Recalcitrant Erythrodermic Psoriasis Complicated by Septic Shock and Mycotic Aneurysm: A Call for Treatment Guidelines.

Erythroderma is characterized by diffuse erythema and scale covering over 90% body surface area that can affect individuals with inflammatory dermatoses such as psoriasis. Complications of erythrodermic psoriasis include infection and cardiovascular compromise. Here we present a case of a 68 year-old man who was hospitalized for erythrodermic psoriasis refractory to multiple immunosuppressive and immunomodulatory therapies, ultimately developing sepsis due to bacteremia and fungemia complicated by infective endocarditis and a mycotic aneurysm. Although the widespread loss of epidermal function in erythroderma increases the risk of infection by opportunistic pathogens, water loss, and electrolyte imbalances, there are very few reported cases of psoriatic erythroderma complicated by fungemia and mycotic aneurysm. Given the high mortality associated with widespread epidermal dysfunction, there is a great need for evidence-based treatment guidelines for psoriatic erythroderma. J Drugs Dermatol. 2024;23(8): doi:10.36849/JDD.7751.

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.

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.

Homozygous CARD14 variant presenting as infantile erythroderma.

A wide range of inherited and acquired conditions can manifest as infantile erythroderma, among which CARD14-associated papulosquamous eruption (CAPE) is a rare cause. An infant boy presented with a psoriasiform rash that progressed to erythroderma and was unresponsive to topical steroids and cyclosporine. The early onset of the disease, its severity and resistance to conventional treatment were suggestive of a genetic cause. Genetic evaluation revealed a homozygous CARD14 variant of uncertain significance establishing the diagnosis of CAPE, and his parents were heterozygous carriers. There was only minimal improvement in the condition with supportive management and treatment with acitretin. Unfortunately, the child succumbed to sepsis and metabolic complications following a sudden worsening of skin disease. This case highlights the significance of genetic studies in diagnosing treatment-refractory cases of infantile erythroderma and emphasises the importance of early recognition of this rare condition.

Pulmonary manifestation of VEXAS syndrome.

This case report presents the diagnostic journey of a man in his mid-70s who experienced shortness of breath, cough, recurrent episodes of fever, weight loss, pruritic erythroderma, uveitis and macrocytic anaemia. The initial diagnosis of cryptogenic organising pneumonia was made based on antibiotic refractory infiltrates seen in the lung CT scan. The patient initially responded favourably to immunosuppression but experienced a recurrence of symptoms when the corticosteroid dose was tapered. Despite ongoing systemic inflammation and refractory symptoms, it took nearly a year to establish the diagnosis of VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic) syndrome. This case highlights the challenges in diagnosing and managing VEXAS syndrome due to its recent discovery and limited awareness in the medical community, as well as the need to consider this syndrome as a rare differential diagnosis of therapy-refractory pulmonary infiltrates.

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?

Queilitis exfoliativa / Exfoliative cheilitis

La queilitis exfoliativa se caracteriza por una descamación recurrente del borde labial, con eritema y formación de costras. Aunque la etiología es desconocida, además de la posible intervención de los agentes causantes de queilitis agudas, en la queilitis exfoliativa suelen existir alteraciones psicológicas o situaciones de estrés que parecen favorecerla

Exfoliative cheilitis is characterized by recurrent desquamation of the labial border, with erythema and crusting. Although its etiology is unknown, apart from the possible intervention of the agents that cause acute cheilitis, there are usually psychological disorders or stress situations that seem to contribute to its development

Erythroderma as a manifestation of leprosy

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.

Síndrome da pele escaldada estafilocócica no adulto. Relato de caso / Staphylococcal Scalded Skin Syndrome in adults: case report

A síndrome da pele escaldada estafilocócica é uma dermatose esfoliativa rara no adulto, que acomete cerca de 0,09 a 0,56 por milhão de habitantes. É causada por exotoxinas produzidas por Staphylococcus aureus e manifesta-se com a formação de lesões bolhosas difusas pelo corpo. O diagnóstico é feito por meio de exame físico, hemocultura, cultura de sítio infectado e análise histopatológica. As medidas de suporte e a antibioticoterapia são a base do tratamento. Este relato descreve o raro acometimento de paciente idoso e evidencia a associação da doença com a imunossupressão. A presença de lesões em mucosa oral é um achado atípico e similar a um dos principais diagnósticos diferenciais da síndrome da pele escaldada estafilocócica: a necrólise epidérmica tóxica. É de suma importância diferenciá-las por meio de análise histopatológica das lesões de pele devido às formas inerentes de tratamento e à gravidade. O relato alerta para a importância do rápido reconhecimento do diagnóstico, a fim de introduzir tratamento adequado precoce, evitando os riscos da terapia inadequada e das complicações naturais da doença. Desta forma, é possível alcançar um desfecho positivo em uma doença de baixa prevalência e alta mortalidade no adulto.(AU)

The Staphylococcal Scalded Skin Syndrome is a rare exfoliative dermatitis in adults, affecting about 0.09 to 0.56 per million inhabitants. It is caused by exotoxins produced by Staphylococcus aureus and is manifested by the formation of diffuse bullous body lesions. The diagnosis is made through physical examination, blood culture, infected site culture, and histopathology. Supportive measures and antibiotics are the mainstay of the treatment. This report describes the rare involvement of an elderly patient, and highlights the association of the disease with immunosuppression. The presence of lesions in the oral mucosa is an atypical finding, being similar to one of the main differential diagnosis of the Staphylococcal Scalded Skin Syndrome: the Toxic Epidermal Necrolysis. It is very important to differentiate them through histopathology of the skin lesions due to the peculiar forms of treatment and the severity of the diseases. The report highlights the importance of rapid recognition of diagnosis in order to introduce early appropriate treatment, avoiding the risks of inappropriate therapy, and natural complications of the disease. This way, it is possible to achieve a positive outcome in a disease of low prevalence and high mortality in adults.(AU)

Exfoliative erythroderma and palmoplantar hyperkeratosis associated with Majocchi's granuloma by Trichophyton tonsurans in a patient with AIDS / Eritrodermia exfoliativa e hiperqueratosis palmoplantar asociada con granuloma de Majocchi por Trichophyton tonsurans en un paciente con sida

Background. Dermatophytoses are skin superficial mycoses in which clinical manifestations are directly related to the virulence of the infecting microorganism or the host immunity. Case report. We describe a severe case of dermatophytosis associated with exfoliative erythroderma, substantial palmoplantar keratoderma, onychodystrophy affecting all nails, diffuse non-scarring alopecia and tissue fungal invasion by Trichophyton tonsurans, which led us to the diagnosis of AIDS. Direct examination and culture for fungi from skin scraping from two different sites were performed. Biopsy and histopathological exam were also performed on three different sites. Direct examination of the lesions’ scraping revealed septate hyaline hyphae and arthroconidia, identified as Trichophyton tonsurans by culture in glucose Sabouraud agar and Mycosel agar. A scalp biopsy revealed follicular fungal invasion and Majocchi's granuloma. Due to the severity of the presentation we requested an anti-HIV serology, which was positive. The patient was treated with itraconazole, 200mg/day, for 120 days, which promoted a complete regression of the lesions. Conclusions. Severe and atypical forms of dermatophytosis could lead to a diagnosis of AIDS (AU)

Antecedentes. Las dermatofitosis son micosis cutáneas superficiales cuyas manifestaciones clínicas están relacionadas directamente con la virulencia del microorganismo involucrado y la inmunidad del huésped. Caso clínico. Se describe un caso grave de dermatofitosis asociado con eritrodermia exfoliativa, con apreciable queratodermia palmoplantar, onicodistrofia de las 20uñas, alopecia no cicatricial difusa e invasión fúngica del tejido por Trichophyton tonsurans, lo cual permitió establecer el diagnóstico de sida. Se llevó a cabo exploración directa y cultivo de hongos de dos muestras tomadas por raspado en dos localizaciones distintas. También se llevaron a cabo una biopsia de piel y un estudio histopatológico de tres localizaciones. En la exploración directa del raspado de las lesiones se observaron hifas tabicadas hialinas y artroconidios; en el cultivo en agar Sabouraud con glucosa y agar Mycosel se aisló Trichophyton tonsurans. La biopsia de cuero cabelludo mostró una invasión fúngica folicular y la existencia de un granuloma de Majocchi. La gravedad del cuadro motivó la solicitud de la serología para el VIH, que fue positiva. Se trató al paciente con 200mg/día de itraconazol durante 120días, lo que llevó a la remisión completa de las lesiones. Conclusiones. Una dermatofitosis grave o atípica podría considerarse enfermedad reveladora de sida (AU)

Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento / A Practical Approach to the Diagnosis and Treatment of Adult Erythroderma

La eritrodermia es un síndrome inflamatorio de la piel caracterizado por descamación y eritema en más del 90% de la superficie corporal. Representa la etapa final de muchas enfermedades dermatológicas en el adulto. La causa más frecuente es la psoriasis, le siguen las enfermedades eccematosas, las reacciones medicamentosas, la pitiriasis rubra pilaris y los linfomas cutáneos de células T. El abordaje diagnóstico debe incluir una historia y examen físicos exhaustivos. Si se desconoce la etiología de la eritrodermia es posible que múltiples biopsias a lo largo del curso de la enfermedad aumenten las posibilidades de un diagnóstico correcto. El abordaje inicial de la eritrodermia debe incluir la evaluación de un experto en nutrición, la valoración del balance hidroelectrolítico, medidas para mantener la función de barrera de la piel, antihistamínicos con efecto sedante y la exclusión de infecciones bacterianas secundarias. Presentamos una revisión práctica de la etiología, diagnóstico y tratamiento de esta entidad

Erythroderma is an inflammatory skin syndrome that involves desquamation and erythema of more than 90% of the body surface area. It represents a final clinical endpoint for many adult dermatological conditions. The most frequent cause of erythroderma is psoriasis followed by eczematous conditions, drug-induced reactions, pityriasis rubra pilaris and cutaneous T-cell lymphomas. Diagnostic approach must include a thorough history and clinical examination. If the etiology of erythroderma is uncertain multiple skin biopsies may enhance diagnostic accuracy. The initial management of erythroderma must include a nutrition expert evaluation, fluid imbalance assessment, maintaining skin barrier function, sedative antihistamines and exclusion of secondary bacterial infection. We present a practical review of the etiology, diagnosis, and treatment of this entity

Dermoscopy of Erythromelanosis Follicularis Faciei et Colli / Dermatoscopia de erythromelanosis folicular faciei et colli

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Hiperqueratosis folicular filiforme en la cara / Filiform Follicular Hyperkeratosis on the Face

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Síndrome de Stevens-Johnson en la infancia / Stevens-Johnson syndrome in childhood

INTRODUCCIÓN: El síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica son 2 graves enfermedades inmunológicas dentro del contexto de síndrome mucocutáneo ampolloso, con diferente grado de afectación cutánea y que suelen presentar afectación de al menos 2 membranas mucosas. Casos clínicos: Presentamos 3 casos clínicos, 2 de ellos con importantes secuelas oftalmológicas que habían recibido tratamiento farmacológico como posible desencadenante, y otro cuadro más larvado causado por Mycoplasma pneumoniae. DISCUSIÓN: El oftalmólogo desempeña un papel crucial en la evolución y cuidados oculares del paciente para intentar evitar la aparición de secuelas y la consiguiente pérdida de visión

INTRODUCTION: Stevens-Johnson syndrome and toxic epidermal necrolysis are two serious immune diseases within the context of bullous mucocutaneous syndrome. These have varying degrees of involvement of the skin and usually at least two mucous membranes. Clinical cases: Three clinical cases are presented, two of them with significant ophthalmological sequelae, who had received drug treatment as a possible trigger, and another milder clinical case caused by Mycoplasma pneumoniae. DISCUSSION: The ophthalmologist plays a crucial role in the outcome and eye care of the patient in order to try to avoid the appearance of sequelae and subsequent loss of vision

Diagnóstico diferencial em eritrodermias / Differential diagnosis in erythrodermias

Eritrodermia, doença com baixa incidência, caracterizada por eritema em mais de 80% da pele, com limitação importante da qualidade de vida do paciente. Pode apresentar diversas causas, sendo as mais prevalentes dermatoses pré-existentes e uso de fármacos. Frente ao quadro de eritrodermia, torna-se obrigatório a exclusão de neoplasia como causa.

Erythroderma, is an uncommon skin disorder, characterized by erythema in more than 80% of the skin and significant limitation the quality of life. The disease has various causes, the most prevalent are pre-existing dermatoses and drug use. In the moment of diagnose of erythroderma, is mandatory to exclude malignancy as the cause.

Linfoma cutáneo CD8+ en paciente con infección por el VIH, con resolución tras la instauración de tratamiento antirretroviral de gran actividad / Cutaneous CD8+ T-cell lymphoma. Regression after HIV antiviral triple therapy

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Un paciente con eritrodermia descamativa y eosinofilia / A patient with erythroderma desquamativa and eosinophilia

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