Management of catamenial oral erythema multiforme: ovulation suppression for recurrence prevention

Catamenial dermatosis is a rare condition characterised by premenstrual flares of cutaneous and mucosal lesions due to hormonal fluctuations. We present a patient with recurrent oral ulcers beginning before menstruation, starting as painful vesicles that progressed to ulcers and resolved postmenses. Histopathology revealed a subepidermal cleft with inflammatory infiltrates, and viral cytopathic effects were absent. Based on the cyclical pattern and exclusion of other causes, catamenial erythema multiforme was diagnosed. Acute episodes were managed with corticosteroids and antiviral therapy, while continuous ovulation suppression using combined contraceptive pills effectively prevented recurrence. During 6 months of follow-up, no lesions recurred, underscoring the role of ovulation suppression in breaking the cycle of hormonal triggers. This case highlights the multifaceted management of catamenial erythema multiforme, with hormonal modulation as a key strategy for recurrence prevention in this condition potentially linked to Herpes simplex virus reactivation.