Medical Archive

Introduction

????? ?? ??
??? ????? ?? ???

????
SJS / TEN
Sweet SD
?? ??
?? ??

???? Erythema multiforme

Etiology

• ?? HSV? ??? ??.
• Mycoplasma infection, drugs (penicillin and sulfonamides), autoimmune disease (e.g., SLE), and malignancy.

Pathophysiology

• ???? ??? ?? ?????? (Hypersensitivity reaction)
  • Circulating pathogen -> phagocytosed by mononuclear cells and are brought to the epidermis
  • DNA fragments are transferred to keratinocytes via direct cell-to-cell spread
  • Pathogen-specific cytotoxic T-cell then recognize foreign antigens
  • Perivascular lymphocytic infiltrate and epidermal necrosis
• Satellite cell? necrosis. 

Clinical presentation

• ???? ??? EM Major, ??? minor? ?.
• SJS/TEN? EM major? ???? ????
  • EM with oral mucosa/lip involvement and fever
  • ??+??? ?/????. 
  • ??<??, ??? ??.

Treatment

• 1-4? ? ????. 
• ± acyclovir (>6m); does not shorten the course

?? ??? ???? ??? Sweet syndrome

????, ??? ?? ?? ? ??
30~50?, ??? ??????? ?

SJS/TEN Stevens-Johnson syndrome/Toxic epidermal necrosis

?????? ? SJS (????<10%) ? overlap ? TEN (????>30%)
Ag presenting ??????? ?? ??????
??????? / Nikolsky’s Sign (+) : ???? ??? ?? ????
??? ???? ????. ??????? ??!!

Treatment

?? ?? ??, ?? ?? ???
???? systemic glucocorticoid ? anti-histamine ?? ± steroid
???? IVIG? ??? ???

Prognosis

???? ? ????. ??? – SJS: 6%, TEN: 45%
?? ????
40? ?, HR 120 ?, Ca. ??, BSA 10% ?
SUrea < 10mM, SHCO3 < 20mM, SGlucose > 14mM

???? Erythema nodosum vs. ???? Erythema induratum

?? ? ??
Infection ? Salicylate, NSAID
Allergy ? Anti-histamine, steroid
Atypical infection or inflammatory ds ? Skin Bx for ddx
?? ?? 1?? ? ?????? ??? ??/?? ?? ??

????

• Delayed hypersensitivity reaction to antigens associated with various conditions
• Diseases associated with EN
  • Infection
  • Sarcoidosis
  • Tuberculosis
  • Endemic fungal disease (eg, histoplasmosis)
  • IBD and Behçet disease
• Clinical manifestations
  • ?? ??? ??? ??? ??, extensor ??? ????? ??
• Initial workup
  • Basic lab tests (CBC, LFT, RFT), ASO, TB skin testing
  • Chest X-ray d/t sarcoidosis (~28% even without any symptom)
  • Colonoscopy – not indicated without symptoms to suggest IBD

????

??? flexor ??, ??? ????? ?? ????, ??? ???? ???. ???

Urticaria