Inappropriate Use of Steroids in Superficial Dermatophytosis: An Uncommon Case of Erythroderma.

Erythroderma is a dermatological emergency presenting with generalized erythema and scaling involving <90% of the body surface.1 There are various causes of erythroderma, such as psoriasis, atopic dermatitis, phytophotodermatitis, pityriasis rubra pilaris, pemphigus foliaceus, cutaneous T-cell lymphoma, and drug eruptions.2 However, erythroderma induced by dermatophytosis is encountered rarely. We, here, describe a case of erythroderma developed secondary to extensive dermatophytosis.

Early Gestational Diabetes Mellitus: An Update.

Erythroderma is a dermatological emergency presenting with generalized erythema and scaling involving >90% of the body surface.1 There are various causes of erythroderma, such as psoriasis, atopic dermatitis, phytophotodermatitis, pityriasis rubra pilaris, pemphigus foliaceus, cutaneous T-cell lymphoma, and drug eruptions.2 However, erythroderma induced by dermatophytosis is encountered rarely. We, here, describe a case of erythroderma developed secondary to extensive dermatophytosis.

Erythroderma in a Patient With Thymoma-Associated Myasthenia Gravis.

A woman in her 30s with myasthenia gravis diagnosed at age 27 years presented to the emergency department with severe erythroderma over the past 2 months. What is your diagnosis?

Crusted Scabies Presenting as Erythroderma in a Patient With Iatrogenic Immunosuppression for Treatment of Granulomatosis With Polyangiitis.

The diagnosis of scabies can be difficult when the infection presents as erythroderma. Crusted scabies is a severe form of scabies caused by cutaneous ectoparasitic infection by the mite Sarcoptes scabiei var hominis. Crusted scabies most commonly occurs in patients with underlying immunosuppression from acquired infection or subsequent to solid organ or bone marrow transplantation. We present a rare case of a patient with granulomatosis with polyangiitis (GPA) who developed azathioprine-induced myelosuppression and subsequent erythrodermic crusted scabies. It is critical to maintain a broad differential when patients present with erythroderma, especially in the setting of medication-induced immunosuppression for the treatment of autoimmune disease.

Severe Erythroderma Due to Adult-onset Still's Disease-like Disease Related to Graft-versus-host Disease after Allogeneic Hematopoietic Stem Cell Transplantation.

A 35-year-old woman was treated with chemotherapy for leukemia. One year later, allogeneic hematopoietic stem cell transplantation (HSCT) was performed with umbilical cord blood. After nine months, she developed a spiking fever, sore throat, arthralgia, pleural effusion, hyperferritinemia, and persistent generalized pruritic erythema. A skin biopsy showed dyskeratotic cells in the epidermis, neutrophil infiltration in the epidermis and upper dermis, and neutrophils in the parakeratotic layer. Treatment with tocilizumab was effective. Adult-onset Still's disease (AOSD)-like disease related to graft versus-host disease (GVHD) after HSCT was suspected. Abnormal immune states related to GVHD may cause AOSD-like disease with more severe skin lesions than usual.

Malignancy-associated generalised exfoliative dermatitis: A retrospective study in a single-centre Asian cohort.

BACKGROUND: Erythroderma is an inflammatory skin condition that causes extensive erythema and skin scaling amounting ≥90% of the body surface area. This retrospective cohort study describes the prevalence of malignancy-associated erythroderma in a single centre where there was concerted effort to systematically offer malignancy screens to all adult erythroderma patients above the age of 65 years. METHODS: Clinical charts were reviewed for all adult inpatients and outpatients with erythroderma who attended the National University Hospital (NUH) from 1 July 2019 to 31 December 2021. Data collected included patient demographics, clinical findings, laboratory investigations, disease-specific investigations such as endoscopic procedures and biopsies, follow-up duration and mortality data. RESULTS: Seventy-four patients were analysed. The median age of the patients was 73 years old (interquartile range: 59-81 years old). An underlying dermatosis was the most common cause of erythroderma-63 patients having atopic dermatitis/asteatotic eczema or psoriasis. Three patients had erythroderma from drug eruptions, and 1 patient had chronic actinic dermatitis. Four patients had associated malignancies (5.4%). Half of our patients completed further evaluation for malignancy (52.7%). The rest had either declined or were eventually unable to complete the investigations. There was a higher prevalence of associated malignancy (7.8%) in elderly patients above 65 years old. CONCLUSION: When compared to existing literature, our cohort reflects a higher observed occurrence of malignancy in association with erythroderma. As delays in evaluation for underlying malignancy could result in potentially deleterious outcomes, it is prudent to consider systematic screening for malignancy in high-risk populations such as elderly erythroderma patients.

Erythroderma with total scarring alopecia.

A woman in her 50s presented with total scarring ulcerated alopecia evolving for 10 years, and a recent budding tumour on the lower lip. Clinical examination revealed an associated exfoliated and infiltrated erythroderma with ulcerated cutaneous tumours of the legs, palmoplantar hyperkeratosis, hepatosplenomegaly and diffuse lymphadenopathies.Dermatoscopy of the scalp, leg tumours and infiltrated skin showed a typical yellowish background overlaid by arborescent vessels and whitish areas. Cutaneous biopsies of the same areas found sarcoidotic granulomas. Lip biopsy found an associated well-differentiated squamous cell carcinoma. Investigations confirmed the diagnosis of systemic sarcoidosis with an elevated converting enzyme level, mediastinal calcified lymphadenopathies in CT scan and deep localisations in positron emission tomography scan (thyroid, lymph nodes, mediastinum, liver, spleen and adrenal glands).The patient was treated with oral prednisone for sarcoidosis and intramuscular bleomycin followed by surgery and radiotherapy for squamous cell carcinoma. Sarcoidotic lesions healed, but a recurrence of her carcinoma led to death.

[A patient with erythroderma and pruritus: Sézary syndrome]. / Een man met jeuk en roodheid van de huid.

BACKGROUND: Erythroderma could be the first sign of a cutaneous T-cell lymphoma (CTCL), such as Sézary syndrome. Causes of erythroderma include inflammatory dermatosis, toxicoderma, paraneoplastic erytroderma, and CTCL. Hence, diagnosing Sézary syndrome can be difficult. Sézary syndrome is a rare, aggressive disease characterized by erythroderma, generalized lymphadenopathy and the presence of clonally related neoplastic T-cells in skin, peripheral blood, and lymph nodes. Treatment consists of photochemotherapy (PUVA), radiotherapy, immunomodulatory agents, low dose cytotoxic agents, and intensive chemotherapy. Immunotherapy directed against CCR4 and PD1 are new, promising developments. CASE DESCRIPTION: A 51-year-old man presented with a 1-year history of progressive, itchy erythroderma and lymphocytosis. After extensive cytomorphological, histopathological and molecular examination the diagnosis of Sézary syndrome could be established. Combination treatment of interferon and photochemotherapy (PUVA) was started. CONCLUSION: Diagnostic delay in Sézary syndrome is common. Integrated cytomorphological, immunological, and molecular evaluation of peripheral blood in patients with unexplained erythroderma non-responsive to (topical) treatment is warranted.

Papuloerythroderma of Ofuji.

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.

Non-thymoma-associated exfoliative dermatitis in a European shorthair cat: A case report.

The current case report presents a case of non-thymoma-associated exfoliative dermatitis in an 8-year-old European Shorthair female cat. The animal displayed extensive alopecia and excessive peeling of the epidermis. There were no other apparent disorders, except for the skin lesions. Roentgenographic and sonographic examinations, complete blood count and blood serum chemistry analyses, and skin biopsy were performed. The histopathological investigation revealed hyperkeratosis of the epidermis and the infiltration of lymphocytes and macrophages at the dermal-epidermal junction around the hair follicles and sebaceous glands. Moreover, edema of the basal layer and melanin migration from the epidermis to the dermis were observed. The patient underwent treatment with immunosuppressive doses of prednisolone, antibiotic therapy, and baths in anti-seborrheic shampoos and displayed resolution. However, recurrence was observed after one month. Consequently, the patient received cyclosporine A, in addition to the aforementioned treatment and the lesions resolved without relapse.

Erythroderma (exfoliative dermatitis). Part 1: underlying causes, clinical presentation and pathogenesis.

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.

Clinical Patterns and Clinicopathologic Correlation of 100 Patients with Erythroderma in a Tertiary Care Institute in India.

Erythroderma is a severe dermatologic manifestation of a variety of diseases. We analyzed the clinical parameters and the clinicopathologic correlation in patients with erythroderma. Consecutive patients diagnosed with erythroderma at a tertiary care institute were evaluated for 5 years. Detailed history and clinical examination were noted along with extensive hematologic and biochemical investigations, radiologic studies, and skin biopsy for histopathologic examination, and if required, for immunoflourescence and immunohistochemistry; 83 men and 17 women were included in the study. Based on microscopic findings, 34 patients were given a diagnosis of psoriasis, 28 of spongiotic dermatitis with predominant eosinophilic infiltrate, five of chronic actinic dermatitis, 18 of drug-induced erythroderma, three of pemphigus foliaceous, and two each of pityriasis rubra pilaris and erythrodermic mycosis fungoides. Histology was inconclusive in five cases, one each of psoriasis, dermatitis, pityriasis rubra pilaris, bullous pemphigoid, and drug eruption. Clinical-pathologic correlation occurred in 78.3% cases. The most common etiologies found in our study were psoriasis, airborne contact dermatitis, and drugs.

Erythroderma: A clinicopathological study of 47 cases from 2018 to 2020.

Erythroderma, or exfoliative dermatitis, is an inflammatory disorder characterized by erythema and scaling, affecting most of the skin surface. It may be a result of many different causes such as previous dermatoses (psoriasis, eczema, atopic dermatitis [AD], pityriasis rubra pilaris, and pemphigus foliaceous), drug reactions, malignancies (mycosis fungoides [MF], Sézary syndrome, adult T cell leukemia/lymphoma), infections, and idiopathic disorders. Regardless of the etiology, the clinical appearance of erythroderma is similar in all patients. The most prominent physical examination findings in almost all patients are diffuse erythema and scaling. In a 2-year period, 47 patients who were hospitalized and treated in our department were included in the study. We classified patients into seven subgroups: psoriasis, AD, drug-induced erythroderma, MF, pityriasis rubra pilaris, bullous pemphigoid, and polymorphous light eruption. All patients had a biopsy during the acute stage and diagnoses were histopathologically confirmed. Some patients had multiple biopsies for histopathological confirmation. In our study, the majority of the patients were men over the age of 54. The most common etiological cause of erythroderma is psoriasis. We aim to analyze clinical, laboratory, and histopathological findings of erythrodermic inpatients prospectively in Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty between January 2018 and 2020.

Paraneoplastic erythroderma: an insight on the existing data.

Exfoliative erythroderma is a severe dermatologic condition with variable underlying causes. The association of erythroderma with an occult visceral malignancy is a relatively uncommon finding, which, however, can be accompanied by devastating consequences. This report is the first updated overview regarding the latest data on paraneoplastic erythroderma and was conducted according to the PRISMA Guidelines for systematic reviews. Articles derived from the databases PubMed, EMBASE, and SCOPUS were analyzed for this study. Patients with paraneoplastic erythroderma share certain clinical characteristics that physicians should be aware of, so as to avoid potential sequeale of an erroneous management as a result of misdiagnosis. The reporting of such cases is crucial in order to raise awareness of this condition and to facilitate an earlier diagnosis.