Differential Diagnosis

Differential Diagnosis

1. Erysipelas2. Hansen’s Disease (Borderline Type)3. Fixed Drug Reaction4. Erythema Multiforme

Erythema MultiformeEM minor & EM with mucosal involvementEM 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%

EM Minor

• Periphery: ring of erythema

• Central: flatters, more pruritic and dusky

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

Characteristic & Evolution of the LesionCharacteristic & Evolution of the Lesion

1. Central dusky purpura2. Elevated, edematous, pale ring3. Surrounding macular erythema

EM MinorSites of PredilectionSites of Predilection(Symmetrical and acral)• (Best observed on)

Palms and soles• Dorsal feet• Extensor limbs• Elbows• Knees

Age of PredilectionAge of Predilection• young adults

Migs, paano ung extensor limbs?

Erythema MultiformeSteven-Johnson syndrome / EM majorSteven-Johnson syndrome / EM major• Clinically different from minor• Frequently, febrile prodrome

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 LesionCharacteristic & Evolution of the Lesion

EM MajorSites of PredilectionSites of Predilection• Begins diffusely on

the truck and mucous membranes

Age of PredilectionAge of Predilection• Eruption occurs at all

ages

Tama lang ba ung circle for “mucus membranes”

Etiologic Factors • EM minor = herpes simplex infectionEM 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) = medicationsEM major (SJS) = medications– Most centrally accentuated eruptions with atypical

targets – Sulfonamids, antibiotics, NSAIDs, allopurinol,

anticonvulsants– Due to abnormal metabolism of medications

Etiologic Factors

• Also, EM major = Mycoplasma pneumoniaeAlso, EM major = Mycoplasma pneumoniae– Prominent mucosal involvement and bullous skin

lesions – NOT classic iris lesions– Resemble SJS cases

• And, EM major = radiation therapyAnd, EM major = radiation therapy– With phenytoin and tapering corticosteroids –

induces EM starting at radiation port

Pathogenesis

• Activated T lymphocytes – Epidermis: cytotoxic or suppressor cells – Dermis: helper T cells

• EM minor EM minor – specific HLA types (HLA-DQ3)• SJSSJS – abnormalities in drug metabolism

Hence, there is a genetic component for both diseases

Disease

• Please use KEYWORDS only• NO SENTENCES please• You can put pictures if you like.

DiagnosisDiagnosis

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 duration Appearance of multiple pruritic macules and papules after 2 days

sites of predilection Flexor surface of both forearms which gradually spread to the face, trunk and thighs, palms and soles