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occurs as a reaction to exposure to phannacologic agents, such as tetracyclines, penicillins, NSAIDs, sulfonamides, or phenytoin.
Bullous drug reactions occur across a range, with the least severe being toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and erythema multiforme (EM).
Erythema Multiforme: Target-lesion biopsy reveals central necrosis with surrounding area of perivenular inflammation; necrotic keratinocytes are seen beneath a normal layer of stratum corneum; may also notice superficial perivascular lymphocytic infiltration and skin edema.
Erythema Multiforme: Usually accompanied by a sore throat and cough, macular, erythematous lesions grow into target or bullous lesions on the skin, most commonly the extremities.
Bullous drug reactions occur across a range, with the least severe being toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and erythema multiforme (EM).
Erythema Multiforme: Target-lesion biopsy reveals central necrosis with surrounding area of perivenular inflammation; necrotic keratinocytes are seen beneath a normal layer of stratum corneum; may also notice superficial perivascular lymphocytic infiltration and skin edema.
Erythema Multiforme: Usually accompanied by a sore throat and cough, macular, erythematous lesions grow into target or bullous lesions on the skin, most commonly the extremities.
Steven Johnson Syndrome: Characterized by subepidermal blisters, necrotic keratinocytes, and perivascular dermal infiltration, it is comparable to Erythema Multiforme.
Steven Johnson Syndrome: Erythema Multiforme symptoms combined with involvement of two or more mucosal surfaces (often the mouth) and less than 10% of the body's surface area.
Steven Johnson Syndrome: Erythema Multiforme symptoms combined with involvement of two or more mucosal surfaces (often the mouth) and less than 10% of the body's surface area.
Toxic Epidermal Necrolysis is characterized by complete epidermal necrosis, detachment from the underlying dermis, and few signs of inflammation in the dermis or epidermis.
Toxic Epidermal Necrolysis : Steven Johnson Syndrome symptoms, including involvement of more than 30% of the body's surface area and the development of bullae, are indicative of toxic epidermal necrosis. Diffuse skin erythema/desquamation akin to a severe sunburn may also be observed.
Toxic Epidermal Necrolysis : Steven Johnson Syndrome symptoms, including involvement of more than 30% of the body's surface area and the development of bullae, are indicative of toxic epidermal necrosis. Diffuse skin erythema/desquamation akin to a severe sunburn may also be observed.
Toxic Epidermal Necrolysis
Treatment
The removal of the offending agent; supportive care, including wound care, electrolyte and hydration management, and pain control.
The severity of skin and mucosal involvement determines the potential for fatality in Steven Johnson Syndrome and Toxic Epidermal Necrolysis.
The removal of the offending agent; supportive care, including wound care, electrolyte and hydration management, and pain control.
The severity of skin and mucosal involvement determines the potential for fatality in Steven Johnson Syndrome and Toxic Epidermal Necrolysis.
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