Erythroderma

Question 1

Erythroderma

Answer 1

generalized redness and scaliness of the skin - a clinical definition, not a disease entity. Due to preexisting dermatoses or can be idiopathic. Occasionally called “red man syndrome”

Question 2

What is critical to do in managing a pt with Erythroderma

Answer 2

Identify the underlying process to alleviate the condition as erythroderma places high metabolic demands upon the pt and can lead to mortality.

Question 3

Pathogenesis of Erythroderma

Answer 3

due to underlying disorders, like dermatitis, psoriasis, drug eruptions, CTCL. 33% are idiopathic

Question 4

Dermatopathology

Answer 4

scales of nuclei acids and soluble proteins. Losing scales much faster than normal skin

Question 5

Clinical Presentation - Skin symptoms

Answer 5

erythema and scale encompass 90% of the total body surface, pruritus, scratch-itch cycle, hypo/hyperpigment

Question 6

Hair in Erythroderma

Answer 6

can have diffuse non-scarring alopecia

Question 7

Nails in Erythroderma

Answer 7

initially look shiny, can become discolored, brittle with subungal hyperkeratosis, splinter hemorrhages, nail shedding

Question 8

Skin becomes secondarily infected due to

Answer 8

intense scratching from pruritus

Question 9

Other clinical symptoms of erythroderm

Answer 9

can have conjunctivitis, pretibial edema, tachycardia due to increased blood flow and fluid loss, high cardiac output failure with the elderly, Lymphadenopathy, Hepatomegaly

Question 10

Idiopathic Erythroderm

Answer 10

in elderly men, chronic, pruritus, “red man syndrome”. lymphadenopathy, palmoplantar keratoderma

Question 11

Most common drugs a/w Erythroderma

Answer 11

Allopurinol, Dapsone, Vanco, Ampicilin, Pheytoin, Phenobarbital, Sulfa

Question 12

Psoriasis –> Erythroderma

Answer 12

D/t withdrawal of topical or oral corticosteroids or MTX. Check nails as nail changes may still be present

Question 13

CTCL –> Erythroderma

Answer 13

If d/t Sezary, will have malignant T cells and Sezary cells with keratoderma and lymphadenopathy. If MF, no sezary cells.

Question 14

Pityriasis Rubra Pilaris –> Erythroderma

Answer 14

Perifollicular keratotic plugs on the knees, elbows, hands with “nappes claires” islands of uninvolved skin

Question 15

Paraneoplastic Erythroderma

Answer 15

Due to T Cell Lymphoma, will have a brown hue to the skin “melanoerythroderma”

Question 16

Bullous Erythroderma

Answer 16

Involved with PF, blisters and erosions with a collorette scale and crust

Question 17

3 types of Ichthyosis a/w Erythroderm: 1) Ichthyosis Non bullous ichthyosiform erythroderma

Answer 17

(colloidal baby) - erythroderma and a fine white scale.

Question 18

2) Bullous congenital ichthyosisform erythroderma

Answer 18

bullae and generalized erythroderma that turn into hyperkeratotic spiny lesions in flexural areas

Question 19

3) Netherton Syndrome

Answer 19

erythroderma a/w trichorrhexia invaginata

Question 20

Staphylococcal Scalded Skin Syndrome

Answer 20

identified via blood studies and UA

Question 21

Omenn’s Syndrome

Answer 21

fatal without a stem cell transplant. Exfoliative erythroderma with alopecia, will have leukocytosis and elevated IgE

Question 22

Treatment of Erythroderma

Answer 22

Nutrition and fluid assessment is the primary focus, prevent hypOthermia, tx secondary skin infections, oral antihistamines, wet wrap to remove crust, emollients, low topical steroids, tx disease process

Question 23

Severe case tx

Answer 23

systemic corticosteroids 1-3mg/kg/day with a slow taper of Cyclosporine at 1-3mg/kg/day

Question 24

Treatment of Erythroderma

Answer 24

Nutrition and fluid assessment is the primary focus, prevent hypOthermia, tx secondary skin infections, oral antihistamines, wet wrap to remove crust, emollients, low topical steroids, tx disease process

Question 25

Severe case tx

Answer 25

systemic corticosteroids 1-3mg/kg/day with a slow taper of Cyclosporine at 1-3mg/kg/day