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INTRODUCTION

KEY POINTS

  • Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can appear differently across skin types in earlier stages of the diseases prior to the skin becoming denuded.

  • In lighter skin, affected areas can be salmon colored to pink, while in darker skin, they can be violaceous to gray or gray-brown.

  • In both skin types, hemorrhagic bullae and crusting can be seen along with erosions.

  • In darker skin, areas will typically heal with postinflammatory dyspigmentation.

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FIGURE 40-1.

Diffuse salmon-red papules and confluent scaly patches and plaques with minimal areas of sparing on the neck, anterior trunk, and upper extremities. (Reproduced with permission from Prose NS, Kristal L. Weinberg’s Color Atlas of Pediatric Dermatology, 5th ed. New York, NY: McGraw Hill; 2017, Figure 16-3.)

FIGURE 40-2.

Violaceous scaly papules and plaques diffusely distributed on the posterior trunk with numerous areas of bright-pink denuded skin, several of which are also hemorrhagic on the lower back. (Reproduced with permission from Prose NS, Kristal L. Weinberg’s Color Atlas of Pediatric Dermatology, 5th ed. New York, NY: McGraw Hill; 2017, Figure 18-5.)

FIGURE 40-3.

Diffuse confluent salmon-colored patches on an edematous face with areas of hemorrhagic crusting on the eyelids, lips, nose, and periocular and perioral skin. Note the areas of sparing on the forehead and neck, which primarily have salmon-colored papules and plaques. (Reproduced with permission from Soutor C, Hordinsky MK. Clinical Dermatology. New York, NY: McGraw Hill; 2013, Figure 23-6.)

FIGURE 40-4.

Diffuse pink macules and papules on the face of a young woman with overlying hemorrhagic crusting periocularly and periorally. Note the edema of the face and lips and the erosion inferior to the right nasal ala. (Reproduced with permission from Barnhill RL, Crowson AN, Magro CM, et al. Barnhill’s Dermatopathology, 4th ed. New York, NY: McGraw Hill; 2020, Figure 8-21A.)

FIGURE 40-5.

Intact hemorrhagic bullae along the mucosal lips and periorally, surrounded on the face by a large patch of denuded skin on the right cheek and peripheral brown patches. Note the lack of redness and erythema visible in this person who also has active SJS/TEN. (Reproduced with permission from Prose NS, Kristal L. Weinberg’s Color Atlas of Pediatric Dermatology, 5th ed. New York, NY: McGraw Hill; 2017, Figure 16-17.)

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