Shape and configuration of skin lesions: targetoid lesions.

What is probably the first description of targetoid or iris lesions, as they appear in erythema multiforme (EM), can be found in Thomas Bateman's 1836 textbook "Practical Synopsis of Cutaneous Diseases According to the Arrangement of Dr. Willan." EM was initially described by Bateman and later by von Hebra as an acute self-limiting skin disease, symmetrically distributed on the extremities with typical concentric "targetoid" or "iris" lesions, and often recurrent. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) were added to this syndrome later. A newer classification has created two disease spectra: EM consisting of EM minor and EM major (or bullous EM), and SJS and TEN. EM minor and EM major are often recurrent, postinfectious (especially after herpes and mycoplasma) disorders with low morbidity and almost no mortality. SJS and TEN are usually severe drug-induced reactions with high morbidity and poor prognosis. The target lesions found in each form of the disease are described and defined. Although the term "target lesion" originated from the description of EM and despite its being the dominant lesion in this disease, it is not pathognomonic for EM, and these lesions can sometimes appear in other diseases. Short descriptions of these other diseases are presented.

William Osler and development of the concept of systemic lupus erythematosus.

OBJECTIVE: This historical review summarizes the understanding of lupus erythematosus (LE) during the time of the career of William Osler and analyzes factors that may have retarded the clinical identification of this disease. METHODS: All of Osler's writings related to diseases that he defined as the "erythema group" were studied, in conjunction with relevant writings on Schönlein-Henoch purpura and erythema multiforme. RESULTS: Osler did not knowingly describe cases of LE, nor did he discuss the disease in general. He proposed that a primary skin disease, which in some cases has visceral manifestations, may develop as a purely visceral disease, using cases from his "erythema group" cohort as evidence. CONCLUSIONS: The reluctance into the 1940s to diagnose systemic LE was primarily a consequence of the erroneous belief that a skin eruption was required to establish the diagnosis. Osler's teaching the possible dissociation of visceral from cutaneous symptoms with regard to the erythema group was not analogized to LE. The interpretation that Osler had elucidated aspects of LE has developed since 1937 and attributes insights to Osler that his writings do not substantiate.

Eritema multiforme y síndrome de Stevens Johnson asociado a irradiación y uso de Difenil Hidantoina (DFH) / Erythema multiforme and Stevens Johnson sindrome related to the use of diphenil hidantoin an radiation therapy

Entre 1988 y 1989 en el Departamento de Radioterapia del Instituto Nacional de Enfermedades Neoplásicas, se diagnosticarón dos casos de reacciones generalizadas de la piel, ambos asociados a irradiación y uso de Difenil hidatoina después de haber iniciado la radioterapia. El primer caso fue una paciente portadora de tumor intracraneal metastásico primaria del recto, quien desarrollo un cuadro caracterizado por lesiones generalizadas en piel y mucosas, compatible con un Síndrome de Stevens Johnson (S.S.J.) El segundo caso se trato de una paciente portadora de un cáncer de mama operada, con antecedentes de epilepsia y consumo de DFH por 15 años, quien desarrolla un cuadro de eritema multiforme (E.M.) (lesiones cutaneas generalizadas sin compromiso de mucosas). El cuadro clínico mejoró al suspenderse la radioterapia, uso de esteroides, cambio de anticonvulsivantes por Fenobarbital y un tratamiento de soporta