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June 1975

Dermal and Epidermal Types of Erythema Multiforme

Arch Dermatol. 1975;111(6):795. doi:10.1001/archderm.1975.01630180123026

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To the Editor.—  In their paper in the Archives titled "Dermal and Epidermal Types of Erythema Multiforme" (109:682-688, 1974), Orfanos et al attempt to reconcile contradictory reports of histological changes in erythema multiforme by positing two different histologic types of erythema multiforme. In one type, the blister is said to occur in the papillary dermis as a result of dermal edema caused by increased vascular permeability. In describing the second type, Orfanis et al write that "Ackerman and his coworkers have recently reported that liquefaction degeneration at the dermoepidermal interface was the most characteristic light microscopical feature in early target lesions and that vascular changes were lacking." This is not a completely accurate restatement of our findings, published in the British Journal of Dermatology (84:554-566, 1971). We wrote:In summary, the eruption of erythema multiforme exudativum may vary from erythematous edematous papules, with or without "iris" and "target" lesions, to

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