Pediatric emergency medicine trisk 1317 1317
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surface may be involved, including the eyes, lips ( Fig. 68.11 ), tongue, buccal
mucosa, nose, and genitalia. In severe cases, pulmonary and renal involvement
has also been reported. Ocular manifestations include conjunctivitis with
photophobia, keratitis, uveitis, or corneal ulcerations. Close ophthalmologic care
is essential to prevent long-term complications, such as corneal
neovascularization, symblepharon, and blindness. Bullae may not be obvious on
mucous membranes, and often appear as a gray–white film that leaves erosions,
ulcerations, and hemorrhagic crust. Mucosal involvement may lead to difficulty
eating, drinking, dysuria, and pain with defecation. Ultimately, if scarring occurs,
it can result in functional impairment from esophageal stenosis, urethral stenosis,
vaginal stenosis, and anal strictures.
FIGURE 68.10 Confluent epidermal necrosis on the face results in diffuse desquamation and
erosions. Note the involvement of the lips with hemorrhagic crust and erosions. (Reprinted with
permission from Garg SJ. Color Atlas and Synopsis of Clinical Ophthalmology—Wills Eye
Institute—Uveitis . Philadelphia, PA: Lippincott Williams & Wilkins; 2011.)
