Erythrodermic psoriasis is an uncommon, severe variant of psoriasis that is characterized by widespread erythema of the skin. Analytical study of eight cases erythroderma in infants is a rare condition of varied etiology. Indian journal of dermatology, venereology and leprology. A family history was elicited in all with reference to psoriasis, atopic dermatitis and ichthyosis to aid the diagnosis. Histopathology of the skin taken from a bullous lesion showed. The second biopsy of case 6 figure 2 showed sf pattern 6b while biopsy from the trunk of the same infant showed a pf pattern 6a. Xenograft models in which uninvolved psoriatic skins are transplanted onto severely immunodeficient mice have been used as proofs that psoriasis is a disease derived from t. Case 1 figure 1 was a 5dayold newborn, the youngest of the cases analyzed. A practical approach to the diagnosis and treatment of.
Psoriatic erythroderma is psoriasis involving the entire skin. It can be the result of many inflammatory skin conditions, drugs and malignancies but in a third of cases it is due to psoriasis. In 12 patients with psoriatic erythroderma, histopathology was consisten with psoriasis. There are conflicting opinions about the diagnostic value of skin biopsy in erythrodermic psoriasis.
The second most common clinical phenotype was palmoplantar psoriasis followed by flexural psoriasis. Psoriasis is a common, chronic, relapsing, papulosquamous dermatitis, with overlying silvery scales. Series limited to cases of psoriatic erythroderma have also been published. Erythroderma and exfoliative dermatitis are largely synonymous. Previous authors have reported that drugs with the greatest erythroderma inducing potential are antiepileptic medications and allopurinol. A man with chronic psoriatic erythroderma, which had immobilized him economically and socially over a fouryear period, during which he received intensive treatment in. To determine whether histology is helpful in diagnosing psoriasis as a cause of erythroderma, this study examined histologic findings in skin biopsies taken from 45 erythrodermic patients with known psoriasis. Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scale. Hypoalbuminaemia, pedal oedema were more common in psoriatic erythroderma due to profuse scaling.
Psoriatic arthritis occurs in 10 to 25% of patients. Original research paper dermatology volume 7 issue. Mar 31, 2015 we report a 62yearold male with personal history of psoriasis vulgaris who developed disseminated bullous pemphigoid associated with psoriatic erythroderma. Although all the symptoms of psoriasis are present, erythema is the most prominent feature, and scaling is different compared with chronic stationary psoriasis.
Casey gallagher, md, is boardcertified in dermatology and works as a practicing dermatologist and clinical pr. Top news tnfiinduced psoriasis improved or resolved with topical medications alone in 63. Oral lesions geographic stomatitis andor glossitis are commonly described. A number of dermatoses can progress to erythroderma, but the most common include psoriasis and eczema. Erythroderma is an uncommon and severe dermatological manifestation of a variety of diseases. Among the group of patients with a discharge diagnosis of psoriatic erythroderma, the histopathologic changes were specific for psoriasis in 40 cases 88%. Psoriatic arthritis is a condition that affects both your skin and your joints. It causes red, scaly rashes and thick, pitted fingernails. Despite the high prevalence of pfp, little is known about the underlying pfp pathology and it is. What is erythrodermic psoriasis national psoriasis foundation. This book guides the reader to recognize such emergencies, helps to approach the initial phase of management, identifies the investigations, thus leading to a holistic management of the scene. Psoriatic erythroderma associated with bullous pemphigoid.
Psoriatic erythroderma jama dermatology jama network. To reveal histological criteria of psoriatic erythroderma. Identify erythroderma causes, symptoms, and diagnostic testing. In 5 patients, erythroderma was the presenting sign of psoriasis. The most common type of psoriasis found was psoriasis vulgaris 6172, 84. Histopathology is valuable in detecting underlying cause of erythroderma. Within 1 month after a tick bite, a papule or erythema occurs. Chronic plaque type psoriasis was the most common 90% clinical phenotype. Introduction psoriasis is a noninfectious, immunologically mediated, chronic recurrent inflammatory disease of the skin.
Erythroderma exfoliative dermatitis dermatology advisor. There is hyperkeratosis and clubshaped extension of the epidermis regular acanthosis. Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. By definition, generalised erythema and oedema or papulation affect 90. Eight infants with erythroderma, clinically suspected to be of psoriatic etiology were included.
Psoriatic arthritis is similar to rheumatoid arthritis ra in sy. Idiopathic erythroderma cases seen in this study were in the age group of 5 th and 6 th decades of life. Psoriatic erythroderma is usually preceded by typically psoriatic plaques but when the exfoliative stage is reached, these specific features are lost. Walsh nmg, prokopetz r, tron va, et al histopathology in erythroderma. Erythroderma, or generalised exfoliative dermatitis, is a rare inflammatory disorder characterised by generalised erythema, involving more than 90% of the body surface area accompanied by a variable degree of scaling. Its important to recognize the signs of psoriatic arthritis, because starting on treatment sooner may r. Jun 01, 1997 there is some debate in the literature about whether skin biopsy is helpful in determining the cause of erythroderma. Rym et al reported 41 of 80 erythrodermic patients had psoriasis, a finding not inconsistent with spanish, middle eastern, indian studies. Psoriasis is a chronic, common, inflammatory skin disease. Skin histopathology from a scaly plaque was consistent with the diagnosis of psoriasis and showed subepidermal blister with inflammatory infiltrate of eosinophils with some neutrophils. Clinical presentation varies among individuals, from those with only a few localized plaques to those with generalized skin involvement. Learn about the symptoms and your treatment options. Cutaneous tcell lymphoma in erythrodermic cases may be.
Patients with this psoriasis subtype typically present with erythema involving more than 75 percent of the body surface area and associated scale, pustules, or exfoliation of the skin picture 1ac. This can be seen histologically as epidermal thickening hyperkeratosis with regularly elongated rete ridges 51. Use of secukinumab in a cohort of erythrodermic psoriatic. A retrospective clinicohistopathological study of psoriasis. Psoriatic arthritis is a skin condition that affects about 30% of people who have psoriasis, according. It is a chronic, superficial, inflammatory disease with a predilection for the scalp, eyebrows, eyelids, nasolabial creases, lips, ears fig. In case series, drugrelated reactions represent the second most frequent cause of erythroderma, ranging from 11.
The former is characterized by extensive and pronounced erythema, coupled with perceptible scaling, whereas the latter is conspicuous by the presence of widespread erythema and marked scaling. Psoriatic arthritis is a form of arthritis associated with psoriasis. Sugiura k, sugiura m, kondo c, sato t 2017 a case of psoriasis vulgaris coexisting with bullous pemphigoid and eosinophilia in a 69yearold male with diabetes mellitus and chronic renal failure. Histopathology skin biopsies of erythrodermic psoriasis are commonly unrewarding, and it can be difficult to discern an etiologic diagnosis. Histology useful for diagnosing erythrodermic psoriasis. Psoriatic arthritis is a skin condition that affects about 30% of people who have psoriasis, according to the national psoriasis foundation. Hence early intervention and referral of these types of psoriasis patients to ophthalmologists is essential. What is erythrodermic psoriasis national psoriasis.
The condition presents with distinct histopathologic and clinical findings, which include a generalized inflammatory erythema involving at least. A study of correlation between clinical and histopathological. Seborrheic dermatitis as a cause of erythroderma was seen in the age group of 3 rd and 4 th decade. Clinically psoriatic erythroderma was diagnosed in 12 patients. Dermoscopic examination can be used as a diagnostic tool in psoriatic erythroderma cases. A practical approach to the diagnosis and treatment of adult. Psoriatic erythroderma pathology outlines psoriasis causes. In an indian study n 20, the underlying causes were infections 40%. Letter to the editor case of antilaminin 1 pemphigoid. Psoriatic erythroderma rarely develops and is a complication of psoriasis, which in most cases develops as a result of excessively irritating local treatment or the action of any other adverse local influences uv, insolation. Men were affected approximately twice as often as women. Recognition of this potentially lifethreatening form of. Erythroderma is the clinical finding of generalized erythema and scaling of the skin.
Erythroderma, exfoliative dermatitis, red man syndrome, erythrodermatitis, generalised exfoliative dermatitis. Tnfiinduced psoriasis improved or resolved with topical medications alone in 63. Oct 08, 2020 erythrodermic psoriasis is a rare type of psoriasis affecting about 2 percent of people living with psoriasis. Jan 17, 2021 histology of psoriatic erythroderma in infants. Psoriatic arthritis seems to be caused by a combination of genetic, environmental, health and. Treatment of psoriasis and psoriatic arthritis with interferon gamma.
Jul 17, 2018 this case may represent psoriatic erythroderma. The report by boyd and menter 14 of 50 cases in dallas, texas, observed an average age of onset of erythroderma of 48 years. On histopathology, these 12 patients showed features of psoriasis. Our study of clinicopathological correlation of erythroderma patients. Risk factors range from genetics and certain medical conditions to smoking and food choices. Psoriatic erythroderma was more common in 4 th and 5 th decades of life. Internal malignancies, which may present as erythroderma, are reticuloendothelial, solid organ, and blood vessel malignancies. This condition, especially when fulminant, is potentially lifethreatening and has been associated with high mortality in hospitalized patients. Dermatoscopy in lifethreatening and severe acute rashes. Our patients was 43 years old with psoriatic erythroderma. To optimize the diagnosis and management of the erythrodermic patient, healthcare professionals.
Six patients of erythroderma showed features consistnet with that of an eczema, while druginduced erythroderma. This includes severe drug reactions, bullous disorders, erythroderma, infections, vasculitis and systemic emergencies presenting with skin signs. Seborrheic dermatitis is common, occurring in 2%5% of the population. Neither apparent scar formation nor mucosal lesion was seen. Archives of dermatology, it was stated thata man with chronic psoriatic erythroderma, which had immobilized him. Nyoman suryawati, bagianstaf medik fungsional kesehatan kulit dan kelamin fakultas kedokteran universitas udayana rumah sakit umum pusat sanglah, jl. Erythroderma is often preceded by a morbilliform measleslike eruption, dermatitis, or plaque psoriasis. The pruritus is intense and secondary excoriations or prurigolike lesions can be seen.
Follicular psoriasis causing erythroderma in a child. Psoriatic erythroderma represents a form of psoriasis that affects all body sites, including the face, hands, feet, nails, trunk, and extremities 410411. The results of dermoscopic examination on both cases are supported by the histopathological examination. In our study, it was seen that in the active lesions, parakeratosis was more uniform, munromicroabscesses were larger and more numerous 6.
Histopathological findings in all infants with pf pattern showed regular ac, dilated papillary capillaries pc. Multisystemdisorde rs,includingdermatomyositis, systemic lupus erythematosus, and sarcoidosis, may rarely present with erythroderma. Total number of patients with psoriasis on histopathology was thus. People with this form of the disease develop very red and scaly skin over 90% or more of their bodies. Department of dermatology, university of turin, italy.
Psoriasis diagnosis histopathology erythrodermic psoriasis guttate psoriasis pustular psoriasis. A control group of nonpsoriatic erythrodermic patients was also included in the study. Its important to recognize the signs of psoriatic arthritis, because starting on treatment sooner may reduce the risk of joint damage. There is no one single cause of psoriatic arthritis. Jul 01, 2000 series limited to cases of psoriatic erythroderma have also been published. Hyperproliferation and impaired differentiation of keratinocytes are the two key features that lead to the skin findings of psoriatic plaques. Analytical study of eight cases parimalam kumar 1, jayakar thomas 2, devaraj dineshkumar 3 1 department of dermatology, thanjavur medical college, thanjavur, india 2 department of skin and std, sree balaji medical college, chennai, tamil nadu, india 3 department of dermatology, kk childs trust. The role of histological presentation in erythroderma wiley online. Erythroderma is a severe form of psoriasis and life threatening condition characterised by a universal inflammatory affection of the skin and generalised lymphadenopathy. Erythroderma is a condition caused by several etiologies that result in red inflamed skin on 90% or more of the body surface. There may be clues such as bullae indicating the presence of bullous pemphigoid or pemphigus foliaceus. It is a very severe skin condition that can be fatal.
Generalised erythema can develop quite rapidly in acute erythroderma, or more gradually over weeks to months in chronic erythroderma signs and symptoms of erythroderma. Six patients of erythroderma showed features consistnet with that of an eczema, while druginduced erythroderma showed psoriasiform presentation. Histopathology of various clinical types of psoriasis chronic plaque psoriasis n209 follicular psoriasis n1 guttate psoriasis n inverse psoriasis n1 palmoplantar psoriasis n40 psoriatic erythroderma n1 scalppsoriasis n11 total hyperkeratosis 18387. Histopathology of the skin was helpful in the diagnosis of 25 patients.
Jun 30, 2015 psoriatic erythroderma represents the generalized form of the disease that affects all body sites including the face, hands, feet, nails, trunk, and extremities. Erythroderma gradually occupies all or almost all of the skin. The scalp, sacral region, and extensor surfaces of extremity are commonly involved, even if. Efficacy and safety of brodalumab in patients with generalized pustular psoriasis and psoriatic erythroderma.
Request pdf histology of psoriatic erythroderma in infants. The scalp, sacral region, and extensor surfaces of extremity are commonly involved, even if flexural and intertriginous areas may be affected in the socalled inverse psoriasis. Summarize treatment and management recommendations for erythroderma. The condition presents with distinct histopathologic and clinical findings, which include a generalized inflammatory erythema involving at least 75. To determine whether histology is helpful in diagnosing psoriasis as a cause of erythroderma, this study examined histologic findings in skin. Read more about psoriatic disease, including, symptoms, causes, treatments, and more. Schlesinger and milton rosenbaum, which appeared in the july, 1955, issue of the a.
This retrospective study aimed to determine characteristics of erythroderma as a marker of cutaneous and systemic disease and to identify the underlying causes. The most common histopathologic diagnosis was psoriasis 21. Laboratory examinations revealed elevated white blood cell count. A study of conjunctival impression cytology in patients with. If you have this condition or know someone who does, learning more about psoriatic arthritis can he. Understand the signs and symptoms of psoriatic arthritis. Mar 22, 2016 patil jd, chaudhary ss, rani n, mishra ak. Psoriatic arthritis occurs in 5 30% of patients with psoriasis associated with cardiovascular complications increased rate of myocardial infarction, hypertension, hyperlipidemia, obesity, hyperlipidemia, depression, inflammatory bowel disease, diabetes, fatty liver disease and chronic kidney disease j am heart assoc 2020. Firstline treatments for psoriatic erythroderma include immunosuppressive medications such as methotrexate, acitretin, or ciclosporin.
Erythroderma is a severe form of psoriasis and life threatening condition characterised by a. Psoriatic arthritis is an inflammatory type of arthritis that primarily affects the skin and joints. The etiological diagnosis of erythroderma in children can be challenging as a wide variety of conditions can present with erythroderma. Erythroderma due to atopic dermatitis was seen in younger populations before 5 th decade of life. He found guttate psoriasis and psoriatic erythroderma to be uncommon. In psoriatic arthritis, rheumatoid factors are usually negative.
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