Table 3 Differential diagnosis in a patient with suspected exfoliative dermatitis
Pathological condition | Pattern of skin lesions | Body surface area with epidermal detachment (%) | Trigger | Distribution of lesions |
|---|---|---|---|---|
Erythema multiforme major (EMM) | Typical and atypical target papules and plaques, minimum involvement of mucous membranes (especially oral mucosae) | <10 | Infection (Mycoplasma pneumoniae, Herpes simplex), drugs | Predominantly acrally distributed, i.e., begin on hands and feet |
Stevens–Johnson syndrome (SJS) | No target lesions typical/atypical target lesions flattened, cotton wool spots purple confluent in the skin of the face and trunk, serious eruptions mucous membranes at the level of one or more sites | <10 | Drugs | Diffuse. The eruption begins on the trunk |
Overlap syndrome between Stevens–Johnson and Toxic Epidermal Necrolysis (SJS/TEN) | No target lesions/typical target lesions/atypical target lesions flattened | Between 10 and 30 | Drugs | Diffuse. The eruption begins on the trunk |
Toxic epidermal necrolysis (TEN) | No target lesions/typical target lesions/atypical target lesions flattened; begins with severe mucosal erosions and progresses to a detachment spread and generalized epidermis. | >30 | Drugs | Diffuse. The eruption begins on the trunk |
Staphylococcical scalded skin syndrome (SSSS) | Variable detachment between the stratum granulosum and the stratum corneum | Variable | Bacterial infection (Staphylococci) | Diffuse. No mucosal involvement except for conjunctiva |