Target and targetoid lesions in dermatology

M Bhandari, G Khullar - Indian Journal of Dermatology, Venereology …, 2022 - ijdvl.com
M Bhandari, G Khullar
Indian Journal of Dermatology, Venereology and Leprology, 2022ijdvl.com
Target lesions are characterized by a distinct clinical morphology, presenting as three
concentric zones. They classically occur in erythema multiforme, an acute, selflimiting, often
recurrent mucocutaneous disease involving mainly the face and extremities and most
frequently related to infections, particularly herpes simplex virus and Mycoplasma
pneumoniae. Targetoid lesions are target-like in appearance, with usually two concentric
zones and are seen in several dermatologic conditions other than erythema multiforme. In …
Target lesions are characterized by a distinct clinical morphology, presenting as three concentric zones. They classically occur in erythema multiforme, an acute, selflimiting, often recurrent mucocutaneous disease involving mainly the face and extremities and most frequently related to infections, particularly herpes simplex virus and Mycoplasma pneumoniae. Targetoid lesions are target-like in appearance, with usually two concentric zones and are seen in several dermatologic conditions other than erythema multiforme. In 1993, Bastuji-Garin et al. proposed a classification system and defined two disease spectra–(1) erythema multiforme (major and minor) and (2) Stevens-Johnson syndrome–toxic epidermal necrolysis, the latter are usually drug induced and associated with high mortality. 1 These diseases are classified based on the percentage of skin detachment and the pattern of individual target lesions. 1 The various types of target lesions are as follows: i. Typical targets: Round regular lesions with welldefined borders,< 3 cm in diameter and having classic three zones–the inner most purpuric or necrotic with or without blister, the middle pale edematous ring, and the outer erythematous ring ii. Raised atypical targets: Round palpable edematous lesions that have two zones instead of three and/or an ill-defined border iii. Flat atypical targets: Round non-palpable lesions with two zones and/or a poorly defined border. Blister may be present in the center iv. Macules with or without blisters: Non-palpable erythematous macules of irregular size and shape with or without blisters.
Typical targets and raised atypical targets are seen in erythema multiforme, while flat atypical targets and macules with or without blisters are seen in Stevens-Johnson syndrome, Stevens-Johnson syndrome–toxic epidermal necrolysis overlap and toxic epidermal necrolysis. 1 A minor modification of this classification has categorized typical targets as raised typical targets and flat typical targets. Taking this into consideration, raised typical and raised atypical targets are characteristic of erythema multiforme, while flat typical, flat atypical targets and macules with or without blisters are a feature of Stevens-Johnson syndrome/toxic epidermal necrolysis. 2
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