DERMATOLOGY

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DERMATOLOGY
DESQUAMATION OF THE SKIN
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ERYTHEMA MULTIFORME
Iris and target-like patterns with concentric
macules and papules on the palm
Multiple, confluent target-like papules and
vesicles on the central facies. Bullae on the
lips and the buccal mucosa.
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ERYTHEMA MULTIFORME
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ERYTHEMA MULTIFORME MAJOR

• Erythematous iris and target-like papules,
  plaques, bullae, and erosions on the trunk, arms,
  neck, and face.
• Mucosal involvement is manifested by erosive lip
  lesions and conjunctivitis.

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ERYTHEMA MULTIFORME MAJOR
Child with erythema multiforme, following
smallpox vaccination
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STEVENS-JOHNSON SYNDROME
Generalized eruption of lesions that initially
had a target-like appearance but then became
confluent, brightly erythematous, and bullous.
The patient had extensive mucous membrane
involvement and tracheobronchitis.
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STEVENS-JOHNSON SYNDROME
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STEVENS-JOHNSON SYNDROME
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STEVENS-JOHNSON SYNDROME
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TOXIC EPIDERMAL NECROLYSIS
Generalized, macular eruption with some
target-like lesions which rapidly developed
epidermal necrosis, positive Nikolsky's sign,
bulla formation, and denuded erosive areas. This
eruption was due to sulfonamide drugs.
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TOXIC EPIDERMAL NECROLYSIS
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STAPHYLOCOCCAL SCALDED-SKIN SYNDROME
In this infant, painful, tender, diffuse erythema
was followed by generalized epidermal
desquamation. Staph. aureus had colonized the
nares with perioral impetigo, the site of
exotoxin production.
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STAPHYLOCOCCAL SCALDED-SKIN SYNDROME
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TOXIC SHOCK SYNDROME
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DRUG REACTIONS
Cutaneous necrosis warfarin Bilateral areas of
cutaneous infarction with purple-to-black
coloration of the breast surrounded by area of
erythema, occurred on 5th day of warfarin therapy
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DRUG REACTIONS
Ampicillin Symmetrically arranged, brightly
erythematous macules and papules, discrete in
some areas and confluent in others on the back
and extremities.
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DRUG REACTIONS
Penicillin Large, urticarial wheals on face,
neck, trunk with angioedema in periorbital
region
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DRUG REACTIONS
Amiodarone
Drug-induced pigmentation Striking slate-gray
pigmentation in facial distribution. Blue color
(ceruloderma) is due to deposition of melanin
contained in macrophages and endothelial cells in
the dermis. Pigmentation is reversible, but it
may take gt 1 year! In this patient it took 33
months for the ceruloderma to disappear.
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CASE STUDY
A 14-year-old boy presented to the ER
complaining of 4 days of increasing dysphagia,
dysuria, photophobia, and a macular rash
extending from trunk toward the extremities
some lesions are forming bullae. He has been
using tetracycline for 2 weeks for acne. Vital
signs are normal, except for a temperature of
103.1oF. He appears ill and had copious amounts
of ocular drainage and small vesicles on the
nasal and oral mucosa. Vesicles are also present
on the penis and scrotum.
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CASE STUDY

• Labs revealed slight leukocytosis of 11.7
• Blood cultures and herpes tests were negative

Most likely diagnosis Presumptive
cause Treatment
Steven-Johnson syndrome
Tetracycline
Stop the drug. IV steroids.
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CASE STUDY
The oral lesions became so painful, the patient
could not swallow his own saliva. TPN started.
The patient was given a patient-controlled
anesthesia pump for self-administration of
morphine. As the vesicles spread, they
coalesced into larger bullae and sloughed off.
Because of the need for increasing wound care,
the patient was transferred to the
ICU. Ophthalmologic and urology consultation
was obtained to address symptoms.
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CASE STUDY
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CASE STUDY
The area of denuded skin increased, and this
development required even more labor-intensive
treatment patient was transferred to the county
burn unit for wound management. His condition
improved during the next two weeks, and he
eventually recovered with minimal scarring.
Follow-up continued on an outpatient basis in the
Eye, Skin and Urology clinics.