CHAPTER 7: ERYTHEMA AND URTICARIA Flashcards
Is usually
most marked on the hypothenar areas and is associated with
an elevated level of circulating estrogen. Cirrhosis, hepatic
metastases, and pregnancy are common causes.
Erythema palmare
Erythema multiforme major is most often caused by
Mycoplasma infection
Erythema multiforme minor is usually caused by
HSV infection
Recurrent self limited disease Sharply marginated, erythematous macules then evolve to papules Target lesions observed in palms and soles Koebner phenomenon
EM minor
Type of EM: Frequently accompanied by a febrile prodrome Lesions on extremities and face, may include trunk Mucous membrane disease prominent
EM major
Describe the classic “target” or “iris” lesion of erythema multiforme
This lesion is the classic “target” or “iris”
lesion with three zones:
central dusky purpura;
an elevated,
edematous, pale ring; and surrounding macular erythema
(Figs. 7-2 and 7-3)
What diagnostic test is necessary to exclude paraneoplastic pemphigus from mycoplasma-induced EM major?
Direct immunoflorescence
is the most common
gyrate erythema.
. . .
It is characterized by asymptomatic annular
or polycyclic lesions that grow slowly (2–3 mm/day), rarely
reaching more than 10 cm in diameter. Characteristically,
there is a trailing scale at the inner border of the annular
erythema (Fig. 7-7). The surface is typically devoid of crusts
or vesicles, although atypical cases with telangiectasia and
purpura have been described. Lesions usually occur on the
trunk and proximal extremities. Mucosal lesions are absent
Erythema annulare centrifugum
Histologically, the epidermis will show mild focal spongiosis and parakeratosis. Within the superficial dermis and at
times the deep dermis, lymphocytes are organized tightly
around the blood vessels in a pattern described as a “coat
sleeve” arrangement
Erythema annulare centrifugum
a rare disease that is striking and unique in appearance. Lesions consist of undulating
wavy bands of slightly elevated erythema with trailing scale
over the entire body. Lesions migrate rapidly (up to 1 cm/day)
and are characteristically concentric, giving the skin a “wood
grain” appearance (Fig. 7-8)
Erythema gyratum repens
Sharply marginated rapidly extending, tender, erythematous or violaceous, painful, elevated plaque, 2-10cm diameter Face, neck, upper trunk and extremities May burn but do not itch Fever
Sweet syndrome Acute febrile neutrophilic dermatosis
Majority of cases of Sweet syndrome follow this infection
URTI
Pregnancy associated Sweet syndrome usually presents in what trimester
1st or 2nd
Treatment for Sweet syndrome
Self limited Oral prednisone 1mg/kg/day
Begins as an inflammatory pustule with a surrounding halo that enlarges and begins to ulcerate Lower extremities and trunk
Pyoderma gangrenosum