Erythroderma

Plan to spend 5-10 minutes practicing the flow of the presentation and reviewing the images of squamous cell carcinoma provided.

Present the images by expanding the window below or downloading the PowerPoint file (preferred). Ask the learners to provide a description of the lesions they are viewing. Advance using the arrows or scroll wheel on the mouse to reveal subsequent questions with answers and graphics.

Dermatology description: Erythematous patches with scattered areas of sparing appearing to involve >90% of body surface. Minimal overlying scale. No blistering, ulceration or erosions. No mucosal involvement.

Diagnosis: Erythroderma (a clinical sign, not a diagnosis)

Teaching:

Erythroderma implies diffuse erythema and may include scale involving > 90% of body surface area. Erythroderma is technically a clinical sign, not a diagnosis, and may represent the clinical presentation of a WIDE range of cutaneous and systemic diseases including but not limited to: psoriasis (think about recent oral steroid taper), atopic dermatitis, allergic contact dermatitis, drug hypersensitivity reaction, cutaneous T cell lymphoma/Sezary syndrome, seborrheic dermatitis (Think about immunosuppressed patients, like in HIV),  scabies, cutaneous T cell lymphoma, GVHD, staph scalded skin or other. Nearly ¼ of cases are ultimately idiopathic. The mortality rate of erythroderma is over 5%

Question 3: What is your next step in evaluation?

The initial evaluation should include:

1. A thorough history
Recommend screening for any new medications, family or personal history of psoriasis, the recent withdrawal of corticosteroids, occupation, and hobbies.

Pro tip: Drugs most commonly associated with Erythroderma include

Allopurinol, Beta-lactam antibiotics, Carbamazepine, Phenobarbital, Phenytoins, Sulfasalazine, SUlfonamides, Zalcitabine

2. Physical Exam looking for evidence of blistering, mucosal involvement, and lymphadenopathy, or superficial infection (herpetic or staphylococcal)

3. Initial blood work, in part guided by your history. Some common labs include: CBC with differential, Basic Metabolic Panel, Liver function test, and HIV test.

4. Punch or shave biopsy over involved skin.