 |
|
Clinicopathologic Correlation in Erythema Multiforme and Stevens-Johnson Syndrome
Benoît Côté, MD;
Janine Wechsler, MD;
Sylvie Bastuji-Garin, MD;
Haudrey Assier, MD;
Jean Revuz, MD;
Jean-Claude Roujeau, MD
Arch Dermatol. 1995;131(11):1268-1272.
Abstract
| |
Background and Design
To confirm the recent hypothesis that the spectrum of severe erythema multiforme (EM) is actually composed of two different disorders, we retrospectively studied 38 such cases, particularly in regard to their histopathologic features. Based on photographs and a recent proposal, the cases were classified as EM major when the eruption consisted of typical or raised atypical target lesions located on the extremities and/or the face or as Stevens-Johnson syndrome when the eruption consisted of flat atypical target lesions or purpuric macules that were widespread or distributed on the trunk. The cases were also assessed for causal agent. A biopsy specimen was obtained in each case. Several histologic parameters were analyzed (and scored) without clinical data and correlated to the clinical pattern. These parameters were first studied in a global assessment and then in a detailed evaluation.
Results
The global assessment showed two different histologic patterns: (1) a predominantly inflammatory pattern characterized by a lichenoid infiltrate and epidermal necrosis that mainly affected the basal layer; and (2) a predominantly necrotic pattern in which major epidermal necrosis and minimal inflammatory infiltration were found. The former pattern was associated with EM major, the latter with Stevens-Johnson syndrome (P<.001) and with drug-related cause (P<.001). The detailed evaluation showed also less epidermal necrosis, more dermal inflammation, and more exocytosis in EM major. Conversely, there was more epidermal necrosis, less dermal inflammation, and less exocytosis in Stevens-Johnson syndrome. The difference was statistically significant for the inflammation and exocytosis.
Conclusions
This study suggests that the two different symptomatologies in the spectrum of severe EM correlate with two different patterns of histopathologic changes. A prospective multicentered study should be conducted to definitively characterize these entities.
(Arch Dermatol. 1995;131:1268-1272)
Author Affiliations
From the Departments of Dermatology (Drs Côté, Assier, Revuz, and Roujeau), Anatomy and Pathologic Cytology (Dr Wechsler), and Epidemiology and Public Health (Dr Bastuji-Garin), Hôpital Henri-Mondor, Université Paris XII, Créteil, France. Dr Côté is now with the Department of Dermatology, Hôpital Saint-Luc, Université de Montréal (Québec) and Dr Assier is with the Department of Dermatology, Hôpital Ambroise Paré, Université Paris Ouest, Boulogne, France.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Correlations Between Clinical Patterns and Causes of Erythema Multiforme Majus, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis: Results of an International Prospective Study
Auquier-Dunant et al.
Arch Dermatol 2002;138:1019-1024.
ABSTRACT
| FULL TEXT
CC and CXC Chemokines Are Differentially Expressed in Erythema Multiforme In Vivo
Spandau et al.
Arch Dermatol 2002;138:1027-1033.
ABSTRACT
| FULL TEXT
Erythema Multiforme and Stevens - Johnson Syndrome Are Histologically Distinct
Journal Watch Dermatology 1996;1996:5-5.
FULL TEXT
|
