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Skin diseases of the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
Pemphigus foliaceus (superficial pemphigus) is seen less frequently than pemphigus vulgaris. In rural areas of South America an endemic form of the disease is seen. The eruption usually involves the seborrheic areas such as the scalp, face, chest and back, and presents clinically as crusted erosions which are painful and have an offensive odor. Sometimes patients present with or develop an exfoliative erythroderma. Histopathology, superficial clefts and bullae are seen immediately below the stratum corneum or high in the granular layer. The bullae contain scattered granular acantholytic keratinocytes, neutrophils and fibrin. Eosinophilic or neutrophilic spongiosis can precede the above changes. The autoantibodies (IgG) recognize the target antigen demoglein 1, a 160-kDa desmosome cadherin.
Approach to Erythroderma
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Idiopathic erythroderma has been considered a distinctive form of prelymphomatous T-cell dyscrasia eventually causing Sézary syndrome in some cases. In histopathology, if dermal infiltrate shows atypical lymphoid cells, lymphomatoid drug eruption, idiopathic erythroderma and Sézary syndrome should be considered. Idiopathic erythroderma should be considered after three key procedures: biopsy of lesional skin, analysis of peripheral blood and lymph node biopsy. Each of these samples needs to be analyzed for morphology, immunophenotype, and the presence of a T-cell clone.
Erythrodermic and Pustular Psoriasis
Published in John Y. M. Koo, Ethan C. Levin, Argentina Leon, Jashin J. Wu, Alice B. Gottlieb, Moderate to Severe Psoriasis, 2014
Ethan C. Levin, Eric Y. Sako, Shannon Famenini, Jashin J. Wu
Psoriasis is the most common cause of erythroderma and represents about 25% of cases. Other causes of erythroderma include cutaneous lymphoma, pityriasis rubra pilaris, severe eczema, and drug eruptions [12–14]. Thus, biopsy may be useful in distinguishing erythrodermic psoriasis from these other causes of erythroderma.
Biological treatment for erythrodermic psoriasis
Published in Expert Opinion on Biological Therapy, 2022
Erythrodermic psoriasis (EP) is a severe subtype of psoriasis involving all or nearly all of the body surface area. It occurs in 1–2% of patients with psoriasis; however, approximately 30% of patients presenting with erythroderma have psoriasis as the underlying cause [1–3]. EP may be acute or chronic. Acute EP is characterized by sudden disease onset, often precipitated by triggering factors such as infection, drugs such as antimalarials, topical irritants, or withdrawal of corticosteroids or cyclosporine. Patients of acute erythroderma may be febrile and systemically ill. Complications of acute skin failure may be seen, including sepsis, hypothermia or hyperthermia, anemia, hypoalbuminemia, dehydration, and high-output cardiac failure. Untreated disease may result in mortality. Such patients require aggressive systemic treatment for disease control. Chronic EP results from gradual extension of plaque psoriasis where general condition is well preserved and overall prognosis is good. Primary EP refers to patients who develop erythroderma at presentation of disease. Secondary EP refers to erythroderma developing in a patient with preexisting psoriasis, either acutely or insidiously. Distinction between generalized pustular psoriasis and erythrodermic psoriasis is often arbitrary, given their frequent cooccurrence and overlapping clinical features.
A systematic review of treatment strategies for erythrodermic psoriasis
Published in Journal of Dermatological Treatment, 2021
Kelly A. Reynolds, Deeti J. Pithadia, Erica B. Lee, Wilson Liao, Jashin J. Wu
The first steps in the management of EP are corrections of any fluid, electrolyte, and protein imbalances, prophylactic measures to protect against hypothermia, and identification and treatment of any secondary infections (2). After supportive measures have been initiated, subsequent management strategies for EP are often based on clinical experience and anecdotal evidence. This is in part due to the fact that acute-onset EP often requires immediate intervention, which precludes investigators’ ability to randomize patients in head-to-head clinical trials (1). Further, erythroderma is rare and often listed as an exclusion criterion in clinical trials. The National Psoriasis Foundation established guidelines for EP management in 2010 (1), but given the emergence of a vast number of new biologic therapies in the intervening years, the literature on this topic warrants re-exploration.
A clinical case of severe disease burden: an erythrodermic psoriatic patient treated with secukinumab
Published in Journal of Dermatological Treatment, 2018
M. Galluzzo, S. D’Adamio, E. Campione, S. Mazzilli, L. Bianchi, M. Talamonti
Erythrodermic psoriasis (EP) is a severe variant of psoriasis characterized by prominent erythema, rather than thick scaling plaques, affecting the entire body surface including the face, trunk, and extremities. It has an estimated prevalence of 1–2.25% among psoriatic patients, and is the most common form of erythroderma. Commonly associated symptoms are chills, exudation, edema, onycholysis, onychodystrophy, weight loss, pruritus, and fever. Skin scaling may also be present, but it is quite different from chronic plaque-type psoriasis (psoriasis vulgaris) since there is a superficial exfoliation rather than thick, adherent, white scales. Although EP may be the first manifestation of psoriasis in some subjects, it generally occurs in patients who already have chronic plaque-type psoriasis, triggered by occasional events such as infections, drugs, or stress, and it commonly represents a life-threating manifestation of unstable chronic plaque-type psoriasis (1).