Epidermal necrosis

From Libre Pathology
Revision as of 15:35, 9 September 2011 by Michael (talk | contribs) (create -- split-out of cysts)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

Epidermal necrosis is an important finding in dermatopathology. Full-thickness necrosis, especially is very serious.

General

Full thickness DDx:

  • Erythema multiform (EM).
  • Toxic epidermal necrolysis (TEN).
  • Stevens-Johnson syndrome (SJS).
  • Trauma.
  • Others. (???)

Partial thickness DDx:

  • Staphylococcal scalded skin syndrome.
  • Trauma. (???)
  • Others. (???)

Notes:

  • SJS and TEN are on a spectrum, EM (depending on who you ask) is considered separate.

Erythema multiforme

  • Abbreviated EM.

General

Features:[1]

  • Hypersensitivity disorder due to a drug or infection.

Clinical:

  • Target-like lesion.

Microscopic

Features:[1]

  • Lymphocytic interface dermatitis (lymphocytes at the dermal-epidermal junction).
  • Necrotic/degenerative keratinocytes - key feature.
  • +/-Epidermal blistering.
  • +/-Epidermal sloughing.

Stevens-Johnson Syndrome

  • Abbreviated SJS.

General

Rx causes of SJS:

  • NSAIDs.
  • Anticonvulsants.
  • Sulfonamides.
  • Penicillins.

Microscopic

Features:

Toxic epidermal necrolysis

  • Abbreviated TEN.

General

  • TEN more severe form SJS.

Definition:

  • >30% sheet-like epidermal detachment, diffuse erythema, severe mucous membrane involvement.
  • Most TEN (80%) Rx-related, only 50% of SJS Rx-related.

Microscopic

Features:

See also

References

  1. 1.0 1.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1189. ISBN 978-1416031215.
  2. S. Sade. 8 September 2011.