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

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.

Therapeutic evaluation of UVB-targeted phototherapy in vitiligo that affects less than 10% of the body surface area.

BACKGROUND: Current treatments for vitiligo include different therapeutic modalities, such as corticosteroids, immunomodulators, pseudocatalase, skin grafts, diverse types of phototherapy [ultraviolet B (UVB), psoralen plus UVA (PUVA), narrow-band UVB (NB-UVB)], and, recently, targeted phototherapy. After a literature search, we found only two studies using different targeted broad-band UVB units for the treatment of vitiligo. OBJECTIVE: To evaluate the repigmentation response induced with broad-band, UVB-targeted phototherapy used as monotherapy in patients with vitiligo affecting less than 10% of the skin surface. METHODS: Twelve patients were recruited for treatment with 30 sessions of UVB-targeted phototherapy administered twice weekly. The assessment of repigmentation was made from a comparison of baseline photographs with those after 30 sessions by two independent investigators. Morphometric analysis was performed using a computer program. RESULTS: Repigmentation with an average of 66.25% was obtained on lesions of the face, and of 31.5% on the neck, trunk, and genitalia. On the extremities, there was no repigmentation. Itching, a burning sensation, erythema, desquamation, and transitory hyperpigmentation were observed in some patients. Minimal blistering and ulceration were observed in one patient. CONCLUSION: Targeted UVB phototherapy seems to be effective for the repigmentation of vitiligo in lesions located on the face, to a lesser degree on the trunk, and with no response in acral lesions; there were minimal adverse effects that did not require discontinuation of treatment.