Presentation on theme: "Do we need to distinguish kung EM Minor or Major ung patient?"— Presentation transcript:
1 Do we need to distinguish kung EM Minor or Major ung patient? Jesus, made changes sa last slide (table) and the circles (site of predilection)Do we need to distinguish kung EM Minor or Major ung patient?
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 (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 maculesincomplete “atypical targets” (may blister centrallyLarger and more commonly confluent lesions compared to EM minor
8 EM Major Sites of Predilection Begins diffusely on the trunk and mucous membranesSpreads centripetallyAge 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 targetsSulfonamides, 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 Physical examination Characteristic Target Lesions Distribution- symmetrical and acralEvolution:Center becomes darker and purpuricLesions flatten at the centerRing of Erythema
13 Salient Features Erythema Multiforme EM Minor: Young adults EM Major: Eruption occurs at all ages25 year old femaleSharply marginated erythematous maculesBecome raised edematous papules in 24 to 48 hoursCentral area may darken and form blistersMultiple erythematous papules, macules and patches with dark centers5 days durationAppearance of multiple pruritic macules and papules after 2 dayssites of predilectionDorsum of handsDorsum of feetExtensor limbsElbowsKneesPalmsSolesTrunkFlexor surface of both forearms which gradually spread to the face, trunk and thighs, palms and soles
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