Chapter 054. Skin Manifestations of Internal Disease (Part 2) ppt

Skin Manifestations of Internal Disease Part 2 Erythroderma Table 54-2 Erythroderma is the term used when the majority of the skin surface is erythematous red in color.. The major et

Chapter 054 Skin Manifestations

of Internal Disease

(Part 2)

Erythroderma

(Table 54-2) Erythroderma is the term used when the majority of the skin

surface is erythematous (red in color) There may be associated scale, erosions, or pustules as well as shedding of the hair and nails Potential systemic manifestations include fever, chills, hypothermia, reactive lymphadenopathy, peripheral edema, hypoalbuminemia, and high-output cardiac failure The major etiologies of erythroderma are (1) cutaneous diseases such as psoriasis and dermatitis (Table 54-3); (2) drugs; (3) systemic diseases, most commonly CTCL; and (4) idiopathic In the first three groups, the location and description of the initial lesions, prior to the development of the erythroderma, aid in the diagnosis For example, a history of red scaly plaques on the elbows and knees would point

to psoriasis It is also important to examine the skin carefully for a migration of the erythema and associated secondary changes such as pustules or erosions Migratory waves of erythema studded with superficial pustules are seen in

pustular psoriasis

Table 54-2 Causes of Erythroderma

1 Primary cutaneous disorders

a Psoriasisa

b Dermatitis [atopic, contact >> seborrheic or stasis (with autosensitization)]a

c Pityriasis rubra pilaris

2 Drugs

3 Systemic diseases

a Cutaneous T cell lymphoma

b Lymphoma

4 Idiopathic

a

Discussed in detail in Chap 53

Table 54-3 Erythroderma (Primary Cutaneous Disorders)

Initial Lesions

Locati

on of Initial Lesions

Othe

r Findings

Diag nostic Aids

Treat ment

Psori

asisa

Pink-red, silvery scale, sharply demarcated

Elbow

s, knees, scalp,

presacral area

Nail dystrophy, arthritis, pustules

Skin biopsy

Topic

al glucocortico ids, vitamin

retinoid and/or PUVA; MTX, cyclosporine , anti-TNF agents

Derm

atitisa

Atop

ic

Acute:

Erythe

ma, fine scale, crust, indistinct borders

Antec ubital and popliteal fossae, neck, hands

Prurit

us

Fami

ly history of atopy, including

Skin biopsy

Topic

al glucocortico ids,

tacrolimus, pimecrolimu

s, tar, and

Chronic:

Lichenif

ication

(increased skin

markings)

asthma, allergic rhinitis or conjunctiviti

s, and atopic dermatitis

Excl ude

secondary infection

aureus

Excl ude

superimpose

d irritant or allergic contact dermatitis

antipruritics; oral

antihistamin es; open wet dressings;

UV-A; PUVA; oral/IM glucocortico ids; MTX; cyclosporine

Topic

al or oral antibiotics

Cont

act

Local:

Erythe

ma, crusting, vesicles, and bullae

Depen

offending agent

Irrita nt—onset often within hours

Aller gic—

delayed-type hypersensiti vity; lag time of 48 h

Patch testing

Remo

ve irritant or allergen; topical glucocortico ids; oral antihistamin es; oral/IM glucocortico ids

Systemic :

Erythe

ma, fine scale, crust

Gener alized

Patie

history of allergic contact dermatitis to topical agent and

Patch testing

Same

as local

then receives systemic medication

structurally related, e.g., ethylenedia mine (topical), aminophylli

ne (IV)

Sebo

rrheic (rare)

Pink-red, greasy scale

Scalp, nasolabial folds, eyebrows, intertriginous zones

Flare

stress, HIV infection

Asso ciated with Parkinson's

Skin biopsy

Topic

al glucocortico

imidazoles

disease

Stasis

(with

autosensitiza

tion)

Erythem

a, crusting, excoriations

Lower extremities

Prurit

us, lower extremity edema

Histo

ry of venous ulcers, thrombophl ebitis, and/or cellulitis

Excl ude

cellulitis

Excl ude

superimpose

d contact

Skin biopsy

Topic

al glucocortico ids; open wet

dressings; leg

elevation; pressure stockings

dermatitis, e.g., topical neomycin

Pityri

asis rubra

pilaris

Orange-red,

perifollicular papules

Gener alized, but characteristic

"skip" areas

of normal skin

Wax-like

keratoderma

Excl ude

cutaneous T cell

lymphoma

Skin biopsy

Isotre tinoin or acitretin; methotrexate

a

Discussed in detail in Chap 53

Note: PUVA, psoralens + ultraviolet A irradiation; UV-B, ultraviolet B;

UV-A, ultraviolet A; MTX, methotrexate; TNF, tumor necrosis factor