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Pang Y, Nguyen WQ, Guerrero LI, Chrisman LP, Hooper MJ, McCarthy MC, Hales MK, Lipman RE, Paller AS, Guitart J, Zhou XA. Deciphering the Etiologies of Adult Erythroderma: An Updated Guide to Presentations, Diagnostic Tools, Pathophysiologies, and Treatments. Am J Clin Dermatol 2024:10.1007/s40257-024-00886-9. [PMID: 39348008 DOI: 10.1007/s40257-024-00886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 10/01/2024]
Abstract
Erythroderma, an inflammatory skin condition characterized by widespread erythema with variable degrees of exfoliation, pustulation, or vesiculobullous formation, is associated with high morbidity and mortality. Determining the underlying cause of erythroderma frequently presents a diagnostic challenge, which may contribute to the condition's relatively poor prognosis. This review covers the clinical presentation, pathophysiology, diagnosis, and treatment of erythroderma. It discusses similarities and differences among the many underlying etiologies of the condition and differences between erythrodermic and non-erythrodermic presentations of the same dermatosis. Finally, this article explores current research that may provide future tools in the diagnosis and management of erythroderma.
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Affiliation(s)
- Yanzhen Pang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - William Q Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Liliana I Guerrero
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Lauren P Chrisman
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Madeline J Hooper
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Morgan C McCarthy
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Molly K Hales
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Rachel E Lipman
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA
| | - Xiaolong A Zhou
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Arkes 1600, Chicago, IL, 60611, USA.
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Kim YH, Bhandarkar AR, Adeleye O, Zhu A, Bydon M, Vidal NY. Socioeconomic predictors of cost and length of stay for erythroderma: a cross-sectional analysis of the national inpatient sample. Arch Dermatol Res 2022; 315:869-877. [PMID: 36367570 DOI: 10.1007/s00403-022-02463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Erythroderma is an uncommon but serious dermatologic disorder that often requires hospitalization for diagnosis and treatment. However, little is known about predictors influencing cost and patient outcomes. The present study sought to characterize the sociodemographic factors that predict patient outcomes and hospital cost. Data were obtained from the 2016-2018 National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality for patients of any age with a primary or secondary diagnosis of exfoliative dermatitis. Regression analyses were performed to find predictors for hospital costs and patient outcomes, represented by the length of stay (LOS). Univariate analysis of LOS revealed urban teaching hospitals were associated with prolonged LOS (p = 0.023). Univariate analysis of hospital cost yielded the following factors associated with increased hospital cost: Black and Asian patients (p = .045), urban teaching hospitals (p = .035), and northeast or south geographic location (p = .004). Multivariable regression analysis revealed prolonged LOS was associated with female sex (p = .043) and large bed capacity (p = .044) while shorter LOS was associated with increased age (p = .025); lower hospital costs were associated with private-owned hospitals - (p = .025). In patients diagnosed with erythroderma, there appear to be racial, economic, and geographic disparities for patients that lead to greater hospital costs and longer LOS.
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Affiliation(s)
- Yong-Hun Kim
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | | | | | - Agnes Zhu
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Nahid Y Vidal
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Patruno C, Potestio L, Napolitano M. Clinical phenotypes of adult atopic dermatitis and related therapies. Curr Opin Allergy Clin Immunol 2022; 22:242-249. [PMID: 35786802 DOI: 10.1097/aci.0000000000000837] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To report current knowledge on the different clinical phenotypes of adult atopic dermatitis. Possible therapeutic intervention in relation to phenotype is also evaluated. RECENT FINDINGS Atopic dermatitis is a chronic inflammatory disease affecting up to 10% of adults. It can manifest with different clinical phenotypes, causing diagnostic difficulties. Long-term is often required and systemic drugs are needed for moderate-to-severe forms. However, few drugs are registered for atopic dermatitis in many countries. Furthermore, limited data exist regarding the treatment in relation to individual clinical phenotypes. SUMMARY Currently, the most relevant data are those for cyclosporine, alitretinoin, and dupilumab. Cyclosporine and dupilumab showed to be effective in the treatment of atopic dermatitis, although in trials and real-life experiences the different phenotypes treated are usually not reported. However, cyclosporine appears to be effective in prurigo nodularis. Alitretinoin is reported to be particularly efficacious for atopic dermatitis of the hands, while it is ineffective for other locations of the disease. Dupilumab demonstrated its efficacy in prurigo nodularis and nummular eczema phenotypes of atopic dermatitis; moreover, especially in elderly patients, its effectiveness seems to be faster if the folds of the limbs are involved.
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Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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