Dermatology picture book

This patient's rash is consistent with erythema

multiforme (EM), an acute inflammatory disorder that

can involve the skin of the extremities, face, trunk,

and neck. Severe cases (EM major) can also affect

oral mucous membranes and the tongue. The appearance of EM can vary, but patients typically

develop erythematous, round papules that evolve into target lesions with a dusky central area, a dark

red inflammatory zone surrounded by a pale ring, and an erythematous halo in the lesion's periphery.

EM represents a cell-mediated immune process, with an inflammatory infiltrate predominated by

cytotoxic CD8+ lymphocytes. EM is most frequently associated with infections (especially herpes

simplex virus and mycoplasma) and may be due to an immune response against antigens deposited

in the skin. EM can also be seen in association with certain medications (eg, sulfonamides),

malignancy, and collagen vascular diseases.