SPECTRUM OF MORPHOLOGICAL CHANGES IN ERYTHEMA MULTIFORME

The spectrum of morphological changes in erythema multiforme   ABSTRACT Introduction: Erythema multiforme (EM) is a self-limiting, acute, immune-mediated condition. There is a long list of differential diagnosis which needs to be differentiated from the erythema multiforme e.g. pemphigus vulgaris, paraneoplastic pemphigus, mucosal bullous pemphigoid, and linear IgA dermatosis. In addition, primary herpetic infection, other viral diseases such as handfoot-mouth disease, erosive lichen planus, fixed drug eruption, lupus erythematosus, urticaria, cutaneous vasculitis, and some neutrophilic dermatoses have to be considered in the differential diagnosis of EM. For diagnostic confirmation of EM and to differentiate it from other related disorders, in addition to the clinical information, histopathology, electron microscopy, immunofluorescence microscopy and even serological studies may be needed to be done. Immunofluorescence and electron microscopy are expensive diagnostic modalities. Pakistan being developing country, it is not possible to have immunofluorescence and electron microscopyin each and every laboratory center of Pakistan, therefore the reliance of diagnosing erythema multifome on the basis of histopathological features becomes very important.   Objective: To evaluate the histopathological changes in erythema multiforme To determine the frequency of microscopic morphological changes in erythema multiforme. Materials and methods Setting: The study will be conducted in the Pathology Department at KTH/KMC Peshawar. Duration of Study: January 2018 to January 2019. Sample Size: Total 34 cases Sampling Technique: Non probability purposive sampling Study design: Retrospective, chart review study Sample Selection          Inclusion criteria: All age groups Both sexes All skin biopsy specimens diagnosed as Erythema multiforme Exclusion criteria: Autolyzed tissue Relevant clinical history is not available Data collection procedure: The retrospective chart review study will be carried out in Pathology section KTH/KMC. In this study all cases of EM between 2018 and 2019 will be analyzed. The demographic profile (i.e. age, sex)The relevant history regarding nature, intensity and duration of the symptoms will be recorded if available. The criteria for microscopic morphology will include epidermal and dermal changes. The epidermal changes to be studied during the research will include hyperkeratosis, epidermal necrosis, scab formation, acanthosis, hemorrhage and ulceration. The dermal changes will include perivascular inflammation, granulation tissue, mucinous degeneration of collagen and fibrin thrombi.   The data will be recorded in anexcel sheet and then entered in SPSS computer software version 16. Key words: Erythema Multiforme, histopathology morphological changes in EM, bullous diseases of skin