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INTRODUCTION

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This chapter describes selected serious generalized skin disorders in adults and discusses their dermatologic diagnosis and treatment. Covered are erythema multiforme, toxic epidermal necrolysis, exfoliative erythroderma, the toxic infectious erythemas, disseminated viral infections, Rocky Mountain spotted fever, disseminated gonococcal infection, purpura fulminans, and pemphigus vulgaris. Staphylococcal scalded skin syndrome and meningococcemia are discussed in the pediatric section, in chapter 141, "Rashes in Infants and Children." Staphylococcal and streptococcal toxic shock syndrome are also discussed in chapter 150, "Toxic Shock Syndromes." Disseminated viral infections are discussed in chapter 153, "Serious Viral Infections" and in chapter 141.

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The disorders erythema multiforme, toxic epidermal necrolysis, exfoliative erythroderma, staphylococcal and streptococcal toxic shock syndrome, and staphylococcal scalded skin syndrome share some features in common. Table 249–1 can help in differentiating these disorders.

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Table 249–1

Comparison of Inflammatory and Infectious Generalized Skin Disorders

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ERYTHEMA MULTIFORME

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Erythema multiforme (EM) is an acute inflammatory skin disease (Figure 249–1) with a broad range of severity, from a minimal, nuisance-level event to a severe multi-system illness. It is divided into two distinct sub-types, considering the extent of involvement, presence of epidermal detachment, and the development of mucous membranes lesions. Erythema multiforme minor, the less severe form of the illness, is a localized papular eruption of the skin, with an acral distribution and involving target lesions and/or raised, edematous papules. Erythema multiforme major is the more severe form of EM with multi-system involvement and widespread vesiculobullous lesions and erosions of the mucous membranes; specifically, EM major includes involvement of one or more mucous membrane areas and epidermal detachment less than 10% of total body surface area.

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Some authorities include Stevens-Johnson syndrome (SJS) as a severe form of EM major while others ...

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