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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?

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Presentation on theme: "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?"— Presentation transcript:

1 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?

2 ERYTHEMA MULTIFORME

3 Erythema Multiforme EM minor & EM with mucosal involvement Self-limited, recurrent disease No 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 photoaccentuation Mucosal involvement in 25% -- usually limited to the oral mucosa More severe classic case? Two or more mucous membranes involved in 45%

4 EM Minor Periphery: ring of erythema Central: flatters, more pruritic and dusky “target” or “iris” lesion with three zones Characteristic & Evolution of the Lesion 1.Central dusky purpura 2.Elevated, edematous, pale ring 3.Surrounding macular erythema

5 EM Minor Sites of Predilection (Symmetrical and acral) (Best observed on) Palms and soles Dorsal feet Extensor limbs Elbows Knees Age of Predilection young adults

6 Erythema Multiforme Steven-Johnson syndrome / EM major Clinically different from minor Frequently, febrile prodrome

7 EM Major Flat, erythematous or purpuric macules incomplete “atypical targets” (may blister centrally Larger and more commonly confluent lesions compared to EM minor Characteristic & Evolution of the Lesion

8 EM Major Sites of Predilection Begins diffusely on the trunk and mucous membranes Spreads centripetally Age of Predilection Eruption occurs at all ages

9 Etiologic Factors EM minor = herpes simplex infection EM minor = herpes simplex infection – Typically orolabial – 1 to 3 weeks (10 day average) after herpes lesion – May or not follow herpes outbreaks EM major (SJS) = medications EM major (SJS) = medications – Most centrally accentuated eruptions with atypical targets – Sulfonamides, antibiotics, NSAIDs, allopurinol, anticonvulsants – Due to abnormal metabolism of medications

10 Etiologic Factors Also, EM major = Mycoplasma pneumoniae Also, EM major = Mycoplasma pneumoniae – Prominent mucosal involvement and bullous skin lesions – NOT classic iris lesions – Resemble SJS cases And, EM major = radiation therapy And, EM major = radiation therapy – With phenytoin and tapering corticosteroids – induces EM starting at radiation port

11 Pathogenesis Activated T lymphocytes Activated T lymphocytes – Epidermis: cytotoxic or suppressor cells – Dermis: helper T cells EM minor EM minor – specific HLA types (HLA-DQ3) SJS SJS – abnormalities in drug metabolism Hence, there is a genetic component for both diseases

12 Disease Physical examination – Characteristic Target Lesions – Distribution- symmetrical and acral – Evolution: Diagnosis Ring of Erythema Lesions flatten at the center Center becomes darker and purpuric

13 Erythema Multiforme Salient Features EM Minor: Young adults EM Major: Eruption occurs at all ages 25 year old female Sharply marginated erythematous macules Become raised edematous papules in 24 to 48 hours Central area may darken and form blisters Multiple erythematous papules, macules and patches with dark centers 5 days duration Appearance of multiple pruritic macules and papules after 2 days sites of predilection Dorsum of hands Dorsum of feet Extensor limbs Elbows Knees Palms Soles Trunk Flexor surface of both forearms which gradually spread to the face, trunk and thighs, palms and soles


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