Study of the Correlation of Erythroderma and Histopathologic Features, Clinical Presentations and Causative Factors
Main Article Content
Abstract
Erythroderma is a medical condition characterized by inflammation involving skin over 90% of the body’s surface area. This condition can result in high mortality rate and many systemic complications including fluid and electrolyte imbalance, infections, thermoregulatory disturbance and high output cardiac failure. In Thailand, limited data have been reported in the literature.
This study aims to investigate epidemiologic, clinical and histologic data relevant to etiologies of erythroderma among adults.
We performed a retrospective study among all patients acquiring erythroderma, aged above 16 years and visiting at the Division of Dermatology, Department of Internal Medicine, Phramongkutklao Hospital, Thailand from January 2015 to December 2019. The following data were recorded: personal data, medical history, clinical manifestations, histopathologic results, possible etiologies, laboratory profiles, treatment methods and outcomes.
During the 5-year study, 35 patients with erythroderma were collected. Men outnumbered women 6:1 (30 men and 5 women). The age of these patients ranged from 18-90 with mean age of 66.4 years. Idiopathic was the predominant etiology with 20/35 cases (57.1%), followed by drug eruption (17.1%). Herbal medicine (33.3%) and spironolactone (33.3%) were the most implicated drugs. Pre-existing skin diseases were observed including psoriasis (17.1%), pityriasis rubra pilaris (2.8%) and malignancy associated erythroderma (2.8%). Epidermal spongiosis was the most common histological feature observed in all etiologies (85.7%), (p=0.029). Complete clearance was obtained in 15/35 (42.8%). Death 2/35 (5.6%) occurred in one patient with drug reaction and one patient with pemphigus vulgaris associated erythroderma complicated with sepsis.
Although data are limited, erythroderma remains a serious condition effecting quality of life of patients. Our study demonstrated further epidemiology, etiologies and clinicopathologic information of erythroderma among Thai patients.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Sigurdsson V, Toonstra J, Hezemans-Boer M, van Vloten WA. Erythroderma. A clinical and follow-up study of 102 patients, with special emphasis on survival. J Am Acad Dermatol. Jul 1996;35(1):53-7. doi:10.1016/s0190-9622(96)90496-x
3. Khaled A, Sellami A, Fazaa B, Kharfi M, Zeglaoui F, Kamoun MR. Acquired erythroderma in adults: a clinical and prognostic study. J Eur Acad Dermatol Venereol. Jul 2010;24(7):781-8. doi:10.1111/j.1468-3083.2009.03526.x
4. César A, Cruz M, Mota A, Azevedo F. Erythroderma. A clinical and etiological study of 103 patients. J Dermatol Case Rep. Mar 31 2016;10(1):1-9. doi:10.3315/jdcr.2016.1222
5. Bolognia, J., Jorizzo, J. and Schaffer, J. Dermatology. 2018; 183 [Philadelphia]: Elsevier Saunders.
6. Leenutaphong V, Kulthanan K, Pohboon C, Suthipinittharn P, Sivayathorn A, Sunthonpalin P. Erythroderma in Thai patients. J Med Assoc Thai. Aug 1999;82(8):743-8.
7. Sigurdsson V, Steegmans PH, van Vloten WA. The incidence of erythroderma: a survey among all dermatologists in The Netherlands. J Am Acad Dermatol. Nov 2001;45(5):675-8. doi:10.1067/mjd.2001.116224
8. Tan G, Kong Y, Tan A, Tey HL. Causes and Features of Erythroderma. Annals of the Academy of Medicine, Singapore. 08/01 2014;43:391-4.
9. Miyashiro D, Sanches JA. Erythroderma: a prospective study of 309 patients followed for 12 years in a tertiary center. Scientific Reports. 2020/06/17 2020;10(1):9774. doi:10.1038/s41598-020-66040-7
10. Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythroderma: A clinical study of 97 cases. BMC Dermatology. 2005/05/09 2005;5(1):5. doi:10.1186/1471-5945-5-5
11. Li J, Zheng HY. Erythroderma: a clinical and prognostic study. Dermatology. 2012;225(2):154-62. doi:10.1159/000342365
12. Porro AM, Seque CA, Ferreira MCC, Simões MM, Enokihara S. Pemphigus vulgaris*. Anais Brasileiros de Dermatologia. 2019/05/01/ 2019;94(3):264-278. doi:https://doi.org/10.1590/abd1806-4841.20199011
13. Gutkowski K, Chwist A, Hartleb M. Liver injury induced by high-dose methylprednisolone therapy: a case report and brief review of the literature. Hepat Mon. Aug 2011;11(8):656-61. doi:10.5812/kowsar.1735143x.713
14. Shahshahani MM, Azizahari S, Soori T, et al. Hepatotoxicity and liver enzyme alteration in patients with immunobullous diseases receiving immunosuppressive therapy. J Dermatol. Dec 2011;38(12):1153-7. doi:10.1111/j.1346-8138.2011.01278.x
15. Botella-Estrada R, Sanmartín O, Oliver V, Febrer I, Aliaga A. Erythroderma. A clinicopathological study of 56 cases. Arch Dermatol. Dec 1994;130(12):1503-7. doi:10.1001/archderm.130.12.1503
16. Chau T, Parsi KK, Ogawa T, et al. Psoriasis or not? Review of 51 clinically confirmed cases reveals an expanded histopathologic spectrum of psoriasis. https://doi.org/10.1111/cup.13033. Journal of Cutaneous Pathology. 2017/12/01 2017;44(12):1018-1026. doi:https://doi.org/10.1111/cup.13033
17. Rosa G, Fernandez AP, Schneider S, Billings SD. Eosinophils are rare in biopsy specimens of psoriasis vulgaris. J Cutan Pathol. Dec 2017;44(12):1027-1032. doi:10.1111/cup.13042
18. Moy AP, Murali M, Kroshinsky D, Duncan LM, Nazarian RM. Immunologic Overlap of Helper T-Cell Subtypes 17 and 22 in Erythrodermic Psoriasis and Atopic Dermatitis. JAMA Dermatology. 2015;151(7):753-760. doi:10.1001/jamadermatol.2015.2
19. Kim HJ, Roh JY, Jung Y. Eosinophils Accelerate Pathogenesis of Psoriasis by Supporting an Inflammatory Milieu that Promotes Neutrophil Infiltration. J Invest Dermatol. Oct 2018;138(10):2185-2194. doi:10.1016/j.jid.2018.03.1509