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Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis: frozen-section diagnosis.
J Dermatol. 2010 May; 37(5):407-12.JD

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) may be fatal. Although classified by body surface area skin detachment, initial stages of both may present with erythema multiforme (EM)-like lesions. To diagnose and predict disease activity adequately as early as possible for patients revealing EM-like lesions, we performed frozen-section diagnosis. Thirty-five patients clinically diagnosed as EM, SJS or TEN were biopsied to diagnose and predict disease progression within the initial-visit day. Half of a histological section taken from a lesion was snap-frozen and immediately cryostat-sectioned, acetone-fixed and stained with hematoxylin-eosin. Specimens were examined with light microscopy for presence of epidermal necrosis. A section from unaffected sites was also examined for 11 patients. Specimens were examined with light microscopy for presence of graft-versus-host reaction (GVHR)-like findings: apoptotic keratinocytes and satellite cell necrosis. Epidermal necrosis was seen in nine patients. Initial diagnosis of the nine was one of overlap SJS-TEN, four of SJS and four of EM, and final diagnosis of those was one of TEN, one of overlap SJS-TEN, four of SJS and three of EM. Dissociation between initial and final diagnosis was seen in three cases. GVHR-like findings in the epidermis were observed in two patients finally diagnosed as overlap SJS-TEN and TEN. Frozen sections are useful not only to make a diagnosis of erythema multiforme but to assess a potential to exhibit more aggressive clinical behaviors (SJS or TEN).

Authors+Show Affiliations

Department of Dermatology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20536645

Citation

Hosaka, Hiroomi, et al. "Erythema Multiforme, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Frozen-section Diagnosis." The Journal of Dermatology, vol. 37, no. 5, 2010, pp. 407-12.
Hosaka H, Ohtoshi S, Nakada T, et al. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis: frozen-section diagnosis. J Dermatol. 2010;37(5):407-12.
Hosaka, H., Ohtoshi, S., Nakada, T., & Iijima, M. (2010). Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis: frozen-section diagnosis. The Journal of Dermatology, 37(5), 407-12. https://doi.org/10.1111/j.1346-8138.2009.00746.x
Hosaka H, et al. Erythema Multiforme, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Frozen-section Diagnosis. J Dermatol. 2010;37(5):407-12. PubMed PMID: 20536645.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis: frozen-section diagnosis. AU - Hosaka,Hiroomi, AU - Ohtoshi,Shinpei, AU - Nakada,Tokio, AU - Iijima,Masafumi, PY - 2010/6/12/entrez PY - 2010/6/12/pubmed PY - 2010/10/5/medline SP - 407 EP - 12 JF - The Journal of dermatology JO - J Dermatol VL - 37 IS - 5 N2 - Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) may be fatal. Although classified by body surface area skin detachment, initial stages of both may present with erythema multiforme (EM)-like lesions. To diagnose and predict disease activity adequately as early as possible for patients revealing EM-like lesions, we performed frozen-section diagnosis. Thirty-five patients clinically diagnosed as EM, SJS or TEN were biopsied to diagnose and predict disease progression within the initial-visit day. Half of a histological section taken from a lesion was snap-frozen and immediately cryostat-sectioned, acetone-fixed and stained with hematoxylin-eosin. Specimens were examined with light microscopy for presence of epidermal necrosis. A section from unaffected sites was also examined for 11 patients. Specimens were examined with light microscopy for presence of graft-versus-host reaction (GVHR)-like findings: apoptotic keratinocytes and satellite cell necrosis. Epidermal necrosis was seen in nine patients. Initial diagnosis of the nine was one of overlap SJS-TEN, four of SJS and four of EM, and final diagnosis of those was one of TEN, one of overlap SJS-TEN, four of SJS and three of EM. Dissociation between initial and final diagnosis was seen in three cases. GVHR-like findings in the epidermis were observed in two patients finally diagnosed as overlap SJS-TEN and TEN. Frozen sections are useful not only to make a diagnosis of erythema multiforme but to assess a potential to exhibit more aggressive clinical behaviors (SJS or TEN). SN - 1346-8138 UR - https://www.unboundmedicine.com/medline/citation/20536645/Erythema_multiforme_Stevens_Johnson_syndrome_and_toxic_epidermal_necrolysis:_frozen_section_diagnosis_ L2 - https://doi.org/10.1111/j.1346-8138.2009.00746.x DB - PRIME DP - Unbound Medicine ER -