Pediatric emergency medicine trisk 1316 1316
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FIGURE 68.9 Erosions on the lips with target lesions on the hands. (Reprinted with permission
from Somolinos AL, Grant LM, Goldsmith LA, et al. VisualDx: Essential Dermatology in
Pigmented Skin . Philadelphia, PA: Lippincott Williams & Wilkins; 2011.)
Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis
SJS and toxic epidermal necrolysis (TEN) are clinically similar, but exist in a
spectrum distinguished by the degree of skin involvement. SJS involves <10% of
body surface area; TEN involves >30% of body surface area; and 10% to 30%
body surface area involvement is considered SJS/TEN overlap.
A prodrome of fever and constitutional symptoms (malaise, headache, sore
throat, myalgias, arthralgias) sometimes precedes the onset of cutaneous lesions.
Erythematous and purpuric macules start on the face and trunk and spread over
hours to a few days to become more confluent and bullous. Tender erosions
remain after the bullae rupture ( Fig. 68.10 ). As the erythematous macules
develop dusky centers indicating epidermal necrosis, they can have a targetoid
appearance but lack the classic three zones seen in the target lesions of EM.
Gentle lateral pressure to an area of macular erythema causes the epidermis to
sheer off, known as the Nikolsky sign. Postinflammatory dyspigmentation is
common.
Mucous membrane involvement can precede cutaneous involvement by 1 to 2
days. Two or more mucosal surfaces are usually involved, while any epithelial
