1. Differential Diagnosis

2. Differential Diagnosis
Erysipelas
Hansen’s Disease (Borderline Type)
Fixed Drug Reaction
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 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 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

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
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

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

10. 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

11. 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

12. Disease Diagnosis Please use KEYWORDS only NO SENTENCES please
You can put pictures if you like.

13. 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