Hypersensitivity Syndromes

Question 1

Erythema Multiforme Etiology

Answer 1

Infections, HSV, Mycoplasma, fungal infections, and medications

Question 2

Erythema Multiforme acute management

Answer 2

Observation and oral antihistamines, topical steroids

Question 3

Erythema Multiforme recurrent management

Answer 3

Antivirals (oral acyclovir, etc), Dapsone, hydroxychloroquine, azathioprine, cyclosporine, thalidomide

Question 4

Erythema Multiforme classic patient

Answer 4

Male, aged 20-40 with few systemic symptoms with symmetric target lesions on dorsal hands/feet/extremities

Question 5

SJS/TEN spectrum grading

Answer 5

1: SJS with <10% epidermal detachment
2. SJS-TEN overlap with 10-30%
3. TEN with >30%

Question 6

MCC of SJS/TEN

Answer 6

Lamotrigene, carbamazepine, phenytoin, phenobarbitol, co-trimoxazole, sulfasalazine, allopurinol, Oxicam NSAIDs

Question 7

Timing of SJS/TEN

Answer 7

Onset 4-28 days post initiation of medication is classic timing

Question 8

SJS lesions

Answer 8

Start on trunk (unlike EM) and see flat atypical targets/purpuric macules that develop bullae. Ulcerative stomatitis leading to hemorrhagic crusting

Question 9

SJS common patient

Answer 9

Children and young adults

Question 10

SJS tx

Answer 10

?Oral corticosteroids with cool compresses (not topical steroids in eroded areas)

Question 11

TEN vs. SSSS

Answer 11

Split in SSSS is just under the stratum corneum while split in TEN is at the dermoepidermal junction

Question 12

SKin findings in TEN

Answer 12

Diffuse, hot erythema covering wide areas, skin becomes painful and + Nikolsky’s sign. Mucous membrane including oral and vaginal mucosa is common. Purulent conjunctivitis.

Question 13

Prognostic scoring system for SJS/TEN

Answer 13

SCORTEN

Question 14

Tx of TEN

Answer 14

Cyclosporine can be considered, treatment at a burn center

Question 15

Erythema Nodosum associated symptoms

Answer 15

Arthralgias (Rheumatoid factor negative), malaise

Question 16

Skin findings in erythema nodosum

Answer 16

poorly demarcated red, nodules that are painful on legs and arms. Individual lesions last ~2 weeks

Question 17

Etiology of erythema nodosum

Answer 17

probably delayed hypersensitivity, most common associations now are strep infection, coccidiodomycosis, and sarcoidosis, IBD, Lofgren’s syndrome (EN or periarticular ankle inflammation w/ hilar or paratracheal LAD), lymphoma

Question 18

Erythema nodosum tx

Answer 18

Mild: naproxen

Recurrent/very painful: potassium iodide in orange joice