DERMATOLOGY
CAUSES
■ Drugs: Antibiotics, anticonvulsants, sulfonylureas, allopurinol, NSAIDs,
barbiturates
■ Infections: HSV, mycoplasma, hepatitis, strep, TB
■ Collagen vascular disorders: RA, SLE
■ Malignancies: Leukemia, lymphoma, carcinoma
DIFFERENTIAL
■ SJS: Skin and oral lesions are more severe involving 10–30% BSA, two or
more mucosal sites involved in SJS
■ Urticaria: Lesions migrate (EM lesions are fixed, persists >24 hours)
TREATMENT
■ Treat cause (treat infection, acyclovir decreases recurrences in patients
with HSV).
■ Oral antihistamines to reduce stinging and burning of skin
■ Hospitalize patients with impaired intake due to oral involvement.
■ Local wound care with wet compresses (Burrows solution)
■ Epinephrine not effective
■ Steroids controversial
STEVENS-JOHNSON SYNDROMEA severe expression of erythema multiforme, though not as severe as toxic epi-
dermal necrolysis (see Figure 17.1)
SYMPTOMS/EXAM
■ More common in children, peak incidence in second decade of life
■ Starts with a prodrome of upper respiratory symptoms, malaise, fever, vom-
iting, and diarrhea; patient appears ill
Four erythemas:- Erythema marginatum—
migratory annular and
polycyclic erythematous
eruption, cutaneous
manifestation of acute
rheumatic fever - Erythema migrans—
expanding red lesion with
central clearing at site of
tick bite, Lyme disease - Erythema multiforme—
target lesions, ± mucosal
involvement, many causes - Erythema nodosum—
tender, raised red nodules
on legs, many causes
FIGURE 17.1. Stevens-Johnson syndrome. Note the target lesions on the hands of this
patient. (See also color insert.)
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency
Medicine, 2nd ed. New York: McGraw-Hill, 2002:379.)