Desquamtion

Desquamation-

-Erythema Multiforme-

-Etiology
-Infection (HSV most common) and mycoplasma
-Drugs (PCN, Sulfonamides, Dilantin, and Allopurinol)
-Connective tissue disease
-Physical agents
-Pregnancy
-Malignancy
-Idiopathic is actually the most common etiology

-Target shaped lesions are classic
-Lesions are most common on the face and extremities

-Ranges from mild (EM minor) to severe (EM major)
-Minor-little or no mucus membrane involvement, vesicles but no systemic symptoms.  Likes extensor surfaces of extremities with target shaped lesions
-Erythema Multiform Major-most commonly from a drug reaction.  Has mucus membrane involvement, tendency for lesions to become confluent and bullous, fever, may have conjunctivitis, and ulcerations in larynx and trachea.
-Maximal Variant-lifethreatening


-Stevens-Johnson Syndrome-

-Consider a severe form of erythema Multiforme
-Lesions are more diffuse
-10% or less epidermal detachment
-Effects the mucus membranes (eyes, mouth, genitalia)
-Most often seen in children and young adults
-Usually preceded by URI symptoms
-Etiologies-
-50% are associated with drug exposure (sulfa, allopurinol, carbamazepine, penicillins, cephalosporins, vancomycin, rifampin, ibuprofen, naproxen, and fluoroquinolones.  Etiologies in not clear)
-chemicals
-infections- mycoplasma, viral infections, and immunizations
-Definitive diagnosis is skin biopsy
-Management-admit to burn center and ICU, IV Fluid replacement, Parkland Formula, Corticosteroids may or not be helpful, immunoglobulins, deride necrotic skin

-Toxic Epidermal Necrolysis (TEN)-

-Full thickness loss of epidermis
-Usually greater than 30% of body surface are and dermal detachment 
-Tends to involve mucus membranes
-Patients should be in a burn unit
-Risk of infection
-Electrolyte disturbance
-Fatalities are common
-80% of cases related to medication however 5% report no med use
-Chemicals can cause
-Also infections mycoplasma, viral infections and immunizations
-Management-admit to burn center and ICU, IV Fluid replacement, Parkland Formula, Corticosteroids may or not be helpful, immunoglobulins, deride necrotic skin