By Disease Name > Erythema Multiforme > EM vs. SJS/TEN

EM vs. SJS/TEN

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A disease spectrum of acute self-limited exanthematic intolerance reactions.

•these conditions share at least 2 salient features:
1.target lesions
2.histologically:  satellite cell (or more widespread) necrosis of the epidermis
•all thought to be the result of a cytotoxic immunologic attack on keratinocytes expressing non-self antigens (virus or drug)

 

Two main subsets:

1.Erythema Multiforme
•fairly common
•usually mild and relapsing eruption
•most often (or exclusively) triggered by HSV
•raised atypical targets;  extremities and/or face (or typical targets)

 

2.SJS/TEN
•infrequent
•severe mucocutaneous intolerance reaction
•most often drugs
•SJS and TEN differ only in the extent of body surface area involved
•flat atypical targets;  widespread or limited to trunk

 

 

 

EM

SJS/TEN

 

 

targets

atypical or no target lesions

 

 

predominantly inflammatory histologic pattern

predominantly necrotic histologic pattern

 

 

Nikolsky sign (-)

Nikolsky sign (+)

 

 

MM: frequent, but mostly mild (oral only)

prominent, severe, 2-3 mucosal sites

 

 

lesions: acral, target shaped, elevated

face and trunk, irregularly shaped, not elevated unless

forming vesicles