Differential Diagnosis

Differential Diagnosis Erysipelas Hansen’s Disease (Borderline Type) Fixed Drug Reaction Erythema Multiforme

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%

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 Minor Sites of Predilection Age of Predilection Migs, paano ung extensor limbs? 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 Multiforme Steven-Johnson syndrome / EM major Clinically different from minor Frequently, febrile prodrome

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 Major Sites of Predilection Tama lang ba ung circle for “mucus membranes” EM Major Sites of Predilection Begins diffusely on the truck and mucous membranes Age of Predilection Eruption occurs at all ages

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 Sulfonamids, antibiotics, NSAIDs, allopurinol, anticonvulsants Due to abnormal metabolism of medications

Etiologic Factors Also, EM major = Mycoplasma pneumoniae 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

Hence, there is a genetic component for both diseases 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 Diagnosis Please use KEYWORDS only NO SENTENCES please You can put pictures if you like.

Disease Salient Features age 25 year old female Characteristic of lesion Evolution of the lesion If SIMILAR WITH THE PATIENT’s.. KINDLY Bold and color it Red . 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 Flexor surface of both forearms which gradually spread to the face, trunk and thighs, palms and soles