2 Differential Diagnosis ErysipelasHansen’s Disease (Borderline Type)Fixed Drug ReactionErythema Multiforme
3 Erythema Multiforme EM minor & EM with mucosal involvement Self-limited, recurrent diseaseNo or only a mild prodrome (1 to 4 weeks)Sharply marginated erythematous macules become raised, edematous papules (24 to 48 hours)Koebner’s phenomenon or photoaccentuationMucosal involvement in 25%-- usually limited to the oral mucosaMore severe classic case? Two or more mucous membranes involved in 45%
4 EM Minor Characteristic & Evolution of the Lesion Periphery: ring of erythemaCentral: flatters, more pruritic and dusky“target” or “iris” lesion with three zonesCentral dusky purpuraElevated, edematous, pale ringSurrounding macular erythema
5 EM Minor Sites of Predilection Age of Predilection Migs, paano ung extensor limbs?EM MinorSites of Predilection(Symmetrical and acral)(Best observed on) Palms and solesDorsal feetExtensor limbsElbowsKneesAge of Predilectionyoung adults
6 Erythema Multiforme Steven-Johnson syndrome / EM major Clinically different from minorFrequently, febrile prodrome
7 EM Major Characteristic & Evolution of the Lesion Flat, erythematous or purpuric macules incomplete “atypical targets” (may blister centrallyLarger and more commonly confluent lesions compared to EM minor
8 EM Major Sites of Predilection Tama lang ba ung circle for “mucus membranes”EM MajorSites of PredilectionBegins diffusely on the truck and mucous membranesAge of PredilectionEruption occurs at all ages
9 Etiologic Factors EM minor = herpes simplex infection Typically orolabial1 to 3 weeks (10 day average) after herpes lesionMay or not follow herpes outbreaksEM major (SJS) = medicationsMost centrally accentuated eruptions with atypical targetsSulfonamids, antibiotics, NSAIDs, allopurinol, anticonvulsantsDue to abnormal metabolism of medications
10 Etiologic Factors Also, EM major = Mycoplasma pneumoniae Prominent mucosal involvement and bullous skin lesions – NOT classic iris lesionsResemble SJS casesAnd, EM major = radiation therapyWith phenytoin and tapering corticosteroids – induces EM starting at radiation port
11 Hence, there is a genetic component for both diseases PathogenesisActivated T lymphocytesEpidermis: cytotoxic or suppressor cellsDermis: helper T cellsEM minor – specific HLA types (HLA-DQ3)SJS – abnormalities in drug metabolismHence, there is a genetic component for both diseases
12 Disease Diagnosis Please use KEYWORDS only NO SENTENCES please You can put pictures if you like.
13 Disease Salient Features age 25 year old female Characteristic of lesionEvolution of the lesionIf SIMILAR WITH THE PATIENT’s.. KINDLY Bold and color it Red .Multiple erythematous papules, macules and patches with dark centers5 days durationAppearance of multiple pruritic macules and papules after 2 dayssites of predilectionFlexor surface of both forearms which gradually spread to the face, trunk and thighs, palms and soles
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