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Dermatology
Erythema Multiforme, Stevens–Johnson Syndrome, and Toxic Epidermal Necrolysis
Built from Dermatology, 5th Edition
What’s inside
3 sections · 117 slides
Overview
- Scope of this topic
- How this chapter is organised
Erythema Multiforme
A self-limited, often recurrent skin disease usually triggered by herpes simplex virus
- What erythema multiforme is
- Key features of erythema multiforme
- History of erythema multiforme
- Epidemiology of erythema multiforme
- What triggers erythema multiforme
- Precipitating factors in erythema multiforme
- Precipitating factors in erythema multiforme.
- Precipitating factors in erythema multiforme. (continued)
- Precipitating factors in erythema multiforme. (continued)
- How HSV triggers an EM lesion
- How HSV-associated EM lesions form
- Mycoplasma pneumoniae and other triggers
- Erythema multiforme lesions on the trunk
- Phenotypic variety of erythema multiforme lesions
- Atypical papular target lesions
- Where EM lesions appear
- Mucosal involvement in erythema multiforme major
- Mucosal and systemic features of EM
- Natural history of erythema multiforme
- Recurrence of erythema multiforme
- Histopathologic features of erythema multiforme
- Pathology of erythema multiforme
- Urticaria multiforme misdiagnosed as erythema multiforme
- Distinguishing EM from urticaria
- Comparison of urticaria and erythema multiforme.
- Erythema multiforme–like lesions in lupus and Sweet syndrome
- Other mimics of erythema multiforme
- Mycoplasma-induced rash and mucositis (MIRM)/RIME
- Key features of MIRM/RIME
- Key features of Mycoplasma pneumoniae-induced rash and mucositis (MIRM)/reactive infectious mucocutaneous eruption (RIME).
- Key features of Mycoplasma pneumoniae-induced rash and mucositis (MIRM)/reactive infectious mucocutaneous eruption (RIME). (continued)
- Treating erythema multiforme
- Preventing recurrent HSV-associated EM
- Summary: erythema multiforme
Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Two ends of one severe, drug-induced spectrum, defined by how much skin comes off
- What SJS and TEN are
- Key features of SJS and TEN
- History of SJS and TEN
- Comparing EM, SJS, and TEN
- Comparison of EM, SJS, and TEN: lesion type and precipitating factors (part 1 of Table 20.1)
- Comparison of EM, SJS, and TEN: distribution, mucosal, and systemic features (part 2 of Table 20.1)
- EM versus SJS/TEN: how they differ
- 1.2–6
- Risk factors for SJS and TEN
- SJS/TEN epidemiology and risk factors
- Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN): epidemiology and risk factors.
- Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN): epidemiology and risk factors. (continued)
- Mortality trends in SJS/TEN
- Drugs associated with SJS/TEN
- Medications most often implicated
- Medications most frequently associated with Stevens–Johnson syndrome and toxic epidermal necrolysis.
- Childhood Stevens–Johnson syndrome from trimethoprim–sulfamethoxazole
- Stevens–Johnson syndrome due to ipilimumab
- Pathogenesis: from drug exposure to immune attack
- Three ways a drug can form a neoantigen
- HLA and drug risk
- Immune cells and cytokines involved
- How keratinocytes die in SJS/TEN
- Proposed pathomechanisms of keratinocyte apoptosis in SJS/TEN
- Four death pathways that kill keratinocytes
- The Fas signalling pathway of apoptotic cell death
- Pathogenesis of SJS/TEN, step by step
- Clinical onset of SJS/TEN
- Early dusky macules of toxic epidermal necrolysis
- Clinical features of toxic epidermal necrolysis
- From macules to blisters: "wet cigarette paper"
- Classifying severity by surface area
- Spectrum of disease by surface area of epidermal detachment
- SJS/TEN overlap and early toxic epidermal necrolysis
- SJS/TEN overlap from trimethoprim–sulfamethoxazole
- Mucosal involvement in Stevens–Johnson syndrome
- Hemorrhagic crusting and mucosal involvement in TEN
- The wider picture of mucosal disease
- Toxic epidermal necrolysis due to an antimalarial drug
- Early Stevens–Johnson syndrome
- Distinguishing SJS from EM
- Predicting outcome in TEN
- SCORTEN: a severity-of-illness score
- SCORTEN prognostic factors
- SCORTEN score and mortality rate
- ABCD-10: an alternative mortality score
- Why patients with TEN die
- Long-term sequelae of toxic epidermal necrolysis
- Healing and long-term sequelae
- Histopathologic features of toxic epidermal necrolysis
- Early histopathologic changes in toxic epidermal necrolysis
- Pathology confirms the diagnosis
- Identifying the culprit drug
- Differential diagnosis of toxic epidermal necrolysis
- Differential diagnosis of toxic epidermal necrolysis.
- Differential diagnosis of toxic epidermal necrolysis. (continued)
- Differential diagnosis of toxic epidermal necrolysis. (continued)
- Approach to the patient with SJS or TEN
- Treatment principles for SJS/TEN
- Wound and skin care
- Eye, mouth, and genital care
- Systemic drug therapy: the evidence
- Facial toxic epidermal necrolysis before and after IVIg
- IVIg in SJS/TEN
- Evidence for and against SJS/TEN therapies
- A cautionary tale: thalidomide
- Long-term management
- Summary: Stevens–Johnson syndrome and TEN
- References
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)