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Am J Dis Child. 1963;105(6):693-694. doi:10.1001/archpedi.1963.02080040694022.
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To the Editor: Thank you for forwarding Dr. Merten's letter to me. He has raised many questions regarding our article entitled "Fatal Reaction to Sulfadimethoxine (Madribon)" and perhaps several points can be made clearer.

Although toxic epidermal necrolysis is a distinct dermatologic condition, its diagnosis often is difficult, primarily because of its confusion with erythema multiforme. Clinically this may be true; however, histologically there is usually no difficulty separating the two conditions. The pathologic findings in toxic epidermal necrolysis primarily involves the epidermis, with varying degrees of necrosis. The dermis is involved secondarily with nonspecific dermal and perivascular infiltration of inflammatory cells. In direct contradistinction, erythema multiforme has primary pathologic changes localized to the dermis, including the dermal vessels where damage to the vascular wall is easily noted. Using Dr. Merten's reference to Scott's1 article, it is clearly stated, "Histologically, the clinical variations (of erythema multiforme) just described represent


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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