditions effectively, as well as ensuring appropriate treatment to better inform future cases.