EM, SJS, TENS

Question 1

Epidermal cells attacked by CD8 cytotoxic T cells

Answer 1

Erythema multiforme

Question 2

Erythematous macules and papules
Vesicles and bullae on extremities symmetrical
Target lesions

Answer 2

Erythema multiforme

Question 3

Triggers - idiopathic, meds, HSV infection, mycoplasma pneumo

Answer 3

erythema multiforme

Question 4

Sulfa, penicillin, phenytoin, allopurinol, barbiturates can trigger

Answer 4

erythema multiforme

Question 5

Can recur from HSV

Answer 5

Erythema multiforme

Question 6

Usually self limited

Answer 6

erythema multiforme

Question 7

Early - superficial perivascular lymphocytic infiltrate. Dermal edema. Accumulation of lymphocytes along dermoepiderrmal junction associated with degenerating and necrotic keratinocytes

Answer 7

Erythema multiforme

Question 8

Later - Lymphocytes migrate into epidermis. Epidermal necrosis with blister formation

Answer 8

Erythema multiforme

Question 9

Central necrosis surrounded by perivenular inflammation

Answer 9

Erythema multiforme

Question 10

More severe than erythema multiforme. Usually affects children.
Mucous membranes (mouth and conjunctivae)
Fever, difficulty eating, renal failure, and sepsis

Answer 10

Stevens-Johnson Syndrome

Question 11

Causes by sulfa drugs and anticonvulsants

Answer 11

Stevens-Johnson Syndrome

Question 12

Treatment usually supportive.
Stop drug, treat pt in burn unit. Maintain hydration, prevent secondary infection, provide pain relief.
Mortality as high as 15%

Answer 12

Stevens-Johnson Syndrome

Question 13

More severe than Stevens-Johnson

Answer 13

Toxic Epidermal Necrolysis

Question 14

Dermatological emergency. Detachment of large areas of epidermis.
Mortality 30%

Answer 14

Toxic Epidermal Necrolysis

Question 15

Necrotic epidermis lifting off dermis to form subepidermal bulla

Answer 15

Toxic Epidermal Necrolysis

Question 16

Immune mediated, hypersensitivity rx causing epidermal cell injury

Answer 16

Erythema multiforme