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Erythema Multiforme vs. Stevens-Johnson Syndrome: Recognizing Clinical Severity and Target Lesions in Mucous Membranes

A Hispanic physician in his 40s carefully examines the arm of a young patient with a rash characterized by target lesions in a medical office. The patient, also Hispanic, is seated on an examination table wearing a hospital gown. This scene highlights the critical importance of careful diagnosis in conditions such as erythema multiforme and Stevens-Johnson syndrome, particularly regarding clinical severity and involvement of mucous membranes.

Erythema multiforme and Stevens-Johnson syndrome (SJS) are two dermatological conditions that, while sharing some clinical features, differ significantly in their clinical severity and management. Both conditions can present with target lesions and affect the mucous membranes, but it is crucial for physicians to recognize the differences to provide appropriate treatment and avoid potentially life-threatening complications.

Profundizando en el tema

The erythema multiforme is an immune-mediated reaction that primarily affects the skin and, occasionally, the mucous membranes. It is characterized by the appearance of target lesions, which are usually symmetrical and present on the extremities. The most common causes include infections, particularly from the herpes simplex virus and Mycoplasma pneumoniae, as well as drug reactions. Treatment focuses on symptomatic management and identifying and treating the underlying cause.

On the other hand, Stevens-Johnson syndrome and its more severe form, toxic epidermal necrolysis (TEN), are severe skin reactions primarily induced by medications. These conditions are characterized by necrosis and detachment of the epidermis, affecting more than 30% of the body surface in the case of TEN. Early identification and discontinuation of the offending medication are crucial for improving patient prognosis.

The differential diagnosis between these conditions is essential. While erythema multiforme is usually self-limiting, SJS/TEN requires urgent medical attention and often hospitalization in intensive care units due to its high mortality rate and systemic complications. The use of systemic corticosteroids and intravenous immunoglobulins are therapeutic options considered in the management of SJS/TEN.

Conclusiones

Recognizing the severity of skin involvement in erythema multiforme and Stevens-Johnson syndrome is fundamental for the appropriate management of these conditions. While erythema multiforme can be managed with symptomatic treatment, SJS/TEN requires rapid and specialized medical intervention. Accurate identification of the cause, whether infectious or drug-related, and the discontinuation of the triggering agent are critical steps to improve patient outcomes and reduce associated mortality.

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Created 6/1/2025