Erythroderma

Question 1

What BSA is needed for Erythroderma?

Answer 1

90%

Question 2

Difference between primary and secondary erythroderma?

Answer 2

Generalization of a preceding localized skin dz. Primary is erythema that goes on that is affecting the skin directly

Question 3

What is the most common sx?

Answer 3

Pruritis is reported in almost all patients

Question 4

The most common cause of erythroderma

Answer 4

Idiopathic (25%), then Dermatitis (atopic, contact, seb derm, chronic actinic), Psoriasis (20%), Drug (19%), CTCL (8%)

Question 5

The most common cause of erythroderma in kids?

Answer 5

Drugs then psoriasis

Question 6

What is the most common cause of erythroderma in HIV pt’s?

Answer 6

Drug

Question 7

2 categories of CTCL erythroderma?

Answer 7

Sezary Syndrome Erythrodermic mycosis fungoides

Question 8

Bad seb derm seen in what pt populations?

Answer 8

HIV and neurologic dz/Parkinson’s dz.

Question 9

How common is palmoplatar keratoderma in erythroderma?

Answer 9

30% of pt’s can have this

Question 10

What are some eye findings seen in erythroderma?

Answer 10

b/l ectropion and purulent conjunctivitis are common ocular complications

Question 11

What percentage of pt’s have LAD in erythroderma?

Answer 11

50%

Question 12

What benign skin lesions can occur after erythroderma?

Answer 12

Multiple pale SK’s may arise

Question 13

What are some serious complications of erythroderma?

Answer 13

• 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

Question 14

Most common cause of erythroderma in adults?

Answer 14

Idiopathic!

Question 15

Most common causes of erythroderma in order?

Answer 15

Idiopathic (25%), dermatitis (24%) [within dermatitis: Atopic (9%) contact (6%), seb derm (4%), chronic actinic (3%)], Psoriasis (20%), Drug (19%), CTCL (8%)

Question 16

Most common cause of erythroderma in kids?

Answer 16

Drug eruption (first) , psoriasis (second)

Question 17

What are a couple of things that might tip you off to erythroderma 2/2 atopic dermatitis?

Answer 17

Prurigo nodular and elevated serum IgE/eosinophilia

Question 18

What might be a clue in the hx that erythroderma is from a drug?

Answer 18

The erythroderma is preceded by morbilliform or scalatiniform exanthem, and facial edema is present.

Question 19

What medications, when withdrawn, can trigger erythroderma in a psoriasis patient?

Answer 19

Prednisone, cyclosporin, methotrexate.

Question 20

In what disease is drug-induced erythroderma more commonly found?

Answer 20

HIV

Question 21

Most common drugs for erythroderma?

Answer 21

Allopurinol, sulfa drugs (TMP-SMX, DAPSONE), anti epileptics, INH, minocycline, HAART

Question 22

What types of cancer are neoplastic erythroderma a/w?

Answer 22

lymphoproliferative dz

Question 23

Other less common causes of eyrthroderma?

Answer 23

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.

Question 24

Epidemiology of idiopathic erythroderma?

Answer 24

Most common form, seen in elderly men and tends to have relapsing course. Cutaneous findings include generalized LAD, PPK, Peripheral edema

Question 25

Diagnostic criteria for sezary syndrome in erythroderma?

Answer 25

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.

Question 26

Causes of neonatal and infant erythroderma?

Answer 26

Staph scalded skin syndrome, toxic shock-like exanthematous disease, congenital cutaneous candidiasis. others: PRP, GVHD, diffuse cutaneous mastocytosis, rare ichthyosis, AEC syndrome, nutritional dermatitis

Question 27

Immunodeficiences a/w erythroderma?

Answer 27

Omenn syndrome, SCID, agammaglobulinemia and complement deficiencies, Wiskott-aldrich syndrome

Question 28

Genoderms a/w erythroderma?

Answer 28

bullous congenital ichthyosiform erythroderma,non-bullous congenital ichthyosiform erythroderma, netherton syndrome, conrad i-Hunemann-Happle syndrome.