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By Lawrence A. Schiffman, DO, and Stephen M. Schleicher, MD
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CASE:
An 18-year-old man presents with a rash on his
arms and hands that has worsened over five
days and has been accompanied by malaise. His
medical history is negative for systemic disease
and he denies taking any oral medications. He
has had cold sores in the past but has no active
lesions. Examination of the affected areas, which
include the palms, reveals scattered papules and
targetoid patches. Some sites manifest either
vesiculation or central denudation. No mucosal
lesions are observed.
WHAT IS YOUR DIAGNOSIS?
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This patient was diagnosed with erythema multiforme
(EM), a symmetrical skin disease characterized by socalled target lesions that begin as erythematous
papules but quickly evolve into annular or ovoid,
dusky-red patches and plaques, many of which develop
central vesiculation. Mucosal involvement in
the form of superficial erosions is common. Although
EM is linked to a variety of infectious agents including
the herpes simplex virus, about half of all cases
are idiopathic. Spontaneous resolution over a twoweek
period is anticipated. Stevens-Johnson syndrome,
a more severe form of EM, is often precipitated
by medications and warrants more intensive
workup and care. |
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Dr. Schiffman is a dermatology resident at St. John’s Episcopal Hospital in Far Rockaway, New York. Dr. Schleicher is director of DermDx Centers and a
clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia
University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 38(8):29-30, 2006
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