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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?. ERYTHEMA MULTIFORME. Erythema Multiforme. EM minor & EM with mucosal involvement Self-limited, recurrent disease

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Jesus made changes sa last slide table and the circles site of predilection

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?


Erythema multiforme

ERYTHEMA MULTIFORME


Erythema multiforme1

Erythema Multiforme

EM minor & EM with mucosal involvement

  • Self-limited, recurrent disease

  • No or only a mild prodrome (1 to 4 weeks)

  • Sharply marginatederythematousmacules 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%


Em minor

EM Minor

Characteristic & Evolution of the Lesion

  • Periphery: ring of erythema

  • Central: flatters, more pruritic and dusky

  • “target” or “iris” lesion with three zones

  • Central dusky purpura

  • Elevated, edematous, pale ring

  • Surrounding macular erythema


Em minor1

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


Erythema multiforme2

Erythema Multiforme

Steven-Johnson syndrome / EM major

  • Clinically different from minor

  • Frequently, febrile prodrome


Em major

EM Major

Characteristic & Evolution of the Lesion

  • Flat, erythematous or purpuric macules

    incomplete “atypical targets” (may blister centrally

  • Larger and more commonly confluent lesions compared to EM minor


Em major1

EM Major

Sites of Predilection

  • Begins diffusely on the trunk and mucous membranes

  • Spreads centripetally

    Age of Predilection

  • Eruption occurs at all ages


Etiologic factors

Etiologic Factors

  • 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

    • Most centrally accentuated eruptions with atypical targets

    • Sulfonamides, antibiotics, NSAIDs, allopurinol, anticonvulsants

    • Due to abnormal metabolism of medications


Etiologic factors1

Etiologic Factors

  • Also, EM major= Mycoplasmapneumoniae

    • Prominent mucosal involvement and bullous skin lesions – NOT classic iris lesions

    • Resemble SJS cases

  • And, EM major = radiation therapy

    • With phenytoin and tapering corticosteroids – induces EM starting at radiation port


Pathogenesis

Pathogenesis

  • Activated T lymphocytes

    • Epidermis: cytotoxic or suppressor cells

    • Dermis: helper T cells

  • EM minor – specific HLA types (HLA-DQ3)

  • SJS – abnormalities in drug metabolism

    Hence, there is a genetic component for both diseases


Disease

Disease

Diagnosis

  • Physical examination

    • Characteristic Target Lesions

    • Distribution- symmetrical and acral

    • Evolution:

Center becomes darker and purpuric

Lesions flatten at the center

Ring of Erythema


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