Erythroderma Flashcards
What BSA is needed for Erythroderma?
90%
Difference between primary and secondary erythroderma?
Generalization of a preceding localized skin dz. Primary is erythema that goes on that is affecting the skin directly
What is the most common sx?
Pruritis is reported in almost all patients
The most common cause of erythroderma
Idiopathic (25%), then Dermatitis (atopic, contact, seb derm, chronic actinic), Psoriasis (20%), Drug (19%), CTCL (8%)
The most common cause of erythroderma in kids?
Drugs then psoriasis
What is the most common cause of erythroderma in HIV pt’s?
Drug
2 categories of CTCL erythroderma?
Sezary Syndrome Erythrodermic mycosis fungoides
Bad seb derm seen in what pt populations?
HIV and neurologic dz/Parkinson’s dz.
How common is palmoplatar keratoderma in erythroderma?
30% of pt’s can have this
What are some eye findings seen in erythroderma?
b/l ectropion and purulent conjunctivitis are common ocular complications
What percentage of pt’s have LAD in erythroderma?
50%
What benign skin lesions can occur after erythroderma?
Multiple pale SK’s may arise
What are some serious complications of erythroderma?
- Increased blood flow to skin leads to increased fluid loss –> tachycardia –> high output cardiac failure/peripheral edema.
- Increased skin perfusion leads to thermoregulatory disturbances (hyperthermia >> hypothermia)
- The chronic heat loss leads to a compensatory hypermetabolism and cachexia
- Anemia
Most common cause of erythroderma in adults?
Idiopathic!
Most common causes of erythroderma in order?
Idiopathic (25%), dermatitis (24%) [within dermatitis: Atopic (9%) contact (6%), seb derm (4%), chronic actinic (3%)], Psoriasis (20%), Drug (19%), CTCL (8%)
Most common cause of erythroderma in kids?
Drug eruption (first) , psoriasis (second)
What are a couple of things that might tip you off to erythroderma 2/2 atopic dermatitis?
Prurigo nodular and elevated serum IgE/eosinophilia
What might be a clue in the hx that erythroderma is from a drug?
The erythroderma is preceded by morbilliform or scalatiniform exanthem, and facial edema is present.
What medications, when withdrawn, can trigger erythroderma in a psoriasis patient?
Prednisone, cyclosporin, methotrexate.
In what disease is drug-induced erythroderma more commonly found?
HIV
Most common drugs for erythroderma?
Allopurinol, sulfa drugs (TMP-SMX, DAPSONE), anti epileptics, INH, minocycline, HAART
What types of cancer are neoplastic erythroderma a/w?
lymphoproliferative dz
Other less common causes of eyrthroderma?
CTCL, PRP, dermatitis (contact and status w/ auto sensitization), paraneoplastic, bulbous dermatoses (PF [mc], BP, PNP), congenital ichthyosis, papuloerthroderma of ofugi, chronic actinic dermatitis.
Rare: hypereosinophilic syndrome, norwegian scabies, lichen plans, GVHD, CTD, primary immundeficiences (omens syndrome), sarcoidosis, mastocytosis, hemophagocytic lymphohistiocytosis, t-cell leukemia.
Epidemiology of idiopathic erythroderma?
Most common form, seen in elderly men and tends to have relapsing course. Cutaneous findings include generalized LAD, PPK, Peripheral edema
Diagnostic criteria for sezary syndrome in erythroderma?
erythroderma, generalized LAD, evidence of a t-cell clone in the BLOOD, plus one of the following - >= 1000 sezary cells/mm3 on peripheral blood smear -CD4:CD8 ratio of >= 10:1 -Loss of CD7 and CD26 >=40% CD4+/CD7- or >= 30% CD4+/CD26- cells on flow cytometry.
Causes of neonatal and infant erythroderma?
Staph scalded skin syndrome, toxic shock-like exanthematous disease, congenital cutaneous candidiasis. others: PRP, GVHD, diffuse cutaneous mastocytosis, rare ichthyosis, AEC syndrome, nutritional dermatitis
Immunodeficiences a/w erythroderma?
Omenn syndrome, SCID, agammaglobulinemia and complement deficiencies, Wiskott-aldrich syndrome
Genoderms a/w erythroderma?
bullous congenital ichthyosiform erythroderma,non-bullous congenital ichthyosiform erythroderma, netherton syndrome, conrad i-Hunemann-Happle syndrome.
