Oral Medicine and Radiology MCQ answer 12

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Answer is D

Below are explanations and amplifying information of the acute inflammatory immune mediated disease of the skin and mucous membranes:

• EM is seen most frequently in children and young adults and is rare after the age of 50 years.

• EM has an acute or explosive onset; generalized symptoms such as fever and malaise appear in severe cases.

• EM simplex is a self-limiting form of the disease and is characterized by macules and papules 0.5 to 2 cm in diameter, appearing in a symmetric distribution.

• The most common cutaneous areas involved are the hands, feet, and extensor surfaces of the elbows and knees. The face and neck are commonly involved. Only severe cases will affect the trunk. Oral lesions commonly appear along with skin lesions in approximately 70% of EM patients. The oral lesions may occasionally be the predominant form or single site of the disease. The oral lesions are an important part of the clinical picture. These lesions are usually rapidly rupturing vesicles and bullae.

• Typical skin lesions of EM are target lesions which are macules or papules with a central area of petechiae. Hence, the pathognomonic lesion is the target or iris lesion. A central bulla or pale clearing area will be surrounded by edema and bands of erythema.

• The more severe vesiculobullous forms of the disease, Stevens-Johnson syndrome and TEN have a high mortality rate. EM is classified as Stevens-Johnson syndrome when the generalized vesicles and bullae involve the skin, mouth, eyes, and genitals.

• The most severe form of the disease is TEN (toxic epidermal neurolysis), which is typically secondary to a drug reaction and results in sloughing of the skin and mucosa in large sheets. Morbidity occurs in 30-40% of patients and is due to secondary infection, fluid and electrolyte imbalance or involvement of the lung, kidneys or liver. These patients are managed best in burn centers. The necrotic skin is removed under general anesthesia. Xenografts may be used to allow healing of the tissues.