■ Relatively sparse inflammatory cell infiltrate that obscures the dermoepidermal junction
■ Vacuolar alteration of basal keratinocytes + necrotic keratinocytes
■ Infiltrate may be only in the superficial dermis, or in both the superficial and deep dermis
Clinical Presentation: Erythema Multiforme Minor:
Synonym: von Hebra's disease.
■ Acute, self-limited, recurrent disease of the skin and mucous membranes, most commonly in response to infection with herpes simplex virus types I and II
■ Pleomorphic eruption with erythematous and violaceous macules, papules, urticarial plaques, vesicles and bullae, and targetoid or iris lesions, in which an erythematous patch or urticarial plaque surrounds a central bulla or dusky macule
■ Lesions distributed symmetrically with a predilection for the distal extremities
Erythema Multiforme Major:
Synonyms: Stevens-Johnson syndrome; toxic epidermal necrolysis (TEN) spectrum; Lyell's syndrome (eponym for TEN).
■ Acute, severe, sometimes fatal systemic disease, with involvement of skin and several mucous membranes, associated with fever; most commonly drug-induced
■ Generalized, tender erythema, which quickly progresses to bulla formation with extensive separation of the epidermis in sheets
■ Erosive mucosal lesions
■ Similar for erythema multiforme minor and major
■ Vacuolar alteration of the basal keratinocytes, which may progress to frank subepidermal vesiculation (Figs. 1A-C)
■ Necrotic keratinocytes that may be individual or confluent; in TEN, there is confluent, full-thickness epidermal necrosis (Fig. 1D)
■ Sparse perivascular lymphohistiocytic infiltrate in superficial to mid dermis obscures dermoepidermal junction
■ Basket-weave stratum corneum (Figs. 1C and D)
Immunofluorescence: Direct Immunofluorescence:
■ Homogeneous staining for IgM (and sometimes granular staining for C3) of intraepidermal cytoid bodies (fluorescent keratinocytes)
■ Granular staining for C3 and fibrinogen along the dermoepidermal junction
Dusky center of
Was this article helpful?
Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.