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Ravindra Surve R, Shenoi SD, Meghashree G, Gowda V M V, Zoya A. Management of leukocytosis in erythroderma. Indian J Dermatol Venereol Leprol 2024; 0:1-2. [PMID: 38594997 DOI: 10.25259/ijdvl_567_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/23/2023] [Indexed: 04/11/2024]
Affiliation(s)
- Ravina Ravindra Surve
- Department of Dermatology, Kanachur Institute of Medical Sciences, Deralakatte, Mangaluru, India
| | - Shrutakirthi D Shenoi
- Department of Dermatology, Kanachur Institute of Medical Sciences, Deralakatte, Mangaluru, India
| | - G Meghashree
- Department of Dermatology, Kanachur Institute of Medical Sciences, Deralakatte, Mangaluru, India
| | - Varsha Gowda V M
- Department of Dermatology, Kanachur Institute of Medical Sciences, Deralakatte, Mangaluru, India
| | - A Zoya
- Department of Dermatology, Kanachur Institute of Medical Sciences, Deralakatte, Mangaluru, India
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2
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Kliniec K, Snopkowska A, Łyko M, Jankowska-Konsur A. Erythroderma: A Retrospective Study of 212 Patients Hospitalized in a Tertiary Center in Lower Silesia, Poland. J Clin Med 2024; 13:645. [PMID: 38337339 PMCID: PMC10856417 DOI: 10.3390/jcm13030645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Erythroderma is a condition characterized by erythema affecting at least 90% of the skin surface area. It can be caused by various underlying conditions. Due to nonspecific clinical and laboratory findings, determining the cause may pose a challenge. In the retrospective study, we identified 212 patients hospitalized for erythroderma in the Department of Dermatology, Venereology, and Allergology at Wroclaw Medical University between January 2012 and March 2022. Clinical, laboratory, and histopathological features, as well as the management of patients, were studied. The median age of adults was 61 years (IQR = 47-68). The most common causes of erythroderma were psoriasis (n = 49, 24.01%), followed by atopic dermatitis (AD) (n = 27, 13.23%), and cutaneous T-cell lymphomas (CTCL) (n = 27, 13.23%). Despite laboratory tests and histopathological examination, the etiology of erythroderma remained undetermined in 39 cases (19.12%). In 70.59% of patients, it was the first episode of erythroderma, while 29.41% experienced a recurrent episode. Regardless of the etiology of erythroderma, patients were most frequently treated with systemic antihistamines (146 cases, 71.57%) and systemic steroids (132 cases, 64.71%). Patients with idiopathic erythroderma constitute the greatest diagnostic and therapeutic challenge, requiring particularly thorough evaluation.
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Affiliation(s)
- Katarzyna Kliniec
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.K.); (A.J.-K.)
| | - Aleksandra Snopkowska
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Magdalena Łyko
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.K.); (A.J.-K.)
| | - Alina Jankowska-Konsur
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (K.K.); (A.J.-K.)
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3
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Yamada A, Umemoto N, Shimoyamada H, Demitsu T, Kitamura O. Deck-chair sign as a diagnostic clue for insidious T-cell lymphoma: An autopsy case of mycosis fungoides. Leg Med (Tokyo) 2023; 65:102326. [PMID: 37778204 DOI: 10.1016/j.legalmed.2023.102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
Skin reflects the presence of systemic diseases, leading to an unexpected diagnosis of insidious diseases. Deck-chair sign is a unique skin eruption characterized by widespread erythematous papules that become erythrodermic with spare skin folds. An association between the deck-chair sign and malignancies, especially hematological neoplasms, has been suggested. We report a forensic case of mycosis fungoides unexpectedly diagnosed in the presence of a deck-chair sign. Mycosis fungoides is representative of cutaneous T-cell lymphomas. Here, we successfully demonstrated the feasibility of analyzing mycosis fungoides in a forensic autopsy case using basic histopathology and serology. We emphasize that the underlying malignancy should be primarily considered in cadavers with a positive deck-chair sign and review current reports about this characteristic skin manifestation.
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Affiliation(s)
- Atsushi Yamada
- Department of Legal Medicine, Kyorin University, Faculty of Medicine, Tokyo, Japan; Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| | - Naoka Umemoto
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiroaki Shimoyamada
- Department of Pathology, Kyorin University, Faculty of Medicine, Tokyo, Japan
| | - Toshio Demitsu
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Osamu Kitamura
- Department of Legal Medicine, Kyorin University, Faculty of Medicine, Tokyo, Japan
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4
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Batra J, Gulati S, Sarangal R, Chopra D, Puri S, Kaur R. Utility of Dermoscopy in the Diagnosis of Erythroderma: A Cross-Sectional Study. Indian Dermatol Online J 2023; 14:821-828. [PMID: 38099018 PMCID: PMC10718095 DOI: 10.4103/idoj.idoj_678_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/05/2023] [Accepted: 06/17/2023] [Indexed: 12/17/2023] Open
Abstract
Background It is difficult to diagnose the underlying cause of erythroderma on mere clinical presentation. The role of dermoscopy in diagnosing erythroderma secondary to various etiologies is evolving. Aim and Objectives This study aimed to observe the dermoscopic features of erythroderma secondary to different cutaneous disorders and compare them with clinical features and histopathology. Materials and Methods Twenty-nine consecutive patients of erythroderma were enrolled in the study. Dermoscopy was performed on every case using a Heine Delta II Dermatoscope with 10x magnification in polarized mode. A histopathological examination was conducted to confirm the diagnosis. Results Eight patients were diagnosed with psoriasis, five with endogenous eczema, four with pityriasis rubra pilaris (PRP), three with pustular psoriasis, two with drug rash secondary to antitubercular therapy, two with dermatophytic infection, one patient each of atopic dermatitis, crusted scabies, pemphigus foliaceous, drug reaction with eosinophilia and systemic symptoms, and mycosis fungoides. Characteristic dermoscopic features were observed in erythroderma due to psoriasis, PRP, pustular psoriasis, endogenous eczema, scabies, and dermatophytosis. Differentiation of other disorders based on dermoscopy alone was difficult, and clinico-histopathological correlation was crucial to reach a diagnosis. Conclusion Dermoscopic features of classical patterns of skin disorders are preserved even in the corresponding erythrodermic or unstable stage. Dermoscopic features of erythroderma secondary to psoriasis, pustular psoriasis, PRP, endogenous eczema, scabies, and dermatophytosis are clearly differentiating, whereas the dermoscopic features in other causes of erythroderma are overlapping. Thus, dermoscopy can be a good screening tool in the clinical assessment of erythroderma.
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Affiliation(s)
- Jayati Batra
- Government Medical College, Patiala, Punjab, India
| | | | | | | | - Sulabh Puri
- Government Medical College, Patiala, Punjab, India
| | - Ravneet Kaur
- Government Medical College, Patiala, Punjab, India
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5
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Paller AS, Silverberg JI, Cork MJ, Guttman-Yassky E, Lockshin B, Irvine AD, Kim MB, Kabashima K, Chen Z, Lu Y, Bansal A, Rossi AB, Shabbir A. Efficacy and Safety of Dupilumab in Patients With Erythrodermic Atopic Dermatitis: A Post Hoc Analysis of 6 Randomized Clinical Trials. JAMA Dermatol 2023; 159:255-266. [PMID: 36723913 PMCID: PMC10018319 DOI: 10.1001/jamadermatol.2022.6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance Erythrodermic atopic dermatitis (AD) is a severe AD subtype defined by extensive skin involvement, leading to complications and sometimes hospitalization. Objective To assess dupilumab's efficacy and safety in patients with erythrodermic AD in clinical trials. Design, Setting, and Participants This post hoc analysis included patients enrolled in 6 multicenter, multinational, randomized, double-blind, placebo-controlled trials. Patients included in this analysis met erythrodermic AD criteria of 90% or greater body surface area (BSA) affected by AD and Global Individual Sign Score for erythema of 1 or higher. Data analyses for this post hoc analysis were conducted between March 5, 2019, and October 24, 2020. Interventions Dupilumab once weekly or every 2 weeks, or placebo, either as monotherapy or with concomitant topical corticosteroids (TCS). Main Outcomes and Measures Efficacy (BSA, Eczema Area and Severity Index [EASI] score, Peak Pruritus Numerical Rating Scale [PP-NRS] score), changes in serum biomarkers (thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase), and safety (incidence of adverse events) at week 16. Data were pooled within each regimen; monotherapy and concomitant TCS results are shown separately. Results Of 3075 randomized patients, 209 met criteria for erythrodermic AD at baseline, with the median age being 31 and 39 years in the monotherapy and concomitant TCS trials, respectively, similar to the overall populations (34 and 36 years, respectively); 71.3% (n = 97) and 74.0% (n = 54) of patients, respectively, were male (compared with 58.7% and 60.6% in the overall populations). In patients with erythrodermic AD, dupilumab once weekly and every 2 weeks vs placebo significantly improved percentage of BSA affected by AD (least squares mean percent change [SE]) with monotherapy (-42.0% [7.7%] and -39.9% [6.5%] vs -17.2% [11.0%]; P = .03) and concomitant TCS (-63.2% [6.7%] and -56.1% [9.1%] vs -14.5% [7.3%]; P < .001); EASI score with monotherapy (-58.5% [9.0%] and -58.3% [7.9%] vs -22.3% [12.4%]; P = .004 and P = .003, respectively) and concomitant TCS (-78.9% [7.8%] and -70.6% [10.1%] vs 19.3% [8.2%]; P < .001); and PP-NRS score in monotherapy (-45.9% [7.8%] and -33.9% [6.6%] vs -0.6% [9.4%]; P < .001) and concomitant therapy (-53.0% [8.1%] and -55.7% [10.8%] vs -26.0% [8.8%]; P = .006 and P = .01, respectively). Nominally statistically significant improvement was seen as early as week 1 (EASI and PP-NRS scores with monotherapy). Biomarker levels were significantly reduced vs placebo. The most frequent adverse events in dupilumab-treated patients were injection-site reaction, conjunctivitis, and nasopharyngitis. Conclusions and Relevance In this post hoc analysis of 6 randomized clinical trials, treatment with dupilumab resulted in rapid, sustained improvements in AD signs and symptoms with acceptable safety in patients with erythrodermic AD, similar to those in the trials' overall patient population. Trial Registration ClinicalTrials.gov Identifiers: NCT01859988, NCT02277743, NCT02277769, NCT03054428, NCT02260986, NCT02755649.
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Affiliation(s)
- Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jonathan I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Michael J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, United Kingdom
| | - Emma Guttman-Yassky
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York.,Rockefeller University, New York, New York
| | | | - Alan D Irvine
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Moon Bum Kim
- Pusan National University Hospital, Busan, South Korea
| | | | - Zhen Chen
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Yufang Lu
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
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6
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Al-Khatib N, Assiri O, Asiri K, Asiri AJ. An Icodextrin-related Allergic Reaction with Cutaneous and Mucosal Involvement. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:833-838. [PMID: 38018724 DOI: 10.4103/1319-2442.390262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Affiliation(s)
- Nour Al-Khatib
- Department of Adult Nephrology, Asir Central Hospital, Abha, Saudi Arabia
| | - Omar Assiri
- Department of Medicine, King Khalid University - Medical City, Abha, Saudi Arabia
| | - Khalid Asiri
- Department of Medicine, King Khalid University - Medical City, Abha, Saudi Arabia
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7
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Las reacciones adversas a fármacos son la primera causa de eritrodermia. Estudio retrospectivo de 70 pacientes en un hospital universitario de Argentina. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:765-772. [DOI: 10.1016/j.ad.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/18/2022] Open
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8
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di Prinzio A, Torre A, Cura M, Puga C, Bastard D, Mazzuoccolo L. [Translated article] Adverse Drug Reactions Are the Main Causes of Erythroderma in an Argentinian Teaching Hospital: A Retrospective Study of 70 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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9
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Tso S, Satchwell F, Moiz H, Hari T, Dhariwal S, Barlow R, Forbat E, Randeva H, Tan YT, Ilchyshyn A, Kwok MM, Barber TM, Thind C, Tso ACY. Erythroderma (exfoliative dermatitis). Part 1: underlying causes, clinical presentation and pathogenesis. Clin Exp Dermatol 2021; 46:1001-1010. [PMID: 33639006 DOI: 10.1111/ced.14625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
Erythroderma (exfoliative dermatitis), first described by Von Hebra in 1868, manifests as a cutaneous inflammatory state, with associated skin barrier and metabolic dysfunctions. The annual incidence of erythroderma is estimated to be 1-2 per 100 000 population in Europe with a male preponderance. Erythroderma may present at birth, or may develop acutely or insidiously (due to progression of an underlying primary pathology, including malignancy). Although there is a broad range of diseases that associate with erythroderma, the vast majority of cases result from pre-existing and chronic dermatoses. In the first part of this two-part concise review, we explore the underlying causes, clinical presentation, pathogenesis and investigation of erythroderma, and suggest potential treatment targets for erythroderma with unknown causes.
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Affiliation(s)
- S Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - F Satchwell
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - H Moiz
- Department of Public Health, University of Warwick, Coventry, UK
| | - T Hari
- University of Buckingham Medical School, Buckingham, UK
| | - S Dhariwal
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - R Barlow
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - E Forbat
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Department of Dermatology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - H Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Y T Tan
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - A Ilchyshyn
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M M Kwok
- Anaesthetics, Westmead Hospital, Sydney, Australia
| | - T M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - C Thind
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - A C Y Tso
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
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10
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Castillo RL, Femia AN. Covert clues: the non-hallmark cutaneous manifestations of dermatomyositis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:436. [PMID: 33842657 PMCID: PMC8033358 DOI: 10.21037/atm-20-5252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dermatomyositis (DM) is a strikingly heterogenous disease characterized by a broad and ever-evolving spectrum of cutaneous manifestations that transcend the classic “hallmarks” defined by Peter and Bohan in 1975. Despite the increasing preponderance and ubiquity of autoantibody, radiologic, and electrophysiologic testing, the diagnosis of DM still hinges largely on prompt detection of cutaneous manifestations of this condition. While pathognomonic cutaneous features of DM are more readily recognizable, many patients present with subtle and/or atypical skin manifestations, and diagnosis of DM may require clinician identification of these cutaneous clues. In this review, we highlight several of the lesser-known skin manifestations of DM, specifically, panniculitis, diffuse subcutaneous edema, erythroderma, calcinosis, ulceration, flagellate erythema, Wong-type DM, gingival telangiectasias, and the ovoid palatal patch. We describe the clinical and histopathologic presentation of these cutaneous findings. While manifesting less frequently than the heliotrope rash, Gottron’s papules, and Gottron’s sign, these cutaneous clues are equally important for clinicians to recognize in order to facilitate timely diagnosis and early intervention.
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Affiliation(s)
- Rochelle L Castillo
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
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11
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Plachouri K, Georgiou S. Paraneoplastic erythroderma: an insight on the existing data. Int J Dermatol 2020; 59:1429-1436. [DOI: 10.1111/ijd.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
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12
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Abstract
Papuloerythroderma of Ofuji (PEO) is a rare skin condition first described in 1984 and characterized by diffuse erythroderma composed of papules coalescing into plaques with sparing of skin folds, known as the deck-chair sign. The disease is almost exclusively seen in the elderly and affects men more frequently than women. Common laboratory findings include peripheral and tissue eosinophilia, elevated levels of immunoglobulin E, and lymphopenia. The diagnosis entails exclusion of potentially causative pathologies, including drug intake, atopy, malignancy, and infection. These factors have frequently been found in association with PEO, but their role in the etiopathogenesis of the disease is poorly understood. A dysregulated immune system, with particular involvement of T-helper (Th)2 and Th22 cells, seems to be important in the development of PEO. Controversy exists as to whether PEO exists as an independent entity or as a clinical pattern of a variety of distinct conditions. Treatment necessitates first addressing any coexisting circumstances that may have a causal relationship with PEO. In idiopathic cases, topical and oral corticosteroids, ultraviolet light therapies, and immunosuppressive/immunomodulating therapies have been used with variable results. Future studies are needed to further understand the disease process and to establish guidelines for diagnostic workup and treatment.
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Affiliation(s)
- Karishma Desai
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mariya Miteva
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paolo Romanelli
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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13
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van Rhijn BD, van Ruth S, Balak DMW. Deck-chair sign: unreserved. Clin Exp Dermatol 2020; 46:560-561. [PMID: 32970866 DOI: 10.1111/ced.14457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- B D van Rhijn
- Department of Dermatology and Allergology, UMC Utrecht, Utrecht, The Netherlands.,Department of Dermatology, Tergooi, Hilversum, The Netherlands
| | - S van Ruth
- Department of Dermatology, Tergooi, Hilversum, The Netherlands
| | - D M W Balak
- Department of Dermatology and Allergology, UMC Utrecht, Utrecht, The Netherlands.,Department of Dermatology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
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14
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Amin SS, Qamar H, Adil M, Mohtashim M, Mushtaq S, Agrawal D. Generalized Parthenium dermatitis with deck-chair sign. GIORN ITAL DERMAT V 2020; 155:368-370. [DOI: 10.23736/s0392-0488.18.06025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Erythroderma: a prospective study of 309 patients followed for 12 years in a tertiary center. Sci Rep 2020; 10:9774. [PMID: 32555205 PMCID: PMC7300014 DOI: 10.1038/s41598-020-66040-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/14/2020] [Indexed: 02/08/2023] Open
Abstract
Erythroderma is characterized by erythema and scaling affecting more than 80% of the body surface area. It is potentially life-threatening, and diagnosis of the underlying disease is a challenge. Despite laboratory improvements, many cases remain idiopathic. We aimed to analyze clinical and laboratory findings of 309 erythrodermic patients to find clues to the etiologic diagnosis. We performed a prospective study at the University of São Paulo Medical School, from 2007 to 2018, with patients with acquired erythroderma. Clinical, laboratory, histology, and molecular biology data were collected. The median age at diagnosis was 57 years, with a male-to-female ratio of 2.2. Eczema was the most frequent etiology (20.7%), followed by psoriasis (16.8%), Sézary syndrome (12.3%), drug eruption (12.3%), atopic dermatitis (8.7%), and mycosis fungoides (5.5%). Other diagnoses (6.8%) included pemphigus foliaceous, paraneoplastic erythroderma, adult T-cell leukemia/lymphoma, dermatomyositis, pityriasis rubra pilaris, lichen planus, bullous pemphigoid, and leprosy. In 52 patients (16.8%), it was not possible to elucidate erythroderma etiology. Atopic dermatitis developed erythroderma at an earlier age (median 25 years; P = 0.0001). Acute onset was associated with drug reactions and atopic dermatitis (median time from erythroderma to diagnosis of 1 and 1.5 months, respectively; P = 0.0001). Higher immunoglobulin E levels were observed in atopic dermatitis (median 24,600 U/L; P = 0.0001). Histopathology was helpful and was consistent with the final diagnosis in 72.4%. Monoclonal T-cell proliferation in the skin was observed in mycosis fungoides (33.3%) and Sézary syndrome (90.9%). At the last assessment, 211 patients (69.3%) were alive with disease, 65 (21.7%) were alive without disease, and 27 (9.1%) died with active disease. Erythroderma is a challenging syndrome with a difficult diagnostic approach. Younger age and higher immunoglobulin E levels are associated with atopic dermatitis; acute onset is observed in drug eruptions and atopic dermatitis. Histopathology and molecular biology tests are essential tools in the investigation of erythroderma.
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16
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Zervakis SG, Spernovasilis N, Boutakoglou E, Panagiotakis S, Thomopoulou K, Samonis G. Erythroderma as a paraneoplastic manifestation of small cell lung cancer. Curr Probl Cancer 2019; 44:100499. [PMID: 31493907 DOI: 10.1016/j.currproblcancer.2019.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/20/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
Erythroderma is a rare clinical entity characterized by generalized erythema affecting the whole or most of the body's skin surface. It is associated with a variety of underlying conditions, including preexisting dermatoses, infections, connective tissue disorders, drugs, malignancies, or it may be idiopathic. A case of a 73-year-old man, with a 5-month history of erythroderma, eventually diagnosed with small cell lung cancer is presented. This is the first reported case indicating an association between erythroderma and small cell lung cancer, extending, thus, current knowledge regarding small cell lung cancer-related paraneoplastic manifestations as well as erythroderma's causative factors.
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Affiliation(s)
- Stylianos G Zervakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Nikolaos Spernovasilis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Erasmia Boutakoglou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Simeon Panagiotakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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Baldissera RL, Shwetz GA, Fillus Neto J, Vigo NDR. Erythroderma as a manifestation of leprosy. An Bras Dermatol 2019; 94:89-92. [PMID: 30726471 PMCID: PMC6360983 DOI: 10.1590/abd1806-4841.20197887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/02/2018] [Indexed: 11/22/2022] Open
Abstract
Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.
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MESH Headings
- Aged
- Biopsy
- Dermatitis, Exfoliative/complications
- Dermatitis, Exfoliative/diagnosis
- Dermatitis, Exfoliative/pathology
- Diagnosis, Differential
- Humans
- Leprosy, Borderline/diagnosis
- Leprosy, Borderline/etiology
- Leprosy, Borderline/pathology
- Leprosy, Lepromatous/diagnosis
- Leprosy, Lepromatous/etiology
- Leprosy, Lepromatous/pathology
- Male
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Affiliation(s)
- Renato Luiz Baldissera
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
| | - Guilherme Athanasio Shwetz
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
| | - José Fillus Neto
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
| | - Noely do Rocio Vigo
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
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Cheong K, Yew Y, Tey H. Idiopathic Generalized Exfoliative Dermatitis and Association with Antihypertensive Drugs and Statins: A Retrospective Case-Control Study. Dermatology 2019; 235:107-111. [DOI: 10.1159/000495836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background/Aims:</i></b> We aim to examine the hypothesis that antihypertensive drugs and statins may be responsible for the development of idiopathic generalized exfoliative dermatitis (GED) with a case-control study. <b><i>Methods:</i></b> All inpatients who were hospitalized under the dermatology service at the Tan Tock Seng Hospital, Singapore, between 1 May 2013 and 31 May 2015, were analysed. Idiopathic GED cases had consistent clinical and histological features but no apparent cause despite comprehensive evaluation. Controls were randomly selected from inpatients with other dermatological conditions in a 1: 1 ratio during the same period. Their relationship was analysed using univariate (χ<sup>2</sup> or Fisher exact tests) and multivariate logistic regression analysis. <b><i>Results:</i></b> There were 78 cases and 83 controls. Of the 78 cases, 42 patients had a history of treatment with antihypertensive drugs or statins. Cases were not found to be more likely on angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, calcium channel blockers, thiazides or statins compared to controls (OR: 0.81; 95% CI: 0.43–1.51; <i>p</i> = 0.507). <b><i>Conclusions:</i></b> There was insufficient evidence to suggest a significant relationship between the chronic use of antihypertensive drugs or statins and idiopathic GED in this study, despite previous evidence reporting this might be so. Further case-control studies with larger sample sizes are needed to evaluate this association.
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Cuellar-Barboza A, Ocampo-Candiani J, Herz-Ruelas M. Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:777-790. [DOI: 10.1016/j.ad.2018.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/20/2018] [Accepted: 05/23/2018] [Indexed: 01/19/2023] Open
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20
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A Practical Approach to the Diagnosis and Treatment of Adult Erythroderma. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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21
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Skaggs Z, Haber J. This Rash Puts You in the ICU. Clin Pract Cases Emerg Med 2018; 2:384-385. [PMID: 30443640 PMCID: PMC6230359 DOI: 10.5811/cpcem.2018.9.39335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/06/2018] [Accepted: 09/21/2018] [Indexed: 11/11/2022] Open
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22
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Abstract
Erythroderma, often described as generalized exfoliative dermatitis, is a condition in which erythema involves greater than 90% of the body surface, often as a result of an underlying inflammatory skin condition, which can result in a variety of systemic manifestations and potentially lead to life-threatening complications.
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Affiliation(s)
- Emily Rose
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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23
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Sharif J, McMullen E. Dermatology emergencies: handy hints for the acute medical team. Br J Hosp Med (Lond) 2018; 79:378-383. [PMID: 29995550 DOI: 10.12968/hmed.2018.79.7.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article will help the general physician recognize and manage acute dermatology presentations. This can be challenging for non-dermatology doctors owing partly to the difficulty in providing an extensive dermatology undergraduate education and the lack of exposure to dermatology patients. The problem is further compounded at many hospital trusts because of the lack of on-site dermatology 'on-call'. The general physician must be able to recognize dermatology emergencies in order to provide initial management and maintain appropriate referrals to acute dermatology services. The emergency presentations discussed are erythroderma, life-threatening drug eruptions, cutaneous vasculitis, eczema herpeticum and bullous disorders.
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Affiliation(s)
- Jennifer Sharif
- Dermatology Speciality Trainee, Department of Dermatology, Salford Royal NHS Foundation Trust, Salford M6 8HD
| | - Emma McMullen
- Dermatology Consultant, Department of Dermatology, Salford Royal NHS Foundation Trust, Salford
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24
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Abstract
Cutaneous adverse drug reactions comprise a significant proportion of all adverse drug reactions. They may mimic other dermatologic or systemic illnesses and may cause significant morbidity or mortality. Seven morphologic groups encompass the most commonly encountered cutaneous drug reaction syndromes: exanthematous (maculopapular), dermatitic/eczematous, urticarial, pustular, blistering, purpuric, and erythrodermic. Drug reactions may have significant downstream consequences for the older individual.
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Fong Y, Kauffmann RM, Marcinkowski E, Singh G, Schoellhammer HF. Dermatologic Emergencies. SURGICAL EMERGENCIES IN THE CANCER PATIENT 2017. [PMCID: PMC7122021 DOI: 10.1007/978-3-319-44025-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, California USA
| | | | - Emily Marcinkowski
- Surgical Oncology Hepatobiliary Surgery, City of Hope Medical Center, Duarte, California USA
| | - Gagandeep Singh
- Department of Surgery, City of Hope Medical Center, Durate, California USA
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Wernham AGH, Fremlin GA, Orpin SD, Salim A. Physician, beware! The deckchair sign can be seen in dermatomyositis. Clin Exp Dermatol 2016; 41:919-920. [DOI: 10.1111/ced.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 10/20/2022]
Affiliation(s)
- A. G. H. Wernham
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital; Birmingham UK
| | - G. A. Fremlin
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital; Birmingham UK
| | - S. D. Orpin
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital; Birmingham UK
| | - A. Salim
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital; Birmingham UK
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Miyamoto D, Sotto MN, Otani CSV, Fukumori LMI, Pereira NV, Santi CG, Maruta CW, Burnier MNN, Rebeis MM, Aoki V. Increased serum levels of vascular endothelial growth factor in pemphigus foliaceus patients with erythroderma. J Eur Acad Dermatol Venereol 2016; 31:333-336. [PMID: 27510449 DOI: 10.1111/jdv.13905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Erythroderma is a clinical skin syndrome shared by patients with cutaneous disorders of distinct aetiologies as a result of the combined actions of chemokines, adhesion molecules, and cytokines, such as vascular endothelial growth factor (VEGF). OBJECTIVE To evaluate the profile of serum levels of VEGF and soluble vascular endothelial growth factor receptor 1 (sVEGFR-1) in pemphigus foliaceus (PF) patients with erythroderma. METHODS We conducted a retrospective study, which included (i) a chart review of all PF patients from the Autoimmune Blistering Clinic, University of Sao Paulo, Brazil, from January 1991 to December 2014, together with an evaluation of demographic variables, hospitalization duration and complications and (ii) analysis of the circulating VEGF and sVEGFR-1 levels in PF patients with erythroderma by ELISA. The controls included patients with pemphigus vulgaris or psoriasis. RESULTS We observed higher serum VEGF levels in PF patients during erythroderma than during the non-erythrodermic phase. PF patients showed increased serum levels of sVEGFR-1 during the erythrodermic phase in comparison to controls. Interestingly, the sVEGFR-1 and antidesmoglein-1 levels were positively correlated during the non-erythrodermic period. CONCLUSION Erythroderma, which represents one clinical form of PF, implies more severe outcomes. The circulating levels of VEGF, a potent endothelial activator, are increased in PF patients with erythroderma; this result suggests the contribution of the blood vessel endothelium to the pathogenesis of this clinical syndrome. Interestingly, our findings showed a positive correlation between the sVEGFR-1 and antidesmoglein-1 antibody levels, indicating a suppressive response to VEGF augmentation during the erythrodermic phase of PF.
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Affiliation(s)
- D Miyamoto
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - M N Sotto
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - C S V Otani
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - L M I Fukumori
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - N V Pereira
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - C G Santi
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - C W Maruta
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - M M Rebeis
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - V Aoki
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
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César A, Cruz M, Mota A, Azevedo F. Erythroderma. A clinical and etiological study of 103 patients. J Dermatol Case Rep 2016; 10:1-9. [PMID: 27119000 DOI: 10.3315/jdcr.2016.1222] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 12/28/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Erythroderma is an uncommon and severe dermatological manifestation of a variety of diseases. It is commonly challenging to find the underlying cause. OBJECTIVE The aim of this study was to analyze the causes of the disease in patients with erythroderma. PATIENTS AND METHODS Data including the clinical symptoms, laboratory examinations, histopathology and follow-up information were collected from patients with erythroderma admitted to our department between 2000 and 2010. RESULTS One-hundred and three patients diagnosed with erythroderma were identified during this period (11.9% of all hospitalized patients; hospital incidence = 9.4 cases/year). The mean age of onset was 54.4 years (range: 17-89 years) with a male:female ratio of 1.5:1. The most frequent cause of erythroderma was exacerbation of preexisting dermatoses (65.0%), including psoriasis (44.7%) and eczema (16.5%). Drugs (18.4%) and cutaneous T-cell lymphomas (11.7%) induced most of the remaining cases. No cause could be identified in four cases (3.9%). Apart from erythema and scaling, that were present in all patients, clinical findings were dominated by pruritus (97.1%), followed by edema (56.3%), fever (54.4%), palmoplantar keratoderma (50.5%), nail changes (42.7%), liver or spleen enlargement (41.7%) and lymphadenopathy (40.8%). CONCLUSIONS Although numerous clinical features and laboratory values were abnormal, most findings were non-specific. The skin biopsy yielded a positive clinical correlation in most cases. Our study had a high percentage of erythroderma secondary to preexisting skin disease and a relatively low percentage of idiopathic erythroderma.
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Affiliation(s)
- Artur César
- Department of Dermatology and Venereology, Centro Hospitalar São João EPE, Porto, Portugal; ; Faculty of Medicine, University of Porto, Portugal
| | - Maria Cruz
- Department of Dermatology and Venereology, Centro Hospitalar São João EPE, Porto, Portugal; ; Faculty of Medicine, University of Porto, Portugal
| | - Alberto Mota
- Department of Dermatology and Venereology, Centro Hospitalar São João EPE, Porto, Portugal; ; Faculty of Medicine, University of Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar São João EPE, Porto, Portugal
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29
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Abstract
Erythroderma or generalized exfoliative dermatitis is a skin disorder that requires attention equivalent to medical emergencies. It is more prevalent in male population. It accounts for 35 cases/100,000 cases in dermatologic outpatient departments. In erythroderma even with proper management there are certain metabolic burdens and complications which make it more critical. The primary aim, in this case, was to treat the patient with Ayurvedic management. A 18-year-old patient, suffering from erythroderma, was treated on the line of Kapala Kushtha and Audumbera Kushtha. The patient had primarily suffered from psoriasis for 8 years. Erythroderma was developed due to abrupt self-medication with an unknown amount of intramuscular methylprednisolone several times in last month. Rasamanikya-125 mg, Arogyavardhini Vati-1 g, Kaishora Guggulu-1 g, Khadirarista-20 ml, and Panchatikta Ghrita-20 ml, all drugs twice a day with 3-4 times local application of Jatyadi Taila were administered. A decoction of Jwarhara Kashaya was also administered in the dose of 40 ml twice a day. The patient had relief from the acute phase after 20 days of treatment and complete remission after 3 months of treatment. This case study demonstrates that Ayurvedic management may be useful in erythroderma like acute and life-threatening condition.
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Affiliation(s)
| | - Kshipra Rajoria
- Department of Panchakarma, S.S.S.B. Ayurvedic College and Hospital, Jaipur, Rajasthan, India
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30
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Banerjee S, Ghosh S, Mandal RK. A Study of Correlation Between Clinical and Histopathological Findings of Erythroderma in North Bengal Population. Indian J Dermatol 2015; 60:549-55. [PMID: 26677266 PMCID: PMC4681191 DOI: 10.4103/0019-5154.169124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Erythroderma is a reaction pattern characterized by erythema and desquamation of 90% or more body surface area along with some metabolic alterations. Materials and Methods: Here we studied 32 patients of erythroderma at of North Bengal Medical College for a period of 1 year to find the etiology, clinical features and histological changes. Detailed history was taken from all the patients followed by relevant biochemical investigations and histological examination. To correlate the clinical and histopathological findings chi square test was used. Results: Male preponderance was present and most of them were in the 4th or 5th decade. Etiologically the patients were divided into secondary erythroderma developing over pre-existing dermatoses, and idiopathic erythroderma. Secondary erythroderma (n = 24) cases outnumbered the idiopathic cases (n = 8). Among the pre-existing dermatoses, psoriasis was found to be the most common etiologic agent. Apart from erythema the other common presenting features were scaling and itching. Histopathological categorization was possible in 59.3% cases, rest of the cases showed non-specific dermatitis. The most common histopathologic diagnosis was psoriasis (21.8% of cases). Conclusions: Our study of clinicopathological correlation of erythroderma patients among north bengal population corroborates with most of the previous studies done in other areas. As ours is a cross-sectional study in a undefined population so we could not determine the true incidence of erythroderma in north bengal population. We might have missed lymphoma as a cause of erythroderma in idiopathic cases due to lack of long follow-up, so we understand that further studies over a defined population with long follow-up is needed to determine the true incidence and causes of idiopathic erythroderma.
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Affiliation(s)
- Sabyasachi Banerjee
- Department of Dermatology, STD and Leprosy Malda Medical College, Burdwan, West Bengal, India
| | - Swarup Ghosh
- Department of Pathology, Asansol SD Hospital, Burdwan, West Bengal, India
| | - Rajesh Kumar Mandal
- Department of Dermatology, STD, and Leprosy, North Bengal Medical College, Darjeeling, West Bengal, India
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31
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Miyamoto D, Batista DIS, Santi CG, Maruta CW, Delgado L, Aoki V. Exfoliative erythroderma as a clinical manifestation of autoimmune bullous diseases. Int J Dermatol 2015; 55:e112-4. [PMID: 26547358 DOI: 10.1111/ijd.13034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Denise Miyamoto
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Daniel I S Batista
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Cláudia G Santi
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Celina W Maruta
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Livia Delgado
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Valéria Aoki
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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32
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Abstract
A 55-year-old male presented with asymptomatic extensive skin lesions since one year. He was found to have diffuse lesions involving the face, trunk, arms, and thighs along with symmetric peripheral nerve thickening. Bacteriological and histopathological examination confirmed lepromatous leprosy. There was a conspicuous sparing of the abdominal creases and axillae from the infiltrative lesions suggesting a positive “deck-chair” sign. This sign has been described in the past with papulo-erythroderma of Ofuji and certain other disorders. Leprosy may be now included among the causes of “deck-chair” sign.
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Affiliation(s)
- M Manjunath Shenoy
- Department of Dermatology, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
| | - Mukhtar Ahmed Bendigeri
- Department of General Medicine, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
| | - Prshanth R Kamath
- Department of Dermatology, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
| | - B Vishal
- Department of Dermatology, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
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Nakano-Tahara M, Terao M, Nishioka M, Kitaba S, Murota H, Katayama I. T Helper 2 Polarization in Senile Erythroderma with Elevated Levels of TARC and IgE. Dermatology 2015; 230:62-9. [DOI: 10.1159/000366502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022] Open
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Tan GFL, Kong YL, Tan ASL, Tey HL. Causes and features of erythroderma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2014. [PMID: 25244987 DOI: 10.47102/annals-acadmedsg.v43n8p391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Erythroderma is a generalised inflammatory reaction of the skin secondary to a variety of causes. This retrospective study aims to characterise the features of erythroderma and identify the associated causes of this condition in our population. MATERIALS AND METHODS We reviewed the clinical, laboratory, histological and other disease-specific investigations of 225 inpatients and outpatients with erythroderma over a 7.5-year period between January 2005 and June 2012. RESULTS The most common causative factors were underlying dermatoses (68.9%), idiopathic causes (14.2%), drug reactions (10.7%), and malignancies (4.0%). When drugs and underlying dermatoses were excluded, malignancy-associated cases constituted 19.6% of the cases. Fifty-five percent of malignancies were solid-organ malignancies, which is much higher than those previously reported (0.0% to 25%). Endogenous eczema was the most common dermatoses (69.0%), while traditional medications (20.8%) and anti-tuberculous medications (16.7%) were commonly implicated drugs. In patients with cutaneous T-cell lymphoma (CTCL), skin biopsy was suggestive or diagnostic in all cases. A total of 52.4% of patients with drug-related erythroderma had eosinophilia on skin biopsy. Electrolyte abnormalities and renal impairment were seen in 26.2% and 16.9% of patients respectively. Relapse rate at 1-year was 17.8%, with no associated mortality. CONCLUSION Our study highlights the significant proportion of malignancy-related erythroderma in those whom common underlying causes such as dermatoses and drugs have been excluded. In cases of drug-related erythroderma, traditional medications and antituberculous medications are common causes in our population. Renal impairment and electrolyte abnormalities are commonly seen and should be monitored in patients with erythroderma.
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Hulmani M, Nandakishore B, Bhat MR, Sukumar D, Martis J, Kamath G, Srinath MK. Clinico-etiological study of 30 erythroderma cases from tertiary center in South India. Indian Dermatol Online J 2014; 5:25-9. [PMID: 24616850 PMCID: PMC3937481 DOI: 10.4103/2229-5178.126024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Erythroderma is a morphological reaction pattern of skin having many underlying causes and finding the etiology helps in the proper management of erythroderma cases. Aim: To evaluate the clinical profile, etiology of erythroderma and to correlate clinical diagnosis with histopathology. Materials and Methods: This study was performed at the department of dermatology, Father Muller Medical College and Hospital, Mangalore, South India. We studied 30 consecutive cases of erythroderma with respect to the epidemiological, clinical and histological data. Clinico-histological correlation was analyzed for etiology of erythroderma. Results: The mean age of onset was 52.3 years with a male to female ratio of 14:1. In addition to erythroderma, other co-existent features included pruritus, fever, lymphadenopathy, and edema. Of the pre-existing dermatoses, psoriasis was the most common (33.3%) disease followed by eczema (20%), atopic dermatitis (6.6%), pityriasis rubra pilaris (3.3%) and drug-induced erythroderma (16.6%). In 16.6% of cases, etiology could not be ascertained. Clinico-histopathological correlation could be established in 73.3% of cases. Conclusion: Clinical features were identical irrespective of etiology. Detailed clinico-histopathological examination helps to establish the etiology of erythroderma.
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Affiliation(s)
- Manjunath Hulmani
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, India
| | - B Nandakishore
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, India
| | - M Ramesh Bhat
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, India
| | - D Sukumar
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, India
| | - Jacintha Martis
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, India
| | - Ganesh Kamath
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, India
| | - M K Srinath
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, India
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Salami TAT, Enahoro Oziegbe O, Omeife H. Exfoliative dermatitis: patterns of clinical presentation in a tropical rural and suburban dermatology practice in Nigeria. Int J Dermatol 2012; 51:1086-9. [DOI: 10.1111/j.1365-4632.2011.05400.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Grekin SJ, Fox MC, Gudjonsson JE, Fullen DR. Psoriasiform pemphigus foliaceus: a report of two cases. J Cutan Pathol 2012; 39:549-53. [PMID: 22449394 DOI: 10.1111/j.1600-0560.2012.01866.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pemphigus foliaceus (PF) represents an autoimmune blistering disease characterized by the disruption of epidermal intercellular adhesion proteins. Clinical findings include superficial crusted erosions in a seborrheic distribution; however, the disease can rarely present as an exfoliative erythroderma. Histopathologic findings include acantholysis with cleavage within the granular layer. Direct immunofluorescence studies show intercellular IgG and complement deposition. We present two patients, to our dermatology department, with a previous diagnosis of psoriasis, with an exfoliative erythroderma, which ultimately proved to be because of PF based on histopathological features, direct immunofluorescence results and levels of antibodies against desmoglein 1. Both patients responded well to oral prednisone and rituximab. This variant of PF should be entertained in both the clinical differential diagnosis of psoriasiform erythroderma and in the microscopic differential diagnosis of psoriasiform epidermal hyperplasia with focal acantholysis, particularly in patients for whom the clinical history is not classic for psoriasis or for whom conventional psoriasis therapies have not proven beneficial.
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Affiliation(s)
- Sarah J Grekin
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109-5602, USA
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Li J, Zheng HY. Erythroderma: A Clinical and Prognostic Study. Dermatology 2012; 225:154-62. [DOI: 10.1159/000342365] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/06/2012] [Indexed: 11/19/2022] Open
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Khaled A, Sellami A, Fazaa B, Kharfi M, Zeglaoui F, Kamoun MR. Acquired erythroderma in adults: a clinical and prognostic study. J Eur Acad Dermatol Venereol 2009; 24:781-8. [DOI: 10.1111/j.1468-3083.2009.03526.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miyakura T, Yamamoto T, Okubo Y, Ishii N, Oyama B, Hashimoto T, Tsuboi R. Pemphigus foliaceus with prominent neutrophilic pustules initially presenting as erythroderma. Clin Exp Dermatol 2009; 34:e46-9. [DOI: 10.1111/j.1365-2230.2008.03190.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Okoduwa C, Lambert WC, Schwartz RA, Kubeyinje E, Eitokpah A, Sinha S, Chen W. Erythroderma: review of a potentially life-threatening dermatosis. Indian J Dermatol 2009; 54:1-6. [PMID: 20049259 PMCID: PMC2800861 DOI: 10.4103/0019-5154.48976] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Erythroderma, or generalized exfoliative dermatitis, is a disease characterized by erythema and scaling of greater than 90% of the body's surface. The resultant dysmetabolism is potentially life threatening. A detailed history is to identify and treat the underlying cause of this dermatitis. We present two cases of erythroderma in African patients and review this important disease.
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Affiliation(s)
- Cynthia Okoduwa
- From the Department of Dermatology and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA
| | - W C Lambert
- From the Department of Dermatology and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA
| | - R A Schwartz
- From the Department of Dermatology and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA
| | - E Kubeyinje
- From the Department of Dermatology and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA
| | - A Eitokpah
- From the Department of Dermatology and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA
| | - Smeeta Sinha
- From the Department of Dermatology and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA
| | - W Chen
- From the Department of Dermatology and Pathology, New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA
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Fernandes NC, Pereira FDSEM, Maceira JP, Cuzzi T, Dresch TFLR, Araújo PP. Eritrodermia: estudo clínico-laboratorial e histopatológico de 170 casos. An Bras Dermatol 2008. [DOI: 10.1590/s0365-05962008000600005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
FUNDAMENTOS - A dermatite esfoliativa/eritrodermia é síndrome rara e grave, de etiologia freqüentemente desconhecida. A hospitalização é necessária para avaliação inicial e tratamento. OBJETIVO - Determinar o perfil clínico, laboratorial e histopatológico dos eritrodérmicos internados no HUCFF-UFRJ. MÉTODOS - No período de 1990 a 2007, 170 casos foram submetidos a hemograma, velocidade de hemossedimentação, bioquímica do sangue, provas de função hepática, proteínas totais e frações, pesquisa de células de Sézary no esfregaço de sangue periférico, radiografia de campos pleuropulmonares e biópsia de pele em três locais. RESULTADOS - Entre 92 homens e 78 mulheres, na faixa de 30 a 80 anos, identificaram-se 99 casos (58,23%) com dermatoses preexistentes; 37 (21,77%) com farmacodermias; 18 (10,58%) com linfomas cutâneos de células T e 16 (9,4%) de causa indeterminada. Calafrios, prurido, linfonodomegalias e edema de membros inferiores destacaram-se dentre sinais e sintomas. O perfil laboratorial consistiu de aumento da VHS, eosinofilia, leucocitose, linfocitose e anemia. No grupo de etiologia indeterminada, dois padrões histológicos emergiram: dermatite psoriasiforme e dermatite inespecífica. CONCLUSÃO - A psoríase foi a causa mais freqüente; três biópsias de pele simultâneas podem aumentar a acurácia do diagnóstico histopatológico.
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Gadgeel SM, Wozniak AJ. Paraneoplastic Syndromes. Oncology 2007. [DOI: 10.1007/0-387-31056-8_85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ortonne N, Le Gouvello S, Mansour H, Poillet C, Martin N, Delfau-Larue MH, Leroy K, Farcet JP, Bagot M, Bensussan A. CD158K/KIR3DL2 transcript detection in lesional skin of patients with erythroderma is a tool for the diagnosis of Sézary syndrome. J Invest Dermatol 2007; 128:465-72. [PMID: 17703174 PMCID: PMC2562434 DOI: 10.1038/sj.jid.5701013] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The distinction between Sézary syndrome (SS) and benign erythrodermic inflammatory diseases (EID) is difficult to make both clinically and on skin biopsies, since histomorphology can provide nonspecific results. New markers of circulating malignant Sézary cells have been recently described, especially CD158k/KIR3DL2 and T-plastin, but it has not been yet determined whether they could help in the diagnosis of erythroderma in skin samples. In this study, 13 frozen skin specimens from 10 SS patients and 26 from EID were analyzed for CD158k/KIR3DL2 expression using immunohistochemistry with AZ158 mAb, which also recognizes the monomeric CD158e/KIR3DL1 receptor. Although positive in all SS samples, immunohistochemistry appeared to not reliably discriminate between SS and EID. Therefore in all samples disclosing a significant staining with AZ158 mAb, CD158k/KIR3DL2, CD158e/KIR3DL1 and T-plastin mRNA expression were analyzed on the same skin specimen using conventional and/or quantitative real-time reverse transcription (RT)-PCR. Interestingly, only CD158k/KIR3DL2 transcripts were found to be significantly overexpressed in skin biopsies from patients with SS (P<0.0001), including when normalization to CD3 expression was achieved (P=0.0003). In light of these findings, CD158k/KIR3DL2 transcripts appear to be a unique molecular marker of SS in skin samples, allowing differential diagnosis with benign EID in routine practice.
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Affiliation(s)
- Nicolas Ortonne
- Department of Pathology, AP-HP, groupe hospitalier Henri Mondor-Albert Chenevier, Créteil, France.
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Abstract
Erythroderma in neonates and infants is a frequently encountered problem in the daily practice of pediatric dermatology. The objective of this study was to determine the frequency of various causes of this clinical entity, as well as which clinical and laboratory findings are useful in the differentiation of these causes, and to assess the evolution of this disease in this age group. Forty-two patients with erythroderma under 1 year of age were included in this study. A follow-up period of 3-5 years was completed. The study was performed in the Department of Dermatology, Al-Sadr and Alhakeem teaching hospitals and a private section in Najaf governorate, Iraq during the period 1998-2006. The diagnosis was made at an average of 3 months after the onset of the disease. The underlying causes included seborrheic dermatitis in 21.4%, atopic dermatitis in 14.3%, different types of Ichthyoses in 31.5%, psoriasis in 4.7%, pityriasis rubra pilaris in 2.4%, Staphylococcal scalded skin syndrome in 7.14%, Netherton syndrome in 4.7%, immune deficiency syndromes in 4.8% and undetermined erythroderma in 9.5% of the patients. Of 29 cases, histopathological examination of skin biopsy showed non-specific features in 58.7% and could confirm the diagnosis in 41.3% cases. The prognosis was poor with a mortality rate of 26.2% and severe dermatoses persisted in 60% of the survivors. It is difficult to make the etiological diagnosis of neonatal erythroderma from the first examination. Associated immune deficiency should be suspected if the condition associated with skin indurations, severe alopecia, failure to thrive and/or have infectious complications. The prognosis is poor especially in those with immune deficiency or a chronic persistent course.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology, Skin/VD Center, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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Abstract
Erythrodermic cutaneous T-cell lymphoma (E-CTCL) is the cause of less than 5% of all cases of generalized erythroderma. A methodical evaluation of skin, blood, and lymph node samples using standard histology, immunohistochemistry (IHC), flow cytometry (FC), and molecular analysis for evidence of a dominant T-cell clone has been recommended in a recently published diagnostic algorithm. In this commentary, the author discusses available information regarding the role of these diagnostic methods for the diagnosis of E-CTCL with emphasis on personal observations regarding skin IHC and polymerase chain reaction (PCR)-based molecular studies as adjunct diagnostic studies on a series of 55 patients with erythrodermic mycosis fungoides and 50 patients with Sézary syndrome compared to 50 patients with extensive benign inflammatory skin disease. The conclusions are (1) IHC of the skin does not reliably differentiate E-CTCL from benign simulants, (2) presence of phenotypically abnormal T cells in the blood or expanded subsets of CD4+CD7- or CD4+CD26- cells by FC is particularly helpful as a diagnostic study, (3) the presence of an identical T-cell clone in the skin and blood also is a specific diagnostic criterion for E-CTCL, but exceptions may occur, and (4) the PCRgamma-denaturing gradient gel electrophoresis technique appears to be more reliable than PCRgamma-single-stranded conformational polymorphism for diagnostic purposes.
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Affiliation(s)
- Eric C Vonderheid
- Department of Dermatology, Johns Hopkins Medical Institutes, Baltimore, MD 21205, USA.
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Abstract
BACKGROUND Erythroderma is a generalized erythema of the skin accompanied by a variable degree of scaling. However, most of the published series originate from Western countries. There is only one report from Africa, conducted in Dakar in 1979. The aim of our study was to provide information about this condition in our country. PATIENTS AND METHODS Our study was retrospective, dealing with 80 erythrodermic adults, examined between January 1981 and December 2000. Patient information included clinical, laboratory, histopathologic and therapeutic data. We also noted patients' outcomes within an average follow-up period of 30 months. Thus, we calculated the mortality rate and estimated the probability of survival without relapses according to the Kaplan-Meier method. RESULTS The frequency of erythroderma in our dermatology department was 0.3. The sex ratio (male/female) was 2.2. The average age of our patients was 53.78 +/- 18 years. Previous history of skin disease was found in 49/80 patients (61.2%) and 32 of them were suffering from psoriasis. Hyperthermia was significantly associated with drug reactions (P = 0.013). Hypereosinophilia was not a specific finding. The mortality rate was higher than that of an age-matched population. CONCLUSION Adult erythroderma is a rare condition. Its most common cause in our study was psoriasis. No cases of atopic dermatitis were found. Prognosis was adversely affected by the presence of erythroderma.
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Affiliation(s)
- Benmously Mlika Rym
- Dermatology Department, La Rabta Hospital, and Preventive Medicine Department, University of Medicine, Tunis, Tunisia
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Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythroderma: a clinical study of 97 cases. BMC DERMATOLOGY 2005; 5:5. [PMID: 15882451 PMCID: PMC1131896 DOI: 10.1186/1471-5945-5-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Accepted: 05/09/2005] [Indexed: 12/03/2022]
Abstract
Background Erythroderma is a rare skin disorder that may be caused by a variety of underlying dermatoses, infections, systemic diseases and drugs. Methods We reviewed the clinical, laboratory and biopsy material of 97 patients diagnosed with erythroderma who were treated in our department over a 6-year period (1996 through 2002). Results The male-female ratio was 1.85:1. The mean age at diagnosis was 46.2 years. The most common causative factors were dermatoses (59.7%), followed by drug reactions (21.6%), malignancies (11.3%) and idiopathic causes (7.2%). Carbamazepine was the most common drug (57.1%). The best clinicopathologic correlation was found in cutaneous T-cell lymphoma and pityriasis rubra pilaris related erythroderma. Apart from scaling and erythema that were present in all patients, pruritus was the most common finding (97.5%), followed by fever (33.6%), lymphadenopathy (21.3%), edema (14.4%) and hyperkeratosis (7.2%). Conclusion This study outlines that underlying etiologic factors of erythroderma may show geographic variations. Our series had a high percentage of erythroderma secondary to preexisting dermatoses and a low percentage of idiopathic cases. There was no HIV-infected patient among our series based on multiple serum antibody tests. The clinical features of erythroderma were identical, irrespective of the etiology. The onset of the disease was usually insidious except in drug-induced erythroderma, where it was acute. The group associated with the best prognosis was that related to drugs.
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Affiliation(s)
- Maryam Akhyani
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Vahdate-Eslami Sq. 11966, Tehran, Iran
| | - Zahra S Ghodsi
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Vahdate-Eslami Sq. 11966, Tehran, Iran
| | - Siavash Toosi
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Vahdate-Eslami Sq. 11966, Tehran, Iran
| | - Hossein Dabbaghian
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Vahdate-Eslami Sq. 11966, Tehran, Iran
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Rothe MJ, Bernstein ML, Grant-Kels JM. Life-threatening erythroderma: diagnosing and treating the “red man”. Clin Dermatol 2005; 23:206-17. [PMID: 15802214 DOI: 10.1016/j.clindermatol.2004.06.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Exfoliative erythroderma, or diffuse erythema and scaling of the skin, may be the morphologic presentation of a variety of cutaneous and systemic diseases. Establishing the diagnosis of the underlying disease is often difficult and, not uncommonly, erythroderma is classified as idiopathic. Several cases are presented to demonstrate the diversity of presentation of this disease. Laboratory findings are typically unhelpful in establishing the etiology of erythroderma. Clinical data combined with multiple skin biopsies over time are necessary. Systemic complications of erythroderma include infection, fluid and electrolyte imbalances, thermoregulatory disturbance, high output cardiac failure, and acute respiratory distress syndrome. The initial approach to the management of erythroderma of any etiology includes attention to nutrition, fluid and electrolyte replacement, and the institution of gentle local skin care measures. Oatmeal baths and wet dressings to weeping or crusted sites should be followed by application of bland emollients and low-potency topical corticosteroids. Systemic dermatologic therapy may be required to maintain improvement achieved with local measures or to control erythroderma refractory to local measures. The prognosis of erythroderma is dependent on the underlying etiology.
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Affiliation(s)
- Marti Jill Rothe
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT 06030, USA.
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