Lyell's syndrome (LS) is a severe drug-induced cutaneous adverse reaction, associated with high morbidity and mortality. We present the case of a 41-year-old male who, after the use of topical medications, developed fever, maculopapular lesions, ocular and mucosal involvement, with affectation of more than 30% of the body surface area. Cutaneous biopsy ruled out other pathologies. Management included systemic methylprednisolone, aluminum subacetate, topical mupirocin, ophthalmic prednisolone, and ophthalmic hypromellose, with a favorable outcome and without complications. This case highlights the importance of considering topical medications as possible triggers for LS, as well as the need for early diagnosis and timely management. Early identification and a multidisciplinary therapeutic approach are fundamental to improve clinical outcomes and reduce the morbidity and mortality associated with this entity.

Reactive infectious mucocutaneous eruption (RIME), a term describing blistering skin and mucosal lesions, is a term coined by a group of Pediatric Dermatology Research Alliance (PeDRA) researchers and first published in 2021. Since that time, the literature has grown with reports of diverse infectious triggers, management strategies, and complications. This expert opinion PeDRA perspective, developed by a group conducting a consensus process on management of RIME, is an interim update on the current state of diagnosis and management of RIME with a focus on practical information for the busy clinician.

Reactive infectious mucocutaneous eruption (RIME) is a recently defined mucocutaneous manifestation associated with respiratory infections, most commonly reported secondary to Mycoplasma pneumoniae. The core diagnostic criteria of RIME involve greater than or equal to two mucosal areas with erosive mucositis, minimal cutaneous lesions, a recent infectious prodrome, and exclusion of drug-induced etiologies. RIME presents with acute mucositis involving the oral, ocular, and genital mucosa, with presentations similar to other mucocutaneous disorders such as Stevens-Johnson syndrome (SJS), erythema multiforme (EM), and multisystem inflammatory syndrome in children (MIS-C) secondary to SARS-CoV-2 infection. This case report describes a unique presentation of RIME secondary to a Mycoplasma infection, highlighting diagnostic challenges and therapeutic approaches. A 16-year-old male, previously healthy with no significant past medical history, was accepted for transfer to our hospital for evaluation of persistent fever, worsening left lower lobe pneumonia, oral mucositis, and conjunctivitis. On examination, extensive erythema and inflammation throughout the oral cavity, exudative pharyngitis, clear ocular discharge with conjunctival injection, and sloughing of the scrotal skin were noted. The patient's medical history and clinical examination raised initial suspicion of Kawasaki disease or possible MIS-C. Lab studies showed elevated CRP, ESR, and B-type natriuretic peptide (BNP), indicating extensive systemic inflammation; however, the PCR was negative for respiratory syncytial virus (RSV), influenza A and B, and SARS-CoV-2. Further investigations revealed a positive Group A Streptococcus PCR on throat swab, felt to be colonization, and elevated Mycoplasma pneumoniae IgG titers suggested previous or recent exposure; however, acute infection could not be confirmed due to negative PCR and IgM. The patient improved over the following several days after initiation of azithromycin, continuation of clindamycin, and wound care for scrotal and oral mucosal lesions. Differentiating RIME from other mucocutaneous disorders is vital to prescribing proper treatment and preventing further systemic effects. This case underscores the importance of considering Mycoplasma as a potential etiology in patients presenting with mucocutaneous lesions and conjunctivitis following a previous respiratory infection.

We report a case of acute hemorrhagic edema in a four-month-old boy, which occurred following a viral respiratory infection seven days prior to his admission. The clinical presentation began with the appearance of erythematous macules initially localized to both feet, which then spread to both thighs. All of this occurred against a background of a fever of 38.5 °C, while the child's general condition remained stable. Initially treated as purpura fulminans, but given the child's stable general condition and normal laboratory findings, the diagnosis was revised to acute hemorrhagic edema of infancy, characterized by fever and large, coin-shaped purpuric skin lesions, often associated with edema. The differential diagnosis includes hemorrhagic urticaria, other non-infectious vasculitides, erythema multiforme, Kawasaki disease, infectious eczema, and sepsis (meningococcal or otherwise). Some of these conditions carry a risk of mortality. Management is based primarily on symptomatic treatment, with a favorable prognosis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threate-ning mucocutaneous reactions characterized by extensive epidermal detachment and systemic complications. Wound management is central to survival and long-term outcomes, yet standardiz-ed care pathways remain controversial and in-consistently implemented. This study aimed to systematically synthesize the best available evidence on wound management for patients with SJS/TEN to support clinical decision-making and optimize clinical outcomes. A comprehensive search of major international and Chinese databases and authoritative websites was conducted from January 2010 to May 2025 to collect relevant clinical decisions, guidelines, expert consensus, systematic reviews, and evidence summaries. Two reviewers independently screened and evaluated the literature, and then extracted and summarized evidence using the JBI grading system. A total of 14 high-quality publications met the inclusion criteria, yielding 28 pieces of best evidence across seven7 domains: wound assessment, conservative management, surgical approach, dressing selection, pain management, infection prevention and surveillance, and hospital setting. Among them, 11 recommendations were graded as strong and 17 as weak. This evidence-based synthesis provides practical guidance for wound management in SJS/TEN and supports the development of standardized care protocols to promote epithelial recovery, reduce complications, and improve quality of life.

We report a case of erythema multiforme (EM) associated with atazanavir/ritonavir in a patient with HIV-1 infection. The patient was receiving tenofovir, lamivudine, and dolutegravir; however, owing to a supply chain issue, dolutegravir was substituted with atazanavir/ritonavir. The patient subsequently developed pruritic erythematous papules and plaques with characteristic target lesions over the face and a hemorrhagic crust on the lower lip, without epidermal detachment or systemic symptoms. The Naranjo probability score indicated a probable adverse drug reaction. This case highlights the importance of recognizing EM as a potential adverse reaction to atazanavir and of early drug withdrawal to prevent progression to more severe cutaneous adverse reactions, including Stevens-Johnson syndrome.

Reactive infectious mucocutaneous eruption (RIME) is a para-infectious syndrome characterised by prominent mucositis with limited cutaneous involvement, typically following a respiratory illness. Diagnostic uncertainty is common because RIME may mimic erythema multiforme and drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), particularly when antibiotics have been initiated shortly before onset. We report a 25-year-old woman presenting with fever, generalised maculopapular rash, severe oral erosions with odynophagia, genital involvement, eyelid and lip oedema, and haemorrhagic lip erosions. Chest radiography demonstrated a right lower lobe opacity consistent with pneumonia despite minimal respiratory symptoms. The eruption developed five days after initiation of oral cefuroxime for a presumed respiratory tract infection. There was no epidermal detachment and the Nikolsky sign was negative; ophthalmologic assessment showed no ocular involvement. Mycoplasma pneumoniae infection was confirmed by sputum multiplex PCR and supported by serology. The clinical phenotype and microbiologic confirmation supported RIME rather than drug-induced SJS/TEN. The patient improved with intravenous corticosteroids, azithromycin, and supportive care, with complete resolution at one-month follow-up. This case-based review summarises diagnostic clues, highlights the role of multiplex PCR in aetiologic attribution, and outlines pragmatic management principles to reduce morbidity and avoid misclassification as a severe drug reaction.

Toxicodendron toxicity results from exposure to urushiol, a highly allergenic oleoresin found in poison ivy, poison oak, poison sumac, the Chinese lacquer tree, and other Toxicodendron species within the Anacardiaceae family. The genus as a whole is widespread throughout North America except for Hawaii and Alaska, and can have regional variations in appearance. While the genus and its many species are mostly encountered in North America, they can also be found in China, Mexico, Africa, Australia, and New Zealand. Most Toxicodendron toxicity manifests as allergic contact dermatitis (ACD), a type IV delayed hypersensitivity reaction that develops 12 to 72 hours after urushiol exposure. Classic Toxicodendron dermatitis presents with intensely pruritic erythematous papules, vesicles, or bullae arranged in linear or streak-like distributions corresponding to areas of plant contact. Disease severity is generally proportional to the amount and duration of urushiol exposure. Extensive contact may result in confluent vesiculobullous eruptions, marked edema, and widespread dermatitis. Less commonly, patients develop an erythema multiforme-like reaction, a noneczematous variant characterized by pruritic targetoid, vesicular, or urticarial lesions that typically appear 7 to 14 days after the initial episode of dermatitis. Systemic absorption of urushiol following ingestion can result in systemic contact dermatitis, which can be a potentially life-threatening complication. Inhalation of aerosolized urushiol released during the burning of Toxicodendron plants can result in upper- and lower-respiratory-tract inflammation, airborne contact dermatitis, and systemic allergic dermatitis. Rare systemic manifestations, including renal involvement, have also been reported. Management is guided by disease severity and emphasizes early decontamination to limit urushiol absorption. Localized dermatitis is typically managed with topical corticosteroids and supportive measures. In contrast, extensive or severe disease requires systemic corticosteroids administered with an adequate taper to prevent rebound symptoms. Prevention through plant identification, avoidance of exposure, protective clothing, and prompt decontamination remains the cornerstone of management.