Erythroderma

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome

BACKGROUND

To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome (AIDS) complicated with drug-induced erythroderma.

METHODS

The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis (SCORTEN) scores, and disease outcome spectrums were analyzed.

RESULTS

Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin (IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%.

CONCLUSIONS

The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.

Erythroderma: A clinicopathological study of 47 cases from 2018 to 2020

Erythroderma, or exfoliative dermatitis, is an inflammatory disorder characterized by erythema and scaling, affecting most of the skin surface. It may be a result of many different causes such as previous dermatoses (psoriasis, eczema, atopic dermatitis [AD], pityriasis rubra pilaris, and pemphigus foliaceous), drug reactions, malignancies (mycosis fungoides [MF], Sézary syndrome, adult T cell leukemia/lymphoma), infections, and idiopathic disorders. Regardless of the etiology, the clinical appearance of erythroderma is similar in all patients. The most prominent physical examination findings in almost all patients are diffuse erythema and scaling. In a 2-year period, 47 patients who were hospitalized and treated in our department were included in the study. We classified patients into seven subgroups: psoriasis, AD, drug-induced erythroderma, MF, pityriasis rubra pilaris, bullous pemphigoid, and polymorphous light eruption. All patients had a biopsy during the acute stage and diagnoses were histopathologically confirmed. Some patients had multiple biopsies for histopathological confirmation. In our study, the majority of the patients were men over the age of 54. The most common etiological cause of erythroderma is psoriasis. We aim to analyze clinical, laboratory, and histopathological findings of erythrodermic inpatients prospectively in Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty between January 2018 and 2020.

Erythroderma as a paraneoplastic manifestation of small cell lung cancer

Erythroderma is a rare clinical entity characterized by generalized erythema affecting the whole or most of the body's skin surface. It is associated with a variety of underlying conditions, including preexisting dermatoses, infections, connective tissue disorders, drugs, malignancies, or it may be idiopathic. A case of a 73-year-old man, with a 5-month history of erythroderma, eventually diagnosed with small cell lung cancer is presented. This is the first reported case indicating an association between erythroderma and small cell lung cancer, extending, thus, current knowledge regarding small cell lung cancer-related paraneoplastic manifestations as well as erythroderma's causative factors.

Adverse Drug Reactions

Adverse events and adverse drug reactions are common in clinical practice. Side effects range from the common to the rare and may be confused with other mucocutaneous manifestations resulting from several medications to treat infections, other medical conditions, and in the clinical setting of oncologic treatment. The objective of this chapter to review current data on adverse drug reactions, here classified as (i) severe adverse drug reactions, (ii) uncomplicated cutaneous adverse drug reactions, and (iii) adverse drug reactions caused by chemotherapy drugs, particularly those cases whereby the dermatologist is requested to issue a report and asked to comment on the safety and viability of readministration of a specific drug. We describe aspects associated with these events, presenting a detailed analysis of each of them.

A Suspected Case of Silodosin-Induced Erythroderma

An 86-year-old man developed a suspected severe erythroderma during treatment with silodosin (dosage unknown) for benign prostatic enlargement. Two weeks after starting silodosin, he developed a total-body scaling dermatitis. A biopsy was planned but the patient improved at his subsequent visit and it was not taken. Silodosin was discontinued and the patient received UVB phototherapy, clobetasol ointment, and several bland and protective skin-care measures. One week after the initial presentation, the patient demonstrated improvement in his total-body scaling. Based on these findings, the patient was diagnosed with a suspected silodosin-induced erythroderma. Due to limitations in the patient’s clinical history and investigations, a Naranjo assessment score was not obtainable.

Erythroderma: a dermatologic emergency

Erythroderma is a potentially fatal dermatologic emergency that is often mistaken for infection. Indeed, the fact that it is difficult to diagnosis is the main contributor to its significant mortality rate, as treatment is readily available. We present a case of a 36-year-old man who was incorrectly diagnosed and treated for 2 months. We review the etiologies, initial work-up and management of this disease. In our case, the patient was ill, had lost 11.3 kg and developed systemic inflammatory response syndrome. Without proper treatment he was at risk of developing full-blown sepsis. Although there are many causes of erythroderma, prompt initial treatment directed at the underlying etiology typically results in a rapid remission.

Erythroderma: review of a potentially life-threatening dermatosis

Erythroderma, or generalized exfoliative dermatitis, is a disease characterized by erythema and scaling of greater than 90% of the body's surface. The resultant dysmetabolism is potentially life threatening. A detailed history is to identify and treat the underlying cause of this dermatitis. We present two cases of erythroderma in African patients and review this important disease.

Dermatite esfoliativa: estudo clínico-etiológico de 58 casos

FUNDAMENTO: Dermatite esfoliativa é síndrome cutânea caracterizada por eritema e descamação generalizados, que pode ser conseqüente ou estar associada a várias doenças dermatológicas prévias, doenças sistêmicas ou reações medicamentosas. OBJETIVOS: Relatar a freqüência das diferentes causas e características clínicas associadas à dermatite esfoliativa nos pacientes atendidos no Setor de Dermatologia do Hospital Universitário Regional do Norte do Paraná, da Universidade Estadual de Londrina. MÉTODOS: Foram revisados os registros de pacientes com diagnóstico de dermatite esfoliativa diagnosticados no Hospital Universitário Regional do Norte do Paraná no período de 10 anos. RESULTADOS: Foi encontrado o total de 58 pacientes com diagnóstico de dermatite esfoliativa, com idade média de 56,89 anos. Em 33 pacientes, foi definida uma dermatose como causa (psoríase, 11 casos; dermatite de contato, nove casos; eritrodermia ictiosiforme congênita, três casos; dermatite seborréica, cinco casos; dermatite atópica, três casos; pitiríase rubra pilar, dois casos). Reações a drogas foram observadas em 11 pacientes. Em 14 casos (24%) não foi possível determinar a causa básica. CONCLUSÕES: Numa amostra de pacientes atendidos num serviço de referência em dermatologia, a dermatite esfoliativa foi ocorrência pouco comum, e a maior parte dos casos estava relacionada a doenças dermatológicas.

Cutaneous paraneoplastic syndromes: uncommon presentations

Paraneoplastic syndromes are a group of clinical manifestations associated with a malignancy, but not directly related to the primary tumor itself or to its metastases. Characteristically, they follow a course parallel to the tumor, resolve with successful treatment of the primary tumor, and tend to recur with its relapse or the onset of metastases. The mechanism by which they occur is not well understood, but may be related to the production of bioactive substances by or in response to the tumor, such as polypeptide hormones, hormone-like peptides, antibodies or immune complexes, cytokines, or growth factors.

Reações cutâneas graves adversas a drogas - aspectos relevantes ao diagnóstico e ao tratamento - Parte I - Anafilaxia e reações anafilactóides, eritrodermias e o espectro clínico da síndrome de Stevens-Johnson & necrólise epidérmica tóxica (Doença de Lyell)

As reações cutâneas graves adversas a droga (RCGAD) são as que geralmente necessitam de internação hospitalar, por vezes em unidade de terapia intensiva ou de queimados, com observação minuciosa dos sinais vitais e da função de órgãos internos. O objetivo é descrever essas reações, facilitando seu reconhecimento e tratamento. Fazem parte desse grupo a anafilaxia, a síndrome de Stevens-Johnson (SSJ), a necrólise epidérmica tóxica (NET) e, dependendo do envolvimento sistêmico, as eritrodermias. Neste artigo, são abordados as características clínicas e o tratamento de algumas reações adversas a droga: anafilaxia, as eritrodermias, a síndrome de Stevens-Johnson (SSJ) e a necrólise epidérmica tóxica (NET).