Chapter 054. Skin Manifestations of Internal Disease (Part 2)

Erythroderma (Table 54-2) Erythroderma is the term used when the majority of the skin surface is erythematous (red in color). There may be associated scale, erosions, or pustules as well as shedding of the hair and nails. Potential systemic manifestations include fever, chills, hypothermia, reactive lymphadenopathy, peripheral edema, hypoalbuminemia, and high-output cardiac failure. The major etiologies of erythroderma are (1) cutaneous diseases such as psoriasis and dermatitis (Table 54-3); (2) drugs; (3) systemic diseases, most commonly CTCL; and (4) idiopathic. In the first three groups, the location and description of the initial lesions, prior to the development of the...
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Chapter 054. Skin Manifestations of Internal Disease (Part 2) Chapter 054. Skin Manifestations of Internal Disease (Part 2) Erythroderma (Table 54-2) Erythroderma is the term used when the majority of the skinsurface is erythematous (red in color). There may be associated scale, erosions, orpustules as well as shedding of the hair and nails. Potential systemicmanifestations include fever, chills, hypothermia, reactive lymphadenopathy,peripheral edema, hypoalbuminemia, and high-output cardiac failure. The majoretiologies of erythroderma are (1) cutaneous diseases such as psoriasis anddermatitis (Table 54-3); (2) drugs; (3) systemic diseases, most commonly CTCL;and (4) idiopathic. In the first three groups, the location and description of theinitial lesions, prior to the development of the erythroderma, aid in the diagnosis.For example, a history of red scaly plaques on the elbows and knees would pointto psoriasis. It is also important to examine the skin carefully for a migration of theerythema and associated secondary changes such as pustules or erosions.Migratory waves of erythema studded with superficial pustules are seen inpustular psoriasis. Table 54-2 Causes of Erythroderma 1. Primary cutaneous disorders a. Psoriasisa b. Dermatitis [atopic, contact >> seborrheic or stasis (withautosensitization)]a c. Pityriasis rubra pilaris 2. Drugs 3. Systemic diseases a. Cutaneous T cell lymphoma b. Lymphoma 4. Idiopathic a Discussed in detail in Chap. 53. Table 54-3 Erythroderma (Primary Cutaneous Disorders) Initial Locati Othe Diag Treat Lesions on of Initial r Findings nostic Aids ment Lesions Psori Pink- Elbow Nail Skin Topicasisa red, silvery s, knees, dystrophy, biopsy al scale, sharply scalp, arthritis, glucocortico demarcated presacral area pustules ids, vitamin D; UV-B (narrowband ); oral retinoid and/or PUVA; MTX, cyclosporine , anti-TNF agents Dermatitisa Atop Acute: Antec Prurit Skin Topicic ubital and us biopsy al Erythe popliteal glucocortico ma, fine scale, Fami fossae, neck, ids, crust, indistinct ly history of hands tacrolimus, borders atopy, pimecrolimu including s, tar, and Chronic: asthma, antipruritics; allergic oral Lichenif rhinitis or antihistaminication conjunctiviti es; open wet(increased skin s, and atopic dressings;markings) dermatitis UV-B ± UV-A; Excl PUVA; ude oral/IM ...