Confluent epidermal necrosis is seen in the context of erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

SJS and TEN are generally considered to be on a spectrum and usually due to medications. EM is histomorphologically indistinguishable from SJS/TEN. It is usually due to an infection.

Histomorphologic features:

1. A basket weave-type stratum corneum (indicative of the acuity).
2. Epidermal necrosis.
3. Separation of the epidermis and dermis.
4. Minimal inflammation.

Related images

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  Low mag.
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  Intermed. mag.
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  Very high mag.