RESUMEN
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.
Asunto(s)
Aneurisma Infectado , Dermatitis Exfoliativa , Psoriasis , Choque Séptico , Humanos , Masculino , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Psoriasis/diagnóstico , Anciano , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/etiología , Dermatitis Exfoliativa/terapia , Dermatitis Exfoliativa/tratamiento farmacológico , Choque Séptico/diagnóstico , Choque Séptico/microbiología , Choque Séptico/terapia , Choque Séptico/etiología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/terapia , Aneurisma Infectado/microbiología , Resultado Fatal , Fungemia/diagnóstico , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Fungemia/complicaciones , Guías de Práctica Clínica como Asunto , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/complicaciones , Bacteriemia/microbiologíaRESUMEN
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.
Asunto(s)
Dermatitis Exfoliativa , Humanos , Antifúngicos/uso terapéutico , Dermatitis Exfoliativa/etiología , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/tratamiento farmacológico , Tiña/diagnóstico , Tiña/tratamiento farmacológicoAsunto(s)
Humanos , Masculino , Recién Nacido , Piel/lesiones , Exantema , Dermatitis Exfoliativa/tratamiento farmacológico , Staphylococcus aureus , Floxacilina/administración & dosificación , Síndrome Estafilocócico de la Piel Escaldada/tratamiento farmacológico , Resultado del Tratamiento , Pacientes Internos , Síndrome Estafilocócico de la Piel Escaldada/complicaciones , Examen Físico , Enfermedades del Recién NacidoAsunto(s)
Dermatitis Exfoliativa , Enfermedades Cutáneas Papuloescamosas , Timoma , Neoplasias del Timo , Humanos , Timoma/complicaciones , Dermatitis Exfoliativa/complicaciones , Dermatitis Exfoliativa/tratamiento farmacológico , Neoplasias del Timo/complicaciones , Enfermedades Cutáneas Papuloescamosas/patologíaRESUMEN
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.
Asunto(s)
Dermatitis Exfoliativa , Granulomatosis con Poliangitis , Escabiosis , Animales , Humanos , Escabiosis/complicaciones , Escabiosis/diagnóstico , Escabiosis/tratamiento farmacológico , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/etiología , Sarcoptes scabiei , Terapia de Inmunosupresión , Celulitis (Flemón) , Enfermedad IatrogénicaAsunto(s)
Dermatitis Exfoliativa , Micosis Fungoide , Neoplasias Cutáneas , Humanos , Brentuximab Vedotina , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/etiología , Micosis Fungoide/complicaciones , Micosis Fungoide/tratamiento farmacológico , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
Tuberculosis is a serious contagious disease mainly affecting the lungs and is common in the developing countries. The essential component of all antitubercular regimens include Isoniazid, pyrazinamide as first-line drugs. A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use though uncommon but is common among pyrazinamide users. Here we report 3 cases of tuberculosis patients on antitubercular therapy (ATT) for 8 weeks, came to hospital OP (outpatient) with severe generalized redness and scaling with itching distributed all over the body and trunk. Immediately ATT was discontinued and all the three patients were administered antihistaminic and corticosteroid. The patients recovered within 3 weeks. To confirm ATT induced erythroderma and narrow down the offending agents, sequential rechallenge with ATT was done and again these patients had similar lesions erupt all over the body only with isoniazid and pyrazinamide. Antihistamine, steroids were started and the symptoms resolved and completely recovered within 3 weeks. Prompt withdrawal of the culprit drug along with appropriate medications and supportive measures is necessary for good prognosis. Physicians must be judicious while prescribing ATT especially, isoniazid and pyrazinamide as these can precipitate fatal cutaneous adverse reactions. Strict vigilance may help in early detection of this type ADR and timely management.
Asunto(s)
Dermatitis Exfoliativa , Tuberculosis , Humanos , Isoniazida/efectos adversos , Pirazinamida/efectos adversos , Dermatitis Exfoliativa/inducido químicamente , Dermatitis Exfoliativa/tratamiento farmacológico , Antituberculosos/efectos adversos , Tuberculosis/tratamiento farmacológicoRESUMEN
CARD14-associated papulosquamous eruption (CAPE) was proposed in 2018 to describe the clinical features of psoriasis and pityriasis rubra pilaris with CARD 14 mutations. We report a 5-month-old female infant who developed CAPE-associated erythroderma. Although she did not respond to conventional therapies, she responded well to ustekinumab treatment at the age of 4 years.
Asunto(s)
Dermatitis Exfoliativa , Exantema , Pitiriasis Rubra Pilaris , Psoriasis , Preescolar , Femenino , Humanos , Lactante , Proteínas Adaptadoras de Señalización CARD/genética , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/tratamiento farmacológico , Exantema/tratamiento farmacológico , Guanilato Ciclasa/genética , Guanilato Ciclasa/uso terapéutico , Proteínas de la Membrana/uso terapéutico , Pitiriasis Rubra Pilaris/diagnóstico , Pitiriasis Rubra Pilaris/tratamiento farmacológico , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Psoriasis/genética , Ustekinumab/uso terapéuticoRESUMEN
COVID-19 caused by the SARS-CoV-2, became pandemic very quickly. Management of severe dermatologic disorders in patients who require systemic immunosuppressive treatment is a major concern in COVID-19 pandemic era. Here, we report a 45-year-old homeless addicted male with second flare of psoriatic erythroderma and positive PCR test for COVID 19. His first attack occurred two months earlier, when he was screened for SARS-CoV-2 before admission which all evaluations showed nagative results. The patient was treated and relatively controlled with cyclosporine and therefore he was discharged. During this interval, he not only discontinued his medication, but also became SARS-CoV-2 positive. It seems that both factors participated in flare of his erythroderma.
Asunto(s)
COVID-19 , Dermatitis Exfoliativa , COVID-19/complicaciones , Ciclosporina/uso terapéutico , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/etiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2RESUMEN
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.
Asunto(s)
Enfermedades de los Gatos , Dermatitis Exfoliativa , Animales , Gatos , Ciclosporina , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/etiología , Dermatitis Exfoliativa/veterinaria , Epidermis/patología , Femenino , Inmunosupresores , RecurrenciaRESUMEN
With the onset of the COVID-19 pandemic, healthcare providers have made increasing use of inpatient teledermatology; however, few studies have analysed the impact of teledermatology on patient outcomes. In this study, we investigated the diagnostic concordance between the primary team and teledermatologist, and we analysed the impact of this technology on the diagnosis and management of erythroderma, a condition with high morbidity and mortality. Overall, out of 2987 inpatient teledermatology encounters reviewed, we found 33 cases of erythroderma, and, of these, 78.8% had a change in diagnosis after teledermatology consult, 81.8% were recommended biopsy and all patients had a change in topical/systemic therapy. We hope to promote further study of the efficacy of teledermatology as it may begin to address large gaps in dermatological access to care particularly in regional and community hospitals.
Asunto(s)
Dermatitis Exfoliativa/diagnóstico , Hospitalización , Telemedicina , Anciano , COVID-19/epidemiología , Dermatitis Exfoliativa/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Pandemias , Estudios RetrospectivosRESUMEN
Exfoliative dermatitis (ED) or erythroderma is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface, which can be caused by variety of systemic and cutaneous diseases, such as infection, including dermatophytosis. Dermatophytosis is a superficial fungal infection of keratinized tissue caused by dermatophytes. There are only few case reports of ED due to dermatophytosis in literature. A 39-year-old male present with history of diffuse erythematous macules and scales almost on entire body due to dermatophytosis was reported. The diagnosis of dermatophytosis was confirmed by direct microscopic examination, fungal culture, and histopathological examination. Patient was treated with 2% ketoconazole shampoo and two pulses of 1-week of 200 mg itraconazole twice a day for each month. Clinical improvement was showed on the 7th day of observation characterized by decreasing of erythematous macules and scales. Mycological and clinical improvements were obtained on the 29th day of observation. The etiology of ED should be determined in order to give an appropiate treatment.
Asunto(s)
Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/microbiología , Dermatomicosis/diagnóstico , Piel/microbiología , Adulto , Antifúngicos/farmacología , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatomicosis/tratamiento farmacológico , Técnicas Histológicas , Humanos , Masculino , Piel/efectos de los fármacos , Piel/patologíaAsunto(s)
Abatacept/administración & dosificación , Abatacept/efectos adversos , Artritis Psoriásica/tratamiento farmacológico , Dermatitis Exfoliativa/inducido químicamente , Dermatitis Exfoliativa/tratamiento farmacológico , Brote de los Síntomas , Antirreumáticos/administración & dosificación , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: To date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted. CASE PRESENTATION: The Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectatic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died. The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing. CONCLUSIONS: The endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.
Asunto(s)
COVID-19/patología , Dermatitis Exfoliativa/patología , Endotelio Vascular/patología , Parapsoriasis/patología , SARS-CoV-2/patogenicidad , Piel/patología , Anciano de 80 o más Años , COVID-19/complicaciones , COVID-19/virología , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/virología , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/virología , Resultado Fatal , Interacciones Huésped-Patógeno , Humanos , Masculino , Parapsoriasis/tratamiento farmacológico , Parapsoriasis/virología , Piel/efectos de los fármacos , Piel/virología , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19Asunto(s)
Antirreumáticos , Artritis Psoriásica , Dermatitis Exfoliativa , Infecciones por VIH , Antirreumáticos/uso terapéutico , Artritis Psoriásica/tratamiento farmacológico , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/tratamiento farmacológico , Etanercept/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Inducción de Remisión , Resultado del TratamientoRESUMEN
We describe an 11-year-old girl with PLACK Syndrome (peeling skin, leukonychia, acral punctate keratosis, cheilitis, and knuckle pads), who was found to have a novel homozygous variant in CAST, the pathogenicity of which was confirmed using blood-derived RNA. There is no established treatment for PLACK syndrome. However, we demonstrate for the first time that this condition is associated with low levels of vitamin A and essential fatty acids, which prompted us to consider a potential treatment strategy. Indeed, we initiated this patient on intravenous lipid infusion (Vitalipid®; an emulsion of fat-soluble vitamins and lipofundin-MCT/LCT 20%) and the response was dramatic. Following the fourth monthly course of treatment, pruritis disappeared and the skin lesions showed remarkable objective improvement. PLACK syndrome is a very rare genodermatosis and only six families have been described to date with pathogenic CAST variants. This is the first report of an objective response to a therapeutic agent, which suggests that PLACK is a potentially treatable condition. The remarkable response we report and the relative safety of the intervention should prompt healthcare providers who care for PLACK syndrome patients to explore this as a potential treatment strategy in future studies.