Erythroderma Flashcards
Explain the pathogenesis of erythroderma
1) Pre-existing/underlying dermatosis eg AD, psoriasis each with its own pathogenesis
2) De novo erythroderma - not well understood
3) number of germinative keratinocytes and mitotic rate increased
4) Transit time of epidermal cells shortened
5) scale consist of material normally retained by skin (nucleic acid, amino acid, soluble protein)
6) dly loss of scales is increased
7) in acute erythroderma - marginal metabolic significance
8) In chronic erythroderma protein loss can be significant (hypoalbuminrmia and anemia of chronic disease)
9) peak onset - 6th to 7th : age related immune senescence
10) Erythroderma in children with immunodeficiency - role of immune dysregulation
Name the common causes of adult erythroderma
1) psoriasis
2) atopic dermatitis
3) drug reactions
4) idiopathic erythroderma
Name less common causes of adult erythroderma
1) cutaneous T cell lymphoma (sezary syndtome > erythrodermic MF)
2) Pityriasis Rubra Pilaris
3) Dermatitis (contact, stasis)
4) Paraneoplastic erytrhoderma
5) Bullous dermatoses eg pemphigus foliaceus, bullous pemphigoid, paraneoplastic pemphigus, inherited ichtyosis
Name rare causes of adult erytroderma
1) papuloerythroderma of ofuji
2) chronic actinic dermatitis
3) other: Hypereosinophilic syndrome, crusted scabies, lichen planus, GVHD, AICTD, dermatophyte, primary immunodeficiency, sarcoidosis, mastocytosis, Langerhans cell histiocytoses, other T cell malignancies eg T cell leukemi
Name the causes of erythroderma in neonates and infants
1) Inherited ichthyosis (epidermolytic icthyosis, CIE, Netherton syndrome, Conradi-Hunermann Happle syndrome)
2) Immunodeficiency (Omenn syndrome, Complement deficiencies, wiskotr-Aldrich syndtome)
3) Primary dermatosis (atopic dermatitis, seborrheic dermatitis, psoriasis)
4) Drug reactions
5) infections (SSSS, congenital cutananeous candidiasis)
6) Others: PRP, GVHD, diffuse cutaneous mastocytosis, rare icthyosis eg tricthiodystophy, KID syndrome, sjogren larsson, AEC, nutritional dermatitis eg kwashiorkor
Name clinical and histological/additional clues with regards to erythroderma in
1) psoriasis
2) atopic dermatitis
3) drug reactions
4) idiopathic erythroderma
Name the clinical and histological and additional clues regarding adult erythroderma in
1) cutaneous T cell lymphoma
2) PRP
3) Dermatitis (contact/stasis/ID)
4) paraneoplastic erythroderma
Name the clinical, histological and additional clues with regards to erytrhoderma in adults in
1) pemphigus foliaceus
2) bullous pemphigoid
3) paraneoplastic pemphigus
4) inherited icthyosis
5) papuloerythroderma of ofuji
6) chronic actinic dermatitis
Name histological, clinical and additional clues with regards to neaonatal erythema
1) inherited ichthyosis - EI, CIE, netherton syndrome, conradi hunnerman happle syndrome
2) imminodeficiency
Name clinical, histological, additional clues with regards to neonatal/infantile erythroderma in
1) atopic dermatitis
2) seborrheic dermatitis
3) psoriasis
4) infections SSSS, congenital candidiasis
Describe the cutaneous clinical features of erytroderma
1) erythema and scaling TBSA 80-90%
2) Classified as primary and secondary types
3) Primary type - erythema (often initially on trunk) extend within few days or weeks to involve the entire skin surface followed by scaling
4) Generalization of preceeding localised disease (eg psoriasis, atopic dermatitis)
5) erythema preceeds the development of exfoliation by 2-6 days (exception is very slow profressinf secondary erythroderma)
6) associated scaling varies in size and color
7) acute phase - scale is large and crusted
8) Chronic phase - scale is smaller and drier
9) Sometimes scale can point to the cause of erythroderma
- fine in atopic dermatitis
- bran-like in seborrheic dermatitis
- crusted in pemphigus foliaceus
- exfoliative (peeling) in drug reactions
-color of skin can vary pink-red to red-brown to red-purome
different types of erythroderma share common features
- pruritus (most severe in AD or sezary syndrome)
- dyspigmentation (hyper more than hypo or depigmentation)
-lichenification seen in 1/3
-PPK (can be early sign of PRP)
- Keratoderma with scale-crust can point to crusted scabies
-painful fissured keratoderma - point to sezary
Name the clinical features of appendages in erythroderma
Name other clinical features in erythroderma
