Microdistribution None

Macrodistribution: In EM minor, lesions are symmetrical and are typically found on the palms, dorsum of the hands, wrists, extensor forearms, dorsum of the feet, elbows, and knees (see Fig. 4). Lesions may occur in any location.

Mucosal lesions may occur in EM minor but are limited to one site, usually the oral cavity. Involvement of more than one mucosal site is considered evidence for EM major. In EM major, all mucous membranes, the lining of the esophagus, the upper respiratory epithelium, and the lining of the urinary bladder may be involved. The most characteristic mucosal sign is the bloody denuded vermilion of the upper and lower lips (see Photo 34). Since EM is a clinical spectrum, these different distributions are not mutually exclusive, and a fair degree of overlap can exist.


2. Targetoid (see Photo 35).

3. Annular and polycyclic.

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