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EMERGENCY DERMATOLOGY
Management of erythroderma
Acute Chronic
Investigate underlying cause (e.g. skin biopsy) and tailor treatment accordingly
Figure 1
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EMERGENCY DERMATOLOGY
Investigation
Skin biopsy: this may not be necessary if there is a clear history
and signs of generalized spread of pre-existing eczema or psori-
asis. Histology can be useful to confirm severe drug rashes (see
Drug eruptions on pages 422e428 of this issue), to distinguish
between different inflammatory conditions of the skin where
there is no history or precedent, and to diagnose cutaneous T cell
lymphoma.
Skin biopsy for immunofluorescence (for autoimmune
bullous disorders) and immunohistochemical testing (e.g. T cell
markers in cutaneous T cell lymphoma) can be useful. Several
biopsies can be required from morphologically different areas or
if the presentation changes. PRP and MF produce characteristic
histology, and in lymphoma a T cell clone may be isolated.
In all cases of erythroderma, consult with a dermatologist
before taking the biopsy to ensure that samples are taken from
the correct area and for the appropriate tests. An inexperienced
person can accidentally biopsy a coincidental benign cutaneous
lesion, mistaking it for a florid area of the rash and causing
diagnostic confusion. Biopsies should be taken from areas that
have not been scratched to avoid confusion because of secondary
changes.
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EMERGENCY DERMATOLOGY
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EMERGENCY DERMATOLOGY
TEST YOURSELF
To test your knowledge based on the article you have just read, please complete the questions below. The answers can be found at the
end of the issue or online here.
Question 2 What is the most appropriate next step to support the likely
diagnosis?
A 20-year-old man presented with a 3-week history of eryth-
A. Request a skin biopsy
roderma. He had recently lost weight unintentionally. His past
B. Do a full blood count and blood film
medical history included asthma and allergic rhinitis.
C. Look for scabies burrows on the hands
On clinical examination, there were clear fluid-filled vesicles on
D. Patch testing
his hands with fissured, weeping and lichenified skin but no
E. Take a fungal skin scraping
crusting. There were enlarged lymph nodes in the neck and axillae.
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