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Table 3 Differential diagnosis in a patient with suspected exfoliative dermatitis

From: Drug induced exfoliative dermatitis: state of the art

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