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Allergic and Immunologic Reactions
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Saira N. Agarwala, Aspen R. Trautz, Sylvia Hsu
Clinical presentation: Classically, the eruption of EM is characterized by targetoid lesions; however, these lesions may not be seen in all patients presenting with EM, and, if present, they are often indicative of later stages of the disease process. The targetoid lesions of EM are typically less than 3 cm in diameter, well circumscribed, and display three zones of color. Early lesions can display two colors. The central zone can be crusted or contain a bulla. Lesions often begin as erythematous papules.
Dermatoses of Pregnancy
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Hannah J. Anderson, Dana Correale, Jason B. Lee
PEP is characterized by urticarial lesions that begin on the abdomen, often within abdominal striae, and spare the periumbilical area (Figure 45.1). Lesions frequently spread to the upper thighs and buttocks and occasionally may affect the arms. The face, palms, and soles are usually spared. Despite the severe pruritus, there is notable lack of excoriation. As its name implies, PEP is polymorphous. Clinical lesions may appear vesicular, targetoid, or purpuric. This eruption is seen mostly in primigravidas with onset in the third trimester of pregnancy. It resolves shortly after delivery, but there have been a few cases reported in which onset of the disease has occurred in the postpartum period [24–26]. The diagnosis is primarily clinical. Histopathologic examination of affected skin most often yields nonspecific findings.
Nevi
Published in Aimilios Lallas, Zoe Apalla, Elizabeth Lazaridou, Dimitrios Ioannides, Theodosia Gkentsidi, Christina Fotiadou, Theocharis-Nektarios Kirtsios, Eirini Kyrmanidou, Konstantinos Lallas, Chryssoula Papageorgiou, Dermatoscopy A–Z, 2019
Aimilios Lallas, Zoe Apalla, Elizabeth Lazaridou, Dimitrios Ioannides, Theodosia Gkentsidi, Christina Fotiadou, Theocharis-Nektarios Kirtsios, Eirini Kyrmanidou, Konstantinos Lallas, Chryssoula Papageorgiou
Random mechanical injury of any nevus might occur, and elevated or nodular nevi are more likely to be traumatized than flat ones. The term “targetoid hemosiderotic nevus” refers to the post-traumatic appearance of an ecchymotic, violaceous halo around a long-lasting centrally elevated nevus (Figure 2.57). Dermatoscopy reveals the typical features of the nevus (usually multiple globules) with vascular-hemorrhagic (red to purple or black) changes superimposed on the nevus or surrounding it (Figure 2.58). In a later stage, the hemorrhagic features disappear, and the nevus acquires its previous morphology. Signs of post-traumatic fibrosis (white scar-like areas) might occasionally remain in case of severe trauma (Figure 2.59).
Erythema multiforme following exposure to the herbicide atrazine
Published in Baylor University Medical Center Proceedings, 2021
Madeline Frizzell, Nhan M. Nguyen, Sonal A. Parikh, Maya Sinai, Leonard Goldberg
Infectious causes of erythema multiforme are the most common and include herpes simplex virus, Mycoplasma pneumonia (which usually occurs in children), hepatitis C, coxsackie virus, and Epstein-Barr virus.1 Herpes simplex virus accounts for over 50% of cases and often causes recurrent episodes.6 Mucocutaneous eruptions as a result of M. pneumonia–induced rash and mucositis would present in a similar manner, but our patient tested negative for M. pneumonia.8 The second most common cause is drugs, including anticonvulsants, sulfonamides, penicillin, statins, nitrofurantoin, tetracyclines, and acetylsalicylic acid. Recently, there have been reports of tumor necrosis factor–α inhibitors such as adalimumab, infliximab, and etanercept as well as immunotherapy for melanoma and vaccinations causing an erythema multiforme reaction.1 Rarely, have there been reports of herbicides causing erythema multiforme. Of the published reports, two cases involved an episode of irritant contact dermatitis prior to the eruption of targetoid lesions.4,5 Our patient reported no rash before this presentation. There have been no case reports of atrazine as a cause of erythema multiforme.
Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome
Published in Baylor University Medical Center Proceedings, 2019
Meredith Gavin, Leigha Sharp, Kendra Walker, Emily Behrens, Russell Akin, Cloyce L. Stetson
GBFDE, the rarest variant of FDE, can be misdiagnosed as SJS due to their overlapping features of drug-induced generalized bullae and erosions.1 There are a few clinical and pathological differences that can help clinicians discern between GBFDE and SJS (Table 1). On physical examination, GBFDE generally presents with well-demarcated, erythematous lesions reoccurring at previously affected sites with sparse mucosal involvement.3 In contrast, SJS generally presents with targetoid lesions with mucosal involvement.4 On histopathological examination, variable degrees of epidermal necrosis and inflammatory infiltrate at the dermoepidermal junction can be seen in both GBFDE and SJS. A lichenoid infiltrate with scattered epidermal necrosis is a common finding in GBFDE, whereas SJS is more pauci-inflammatory with greater epidermal necrosis.5 To differentiate GBFDE from SJS, the biopsy specimen should be of an acute lesion, <24 hours old, because older bullae can display epidermal necrosis observed in SJS.6 The previous biopsies from our patient were all performed several days after contrast administration and were therefore more consistent with the histopathology of SJS. Our case denotes the importance of early biopsy in bullous eruptions for accurate diagnosis.
Lyme Neuroborreliosis Presenting as Multiple Cranial Neuropathies
Published in Neuro-Ophthalmology, 2022
Aishwarya Sriram, Samantha Lessen, Kevin Hsu, Cheng Zhang
The disease is classified into three stages, namely, localised, disseminated, and persistent. The localised and disseminated stages are part of early infection, while the persistent stage is indicative of chronic infection. In the first stage, the disease often presents with an erythema migrans rash. This rash is found in 70% to 80% of cases and appears at the site of the tick bite as an enlarging, erythematous skin lesion that may be homogenous or targetoid. In addition to the rash, patients may experience flu-like symptoms, such as fever, myalgias, or headache. However, nearly 30% of patients with the erythema migrans rash will have no additional symptoms.1