10.5826/dpc.1204a141
text/xml
2160-9381
2048
en
Devayani Pol
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
dermoscopy
Erythema multiforme: A clinico-dermoscopic-histopathological correlation of evolving targetoid lesions
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2022-10-31
2021-09-16
2022-10-31
2022-11-29
e2022141
Dermatol Pract Concept
Devayani Pol
2022/10/31
10.5826/dpc.1204a141
e2022141
Department of Dermatology, Venerology and Leprosy, Patil Medical College and Hospital & Research Centre, Pune, India
2160-9381
dermoscopy
en
e2022141
Erythema multiforme: A clinico-dermoscopic-histopathological correlation of evolving targetoid lesions
https://dpcj.org/index.php/dpc/article/download/2048/1799
               Erythema Multiforme: a Clinico-
           Dermoscopic-Histopathological Correlation
                of Evolving Targetoid Lesions
                                             Shreya Deoghare1, Devayani Pol1


1 Department of Dermatology, Venerology and Leprosy, Patil Medical College and Hospital & Research Centre, Pune, India



Citation: Deoghare S, Pol D. Erythema multiforme: A clinico-dermoscopic-histopathological correlation of evolving targetoid lesions.
Dermatol Pract Concept. 2022;12(4):e2022141. DOI: https://doi.org/10.5826/dpc.1204a141
Accepted: March 7, 2022; Published: October 2022
Copyright: ©2022 Deoghare et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Shreya Deoghare, Department of Dermatology, Venerology and Leprosy, Dr. D. Y. Patil Medical College
and Hospital & Research Centre, Sant Tukaram Nagar, Pimpri, Pune, India – 411018 Ph No: +91- 9325307311,
E-mail: shreyadeoghare@yahoo.co.in




Case presentation                                                        dermo-epidermal junction on histopathology. A well-defined
                                                                         urticaria-like erythematous plaque is seen on dermoscopy
A 32-year-old male was diagnosed with recurrent erythema                 as structureless homogenous pink-white area obliterating
multiforme secondary to orolabial herpes. Dermoscopy                     the normal pigment network and correlates with papillary
(­polarised light, Dermlite DL4) of evolving targetoid lesions           ­oedema on histopathology.
is shown in Figure 1.                                                         We discovered that, in the absence of treatment, the size of
                                                                         individual lesions increases as the time since the onset of the

Teaching point                                                           lesion increases. This is associated with dermoscopic feature
                                                                         of increase in the number and density of black-brown dots
The central ruptured vesicle is seen as a central circular               and clods, that we have termed as "splash of ink" appear-
yellowish-pink area on dermoscopy and correlates with                    ance in fully evolved targetoid lesions, which could indicate
subepidermal split on histopathology. The black pigmenta-                ongoing damage to basal keratinocytes and melanocytes and
tion is seen as brown-black colored dots and clods on der-               thus disease activity. Dermoscopy can be used to determine
moscopy and correlates with necrotic keratinocytes along                 the relative age of targetoid lesions. The size of the targetoid




Image Letter | Dermatol Pract Concept. 2022;12(4):e2022141                                                                              1
Figure 1. (A) A 32-year-old male presented with erythema multiforme presented with multiple targetoid lesions (white arrow) and
post-inflammatory hyperpigmented patches (green arrow). Dermoscopy (polarised light, Dermlite DL4) of targetoid lesions of erythema
­multiforme: newest lesion - onset one day back (B), onset two days back (C) and oldest lesion - onset three days back (D). Yellow a­ rrow:
 ­Central circular yellowish-pink area, black arrow: Brown-black colored dots and clods clustered regularly at center with irregular ­distribution
  at periphery, red arrow: Structureless homogenous pink-white area obliterating normal pigment network, blue arrow: pigmented reticular
  lines (pigment network) of normal skin.




lesion and the size of “splash of ink” appearance indicates the            References
evolution of the individual lesion. Targetoid lesions with the
earliest onset will have largest size and “splash of ink” appear-           1. Trayes KP, Love G, Studdiford JS. Erythema Multiforme: Recog-
                                                                               nition and Management. Am Fam Physician. 2019;100(2):82-88.
ance and vice-versa. We believe that regardless of the cause
                                                                               PMID: 31305041.
of EM, its morphological appearance will be consistent in all
                                                                            2. Kaliyadan F. Dermoscopy of erythema multiforme. Indian Der-
cases, and treatment will result in fading of “splash of ink” ap-              matol Online J. 2017;8:75. DOI: 10.4103/2229-5178.198771.
pearance. However, further studies are needed to validate this.                PMID: 28217488. PMCID: PMC5297286.




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