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[[Image:Confluent_epidermal_necrosis_-_very_high_mag.jpg|thumb|right|250px|Confluent epidermal necrosis. [[H&E stain]].]] | |||
'''Epidermal necrosis''' is an important finding in [[dermatopathology]]. Full-thickness necrosis, especially is very serious. | '''Epidermal necrosis''' is an important finding in [[dermatopathology]]. Full-thickness necrosis, especially is very serious. | ||
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**These are signed-out as "confluent epidermal necrosis - see comment". | **These are signed-out as "confluent epidermal necrosis - see comment". | ||
***Comment: The histomorphologic findings are consistent with EM/SJS/TEN. | ***Comment: The histomorphologic findings are consistent with EM/SJS/TEN. | ||
**The clinical DDx of EM/SJS/TEN includes ''[[acute generalized exanthematous pustulosis]]'' (AGEP). | |||
==Erythema multiforme== | ==Erythema multiforme== | ||
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===General=== | ===General=== | ||
Features:<ref name=Ref_PBoD8_1189>{{Ref PBoD8|1189}}</ref> | Features:<ref name=Ref_PBoD8_1189>{{Ref PBoD8|1189}}</ref> | ||
*Hypersensitivity disorder due to a drug ''or'' infection. | *[[Hypersensitivity]] disorder due to a drug ''or'' infection. | ||
**Associated with the following: [[HSV]], Mycoplasma, [[Histoplasma]], others. | **Associated with the following: [[HSV]], Mycoplasma, [[Histoplasma]], others. | ||
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*+/-Epidermal blistering. | *+/-Epidermal blistering. | ||
*+/-Epidermal sloughing. | *+/-Epidermal sloughing. | ||
====Images==== | |||
<gallery> | |||
Image: Confluent epidermal necrosis - low mag.jpg | Confluent epidermal necrosis - low mag. (WC) | |||
Image: Confluent epidermal necrosis - intermed mag.jpg | Confluent epidermal necrosis - intermed. mag. (WC) | |||
Image: Confluent epidermal necrosis - high mag.jpg | Confluent epidermal necrosis - high mag. (WC) | |||
Image: Confluent epidermal necrosis - very high mag.jpg | Confluent epidermal necrosis - very high mag. (WC) | |||
</gallery> | |||
==Stevens-Johnson syndrome== | ==Stevens-Johnson syndrome== | ||
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===General=== | ===General=== | ||
Rx causes of SJS: | Rx causes of SJS: | ||
* | *[[NSAID]]s. | ||
*Anticonvulsants. | *Anticonvulsants. | ||
*Sulfonamides. | *Sulfonamides. | ||
| Line 48: | Line 58: | ||
Features: | Features: | ||
*Similar [[erythema multiforme]]. | *Similar [[erythema multiforme]]. | ||
====Images==== | |||
<gallery> | |||
Image: Confluent epidermal necrosis - low mag.jpg | Confluent epidermal necrosis - low mag. (WC) | |||
Image: Confluent epidermal necrosis - intermed mag.jpg | Confluent epidermal necrosis - intermed. mag. (WC) | |||
Image: Confluent epidermal necrosis - high mag.jpg | Confluent epidermal necrosis - high mag. (WC) | |||
Image: Confluent epidermal necrosis - very high mag.jpg | Confluent epidermal necrosis - very high mag. (WC) | |||
</gallery> | |||
==Toxic epidermal necrolysis== | ==Toxic epidermal necrolysis== | ||
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Features: | Features: | ||
*Like [[erythema multiforme]] - but usu. less inflammation.<ref>S. Sade. 8 September 2011.</ref> | *Like [[erythema multiforme]] - but usu. less inflammation.<ref>S. Sade. 8 September 2011.</ref> | ||
====Images==== | |||
<gallery> | |||
Image: Confluent epidermal necrosis - low mag.jpg | Confluent epidermal necrosis - low mag. (WC) | |||
Image: Confluent epidermal necrosis - intermed mag.jpg | Confluent epidermal necrosis - intermed. mag. (WC) | |||
Image: Confluent epidermal necrosis - high mag.jpg | Confluent epidermal necrosis - high mag. (WC) | |||
Image: Confluent epidermal necrosis - very high mag.jpg | Confluent epidermal necrosis - very high mag. (WC) | |||
</gallery> | |||
==Staphylococcal scalded skin syndrome== | ==Staphylococcal scalded skin syndrome== | ||
*Abbreviated ''SSSS''. | *Abbreviated ''SSSS''. | ||
===General=== | ===General=== | ||
* | *Due to keratinocyte cell-cell adhesion loss in the superficial epidermis - caused by ''S. aureus''.<ref name=pmid17582744>{{Cite journal | last1 = Nishifuji | first1 = K. | last2 = Sugai | first2 = M. | last3 = Amagai | first3 = M. | title = Staphylococcal exfoliative toxins: "molecular scissors" of bacteria that attack the cutaneous defense barrier in mammals. | journal = J Dermatol Sci | volume = 49 | issue = 1 | pages = 21-31 | month = Jan | year = 2008 | doi = 10.1016/j.jdermsci.2007.05.007 | PMID = 17582744 }}</ref> | ||
Clinical: | Clinical: | ||
*Blisters | *Blisters | ||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref name=pmid17582744/> | Features:<ref name=pmid17582744/> | ||
* | *Superficial dermis separates from underlying tissue - looks artefactual. | ||
*Minimal/scant inflammation is typical.<ref>URL: [http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=2105774586 http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=2105774586]. Accessed on: 22 September 2011.</ref> | |||
Image: | |||
*[http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=2105774586 SSSS (jhmi.edu)]. | |||
==See also== | ==See also== | ||
*[[Dermatopathology]] - an introduction to the topic. | *[[Dermatopathology]] - an introduction to the topic. | ||
*[[Non-malignant skin disease]]. | *[[Non-malignant skin disease]]. | ||
*[[Inflammatory skin disease]]. | |||
==References== | ==References== | ||