Erythema Multiforme. Erythema nodosum (EN) is an inflammatory condition characterized by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps that are usually seen on both shins. Granulomatosis with polyangiitis, abbreviated GPA, is a type of vasculitis that typically afflicts the lungs and kidneys . Erythema multiforme is divided into a major and a minor form; the major form includes mucous membrane involvement and, potentially, high-grade fever in children, while the minor form . Part of spectrum of reactive mucocutaneous disorders with maculopapular vesiculobulbous eruptions that includes erythema multiforme (EM - minor and major), Stevens-Johnson syndrome (SJS, if more mucosal involvement and epidermal necrosis) and toxic epidermal necrolysis (TEN) Due to cancer, collagen vascular disorder, drugs . Introduction An acute self-limiting dermatitis characterized by a distinctive clinical eruption manifested as the iris or target lesion. Rashes related to drug reactions are both nonallergic and allergic. Scattered eosinophils are often present. An introduction to skin pathology is in the dermatopathology article. Typical papular urticaria pigmentosa is characterized by dense aggregates of monomorphous mastocytes intradermally (can be diagnosed using HE staining). In three cases of post-herpetic erythema multiforme, few neutrophils were spotted in the papillary dermis, and in one case, a single eosinophil was found. Rubin's Pathology Skin. Positive stains. Episodes can be isolated, recurrent, or persistent. Abbreviated EM. It is common in young people aged 12-20 years. H&E stain. Erythema dyschromicum perstans is a form of acquired dermal macular hyperpigmentation characterised by well-circumscribed round to oval or irregular patches on the face, neck and trunk that are grey in colour. Physical examination reveals numerous scaly, pigmented plaques, which rub off easily. Abstract. Features: Hypersensitivity disorder due to a drug or infection. Dermatopathology is the pathology of skin. Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, medications, and other various triggers. Note: erythema multiforme may have variable histologic changes from toxic epidermal necrolysis to dermal disturbances Microscopic (histologic) images. So, it is a huge area. Moderate or intense pruritus was present in all but one case. Dermatopathologists help diagnose it. Bullous disease of the lung is dealt with in lung . skin pathology pathology in outline format with mouse over histology previews. Specialty. scleroderma. It represents an acute condition, sometimes recurrent, of the skin and mucosal membranes manifested by papular, bullous, and necrotic lesions. A 55-year-old man from China presents with a 3-month history of scales on his skin. . Bullous FDE may resemble erythema multiforme. Bullous disease of the lung is dealt with in lung . 3. Contributed by Mark R. Wick, M.D. Features: Lymphocytic interface dermatitis (lymphocytes at the dermal-epidermal junction). This case . Erythema Multiforme layer to the underlying basement membrane Basement membrane A darkly stained mat-like extracellular matrix (ecm) that separates cell layers, such as epithelium from endothelium or a layer of connective tissue. Types of EM: - EM minor: localized eruption of the skin with mild or no mucosal involvement - EM major skin and mucosal erosions of raised atypical target lesions, usually located on the . The main oral symptoms of COVID-19 associated are taste loss and xerostomia, but literature has reported other oral manifestation, such as oral blisters, ulcers, vesicles and other immunological lesions. Secondary changes of the epidermis and . Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a viral infection involving multi-organ manifestations. Erythema multiforme: Pathogenesis, clinical features, and diagnosis; Exanthematous (maculopapular) drug eruption; Lichenoid drug eruption (drug-induced lichen planus) Parapsoriasis (small plaque and large plaque parapsoriasis) Patch testing; Penicillin allergy: Delayed hypersensitivity reactions; Progestogen hypersensitivity The disorder is a cutaneous reaction consisting of inflammatory, tender, nodular lesions, usually located on the anterior aspects of the lower extremities. Erythema migrans and Lyme disease is discussed elsewhere in the CDS:DERM text. The rash consisted of a symmetric eruption of papules, urticarial lesions, and some erythema multiforme-like target lesions. Histologic examination showed a mild nonspecific lymphohistiocytic perivasculitis. H&E stain. In 1922, two American pediatricians, Stevens and Johnson, described two boys with a more . erythema induratum; polyarteritis nodosa; granuloma faciale; superficial migratory thrombophlebitis. Histology of erythema multiforme. Chronic condition, where destruction of the basal layer leads to release of pigment into the upper dermis. 19 The author has seen 2 cases in dogs in which the underlying pathology was diabetes mellitus. PCR studies can be performed on tissue blocks for identification of coxsackievirus A16 and enterovirus 71.. Erythema multiforme is an immune-mediated reaction that causes a raised, red, target-like rash on the skin or mucous membranes. In ensuing years, controversy existed as to whether SJS indeed was a separate entity or merely a severe form of erythema multiforme (EM). Histology. Definition: Actinic elastosis, or solar elastosis, is an accumulation of abnormal elastin (elastic tissue) in the dermis of the skin, and in the conjunctiva of the eye, which occurs as a result of the cumulative effects of prolonged and excessive sun exposure, a process known as photoaging.. Microscopy. Clin. Special staings: Giemsa, kresyl violet, toluidin blue, naphtol-ASD chloracetate esterase. This differs markedly from the high frequency and often high number of eosinophils and neutrophils in drug eruptions with severe vacuolar interface changes ( Figure 4 a, b ). Bullous diseases are a subset of the large inflammatory skin diseases category. Erythema multiforme is an immune-mediated, typically self-limiting, mucocutaneous condition characterised by 'target' lesions . Bullous diseases, e.g. These lesions are often accompanied by erosions or bullae involving the oral, genital, and/or ocular mucosae ( picture 2A-C ). Stained with HE, alcian blue and colloid iron (Halle): Reticular erythematous mucinosis, HE 10x (604) Reticular erythematous mucinosis, alcian blue 10x (605) Reticular erythematous mucinosis, Halle 10x (606) Reticular erythematous mucinosis, HE 40x (607) Reticular erythematous mucinosis, alcian blue 40x (608) Reticular erythematous . 3. Pictures. Sometimes, erythema nodosum is not a separate disease. Lichenoid interface dermatitides. Introduction. Phototoxic dermatitis is caused by contact or ingestion of some photosensitizing substance. Summary of Contact dermatitis. Common triggers for EN include infection, drugs, pregnancy, malignancy, and inflammatory conditions, such as sarcoidosis or gastrointestinal diseases; however, many cases are idiopathic . Erythema dyschromicum perstans (ashy dermatosis). In the earlier stages of actinic elastosis, elastic fiber proliferation can be seen in the . Erythema Multiforme. Recently, literature on HFMD in adults is increasing. Epidermal necrosis, e.g. It was previously known as Wegener's granulomatosis, abbreviated WG . DDx: Lichen planus; Mycosis fungoides. Significant mucosal involvement distinguishes erythema multiforme major from multiforme minor. Photoallergic dermatitis appears after exposure to some photosensitizing agent . Reports have also linked administration of phenobarbital and development of this syndrome. Erythema multiforme (EM) is a cutaneous and mucosal hypersensitivity reaction with characteristic lesions in target triggered by certain antigenic stimuli. Regarding lymphocytic interface dermatitis, there are 2 broad categories: cell-poor interface dermatitis, when only a sparse infiltrate of inflammatory cells is present along the . Treatment Options. Erythema multiforme (EM) is a disease whose acute, bullous symptoms of autoimmune origin are generally linked to an infection with herpes simplex virus [1, 2].Mycoplasma pneumoniae has also been suspected to trigger the disease [1, 3].However, the role of some drugs, particularly non-steroidal anti-inflammatory drugs (NSAIDs) and penicillin, still remains a controversial issue []. Bullous diseases, e.g. Inflammatory skin diseases. The process is not specific, pigment incontinence can be seen in many . III. Vacuolar interface dermatitis ( VAC, also known as liquefaction degeneration, vacuolar alteration or hydropic degeneration) is a dermatitis with vacuolization at the dermoepidermal junction, with lymphocytic inflammation at the epidermis and dermis. Erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis are separate diseases. Interface dermatitis can be classified based upon the cell type that dominates the infiltrate (ie, neutrophilic, lymphocytic, or lymphohistiocytic) or by the intensity of the interface inflammation. Biopsy of vesicle from flexoral surface of right arm showing intraepidermal and subepidermal bullae, spongiosis with microvesicular Special studies for hand, foot and mouth disease. Erythema multiforme. The salient histological findings include basal cell vacuolization, apoptotic keratinocytes (colloid or Civatte bodies), and obscuring of the dermo-epidermal junction by inflammatory cells. So, it is a huge area. DDx. Journal of Clinical Pathology 58 (12): 1233-1241. doi: 10.1136/jcp.2005.027151. Clinical: Target-like lesion. color: reddish. Stained with HE, alcian blue and colloid iron (Halle): Reticular erythematous mucinosis, HE 10x (604) Reticular erythematous mucinosis, alcian blue 10x (605) Reticular erythematous mucinosis, Halle 10x (606) Reticular erythematous mucinosis, HE 40x (607) Reticular erythematous mucinosis, alcian blue 40x (608) Reticular erythematous . An introduction to skin pathology is in the dermatopathology article. Figurate erythemas induced by . Phytophotodermatitis affects anyone, who gets in contact with some plants containing furocoumarins and later gets exposed to sunlight (dermatitis striata praetensis of Hebra). The ecm layer that supports an overlying epithelium or endothelium is called basal lamina. Contents. Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. Contrast with Erythema Multiforme lesions remain fixed for at least 7 days. Clinical correlation can be very helpful. Up to 55 percent of cases have no clear identifiable cause. Images hosted on other servers: Various images. For example, EAC related to tinea or candidiasis will often respond to management of the superficial cutaneous infection. Differential diagnosis of hand, foot and mouth disease pathology. erythema multiforme; toxic epidermal necrolysis; GVHD; cutaneous lupus; dermatomyositis; pityriasis lichenoides; . The etiology and pathogenesis of each disease remains an enigma; thus, there is no effective widely accepted treatment. Differential Diagnosis: General Skin Lesions. The vast majority of cases are rapidly resolving and self limiting once the offending . This case report showed an Erythema Multiforme (EM) manifesting as oral mucosa lesions in a patient with a late diagnosis of COVID-19 infection. Super lame mnemonic Danny G & SLE: Dermatomyositis, GVHD, SLE, Lichen sclerosus, Erythema multiforme. 1 Specimens; . Dermatopathologists help diagnose it. "Erythema multiforme major" is the term used to describe . Erythema multiforme Lupus erythematosis Typical findings in systemic lupus erythematosus: Fibrinoid necrosis at the dermoepidermal junction; Liquefactive degeneration and atrophy of the epidermis; . a few large (more than 10 cm in diameter), fairly demarcated, iregularly shaped plaques. Vesiculobullous erythema multiforme Result from damage to the basal cells of the epidermis ("interface type dermatitis") Histology: -subepidermal blister -mild to moderately heavy infiltrate of lymphocytes in the underlying dermis -the epidermis overlying the blister may show necrosis -apoptotic keratinocytes are usually present in the Erythema multiforme is a skin disorder that's considered to be an allergic reaction to medicine or an infection. Its name combines the Latin "erythema" (redness . James W. Patterson MD, FACP, FAAD, in Weedon's Skin Pathology, 2021 Actinic Cheilitis. Although one can confirm the causative agent using oral challenge testing, it is not recommended due to the risk of severe exacerbation or possible generalization; patch testing is now preferred. pemphigus vulgaris. In 1866, the Austrian dermatologist Ferdinand von Hebra first described erythema multiforme as a self-limited cutaneous disease characterized by multiform skin lesions. Bullous diseases are a subset of the large inflammatory skin diseases category. Bullous diseases. Liquefaction degeneration of the basal layer (interface dermatitis, 1.64 ), colloid bodies ( 1.27 ), and melanin incontinence ( 1.79) frequently occur together.