Approaching Target and Targetoid Eruptions in Inpatient Dermatology
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HOSPITAL-BASED DERMATOLOGY (L GUGGINA AND C NGUYEN, SECTION EDITORS)
Approaching Target and Targetoid Eruptions in Inpatient Dermatology Alexander M. Cartron 1 & Alecia Blaszczak 2 & Benjamin H. Kaffenberger 2 & John C. L. Trinidad 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To summarize the differential diagnosis and describe a clinical approach for the evaluation of target and targetoid lesions in hospitalized patients. Recent Findings Important diagnostic considerations for target and targetoid lesions in an inpatient setting include erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis, mycoplasma-associated rash and mucositis, fixed drug eruption, urticaria multiforme, subacute cutaneous lupus erythematosus, and Rowell syndrome. Less frequent diagnoses may include erythema migrans, arthropod bite, erythema gyratum repens, erythema annulare centrifugum, tinea concentricum, tinea corporis, Granuloma annulare, elastolytic giant cell granuloma, cutaneous T cell lymphoma, linear IgA syndrome, pigmented purpuric dermatosis of Majocchi, hobnail hemangioma, and acute hemorrhagic edema of infancy. Morphology can be a key in initially discriminating among these entities. Classic target lesions should be distinguished from targetoid, gyrate, and annular lesions. Summary The differential diagnosis of target and targetoid lesions in hospitalized patients is broad; however, attention to additional morphologic features, location, concomitant symptoms, mucosal involvement, histopathology, location, and progression can aid in diagnosis. Clinical evaluation should also consider patient demographics and associated systemic symptoms to elucidate the correct diagnosis. Keywords General dermatology . Inpatient dermatology . Target eruptions . Targetoid eruptions . Erythema multiforme . Stevens-Johnson syndrome . Toxic epidermal necrolysis
Introduction Erythema multiforme (EM) and Stevens-Johnson syndrome (SJS) were the first two diseases in which “target” lesions were described, resembling the “herpes iris” [1–3]. In the past, SJS was thought to be an extreme variant of EM [4], and toxic epidermal necrolysis (TEN) was considered a separate disease process [5]. In 1993, a new classification system was proposed Alexander M. Cartron and Alecia Blaszczak are co-first authors
in which SJS was separated from the EM spectrum (minor and major) and added to TEN, creating a new SJS/TEN continuum [6]. According to this new classification, the diseases were categorized by the percentage of skin detachment and by the appearance of “EM-like” target lesions [7]. Careful attention to lesion morphology, location, and progression can assist in differentiating EM from SJS/TEN as well as other clinical mimickers presenting with target or targetoid lesions. These diagnoses are critical in hospitalized patients, and it is important to distinguish mimicking conditions.
This article is part of the Topical Collection on Hospital-Based Dermatology * John C. L. Trinidad john.trini
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