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Image Number 430 (Erythema multiforme)


Diagnosis: Erythema multiforme

Site: Hand,palm

Sex: M

Age: 24

Type: Clinical

Description: Target lesions on the hands

Submitted by: Ian McColl

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Differential Diagnosis


Recurrent Erythema multiforme is virtually always due to occult herpes simplex infection.It is possible that a drug taken intermittently could cause a similar eruption.The lesions are usually well defined macules that develope a raised papular slightly redder centre within 24 to 48 hours giving target like lesions with a more purpuric centre..This central area may blister.Target lesions are best seen on the palms and soles.Herpes simplex virus DNA may be found in biopsies of these lesions by polymerase chain reaction studies.This was the case in the patient seen above.His attacks were supressed by taking daily Acyclovir in low dosage.

The Stevens-Johnson variant of erythema multiforme is more severe with involvement of two or more mucosal surfaces , more symptoms and more widespread lesions.It is usually drug induced.

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