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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. 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)

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  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 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%

  4. 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

  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 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

  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 • 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

  10. 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

  11. 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

  12. 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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