Erythroderma

Valley fever is a syndrome characterized by erythema nodosum and erythema multiforme of the upper trunk and extremities in association with diffuse joint aches or fever. Valley fever occurs in approximately 25% of infected persons, although, more commonly, a diffuse mild erythroderma or maculopapular rash is observed. 

The physiologic sequelae of biotin deficiency are almost unexplored. Severe skin lesions, especially seborrheic dermatitis and Leiner s disease (Erythroderma desquamativum or exfoliative dermatitis), were increased in young infants bom of mothers on a restricted diet low in eggs, livers, and other biotin-rich foods. After biotin administration the lesions healed. There are claims that excess biotin produces a fatty liver characterized by heightened cholesterol content. Choline has no effect in the prevention of biotin-fatty livers (G2, M2). In mice with transplanted tumors, both the tumors and the blood levels of biotin are below normal (R8). More recent studies established a protection with avidin, the biotin-binding fraction of egg white, against tumor formation (K4). More data along these lines are still needed for confirmation. 

Other skin disorders The use of tacrolimus ointment in patients with Netherton syndrome is not recommended because of the potential for increased systemic absorption of tacrolimus. The safety of tacrolimus ointment has not been established in patients with generalized erythroderma. 

Uses Psoriasis Action Keratolytic Dose Apply daily Caution [C, ] Contra Acutely inflamed psoriatic eruptions, erythroderma Disp Cream SE Irritation hair/fingemails/skin discoloration Interactions T Tox if used immediately after long-term topical corticosteroid therapy EMS None OD Unlikely... 

Contraindications Acute psoriasis where inflammation is present, erythroderma, hypersensitivity to anthralin... 

Dermatological system (erythroderma, icthyosis, Stevens-Johnson syndrome, Behcet s disease, acute blistering diseases)... 

Photosensitivity as a complication of flutamide treatment has been described in one unusually severe case, erythroderma proceeded to extensive vitiligo (50). 

Rafael JP, Manuel GG, Antonio V, Carlos MJ. Widespread vitiligo after erythroderma caused by photosensitivity to flutamide. Contact Dermatitis 2004 50 98-100. 

Allergic skin reactions have been described with all sulfonylureas. They include pruritic rashes, erythema nodosum, urticaria, blisters (100), erythema multiforme, exfoliative dermatitis, Quincke s edema, erythroderma, and itching, while lichenoid drug reactions with ulceration have occurred after chlorpropamide and tolazamide (124). More generalized hypersensitivity reactions may prove fatal, but rarely. 

Mycosis fungoides (MF). This mature T cell lymphoma presents in the skin and is composed of small and medium-sized lymphocytes with cere-briform nuclei, which infiltrate the epidermis and dermis. Sezary syndrome is an aggressive variant of MF characterized cliniopathologically by erythroderma, lymphadenopathy, and circulating malignant cells (W9). 

Toxic shock syndrome is a very damaging, often fatal condition caused by toxins from Staphylococcus aureus or Streptococcus pyogenes. First reported in children in 1978, it is manifested by high fever, erythroderma (a skin rash condition), and severe diarrhea.6 Patients may exhibit confusion, hypotension, and tachycardia, and they may go into shock with failure of several organs. Survivors often suffer from skin desquamation (flaky skin). 

Ichthyosis vulgaris X-Linked ichthyosis Lamellar ichthyosis (nonbullous ichthyosiform erythroderma) Epidermolytic hyperkeratosis (bullous ichthyosis)... 

A 34-year-old man took clozapine for several months, but developed a cardiomyopathy. Clozapine was withdrawn and olanzapine 20 mg/day was given instead 60 days later he developed a recurrent high fever, rash, and pruritus. There was bilateral periorbital edema and generalized erythroderma without target lesions or bullae and no mucosal involvement. He also had an eosinophilia and hepatitis. 

Erythroderma Desquamativum and Acrodynia. Studies on erythroderma desquamativum at different stages in several nursing infants were carried out in 1953 by some authors (B13, S2, S3). 

Exanthematic/maculopapular reactions are the most frequent unlike a viral exanthem the eruption typically starts on the trunk the face is relatively spared. Continued use of the drug may lead to erythroderma. They commonly occur at about the ninth day of treatment (or day 2-3 in previously exposed patients), although onset may be delayed until after treatment is completed causes include antimicrobials, especially ampicillin, sulphonamides and derivatives (sulphonylureas, frusemide (furosemide) and thiazide diuretics). Morbilliform (measles-like) eruptions typically recur on rechallenge. 

Exfoliative dermatitis and erythroderma gold, phenytoin, carbamazepine, allopurinol, penicillins, neuroleptics, isoniazid. 

Cutaneous reactions to aldesleukin generally comprise pruritus, flushing, mild to moderate erythematous macular and desquamative eruptions, while generalized erythroderma or photosensitivity have occasionally been observed (95). The severity was not dose-dependent and... 

In 31 patients with Rhus allergy over a 10-year period the clinical manifestations included maculopapular eruptions (65%), erythema multiforme (32%), erythroderma (19%) pustules, purpura, wheals, and blisters (5). All the patients had generalized or localized pruritus, and other symptoms included gastrointestinal problems (32%), fever (26%), chills, and headache. Many developed a leukocytosis (70%) with neutrophilia (88%), and some had toxic effects on the liver or kidneys. All responded to glucocorticoids or antihistamines. 

There have been numerous reports of different rashes in association with ACE inhibitors. The most common skin reaction is a pruritic maculopapular eruption, which is reportedly more common with captopril (2-7%) than with enalapril (about 1.5%). This rash occurs in the usual dosage range and is more common in patients with renal insufficiency (70). Lichenoid reactions, bullous pemphigoid, exfoliative dermatitis, flushing and erythroderma, vasculitis/purpura, subcutaneous lupus erythematosus, and reversible alopecia have aU been reported (70-72). 

Wengrower D, Tzfoni EE, Drenger B, Leitersdorf E. Erythroderma and pneumonitis induced by penicillin Respiration 1986 50(4) 301-3. 

The first dose of GM-CSF can be followed within 3 hours by flushing, hypotension, tachycardia, dyspnea, musculoskeletal pain, and nausea and vomiting (6). At very high doses (generally over 16 micrograms/kg/day), erythroderma, weight gain, and edema with pleuropericardial effusions and ascites have been reported (10). Renal symptoms have also been described (11,12), as have various biochemical abnormalities, possibly due to secondary hyperaldosteronism (13-15). 

Severe erythroderma was observed in five of 10 patients after interferon gamma was added to ciclosporin for autologous bone marrow transplantation (19). 

Horn TD, Altomonte V, Vogelsang G, Kennedy MJ. Erythroderma after autologous bone marrow transplantation modified by administration of cyclosporine and interferon gamma for breast cancer. J Am Acad Dermatol 1996 34(3) 413-17. 

A 38-year-old man with acute myeloid leukemia underwent allogeneic bone marrow transplantation from his brother. He received iopromide 120 ml during CT scanning of the chest 15 months after the transplantation and 6 hours later developed generalized erythroderma, which was treated with oral prednisolone 50 mg. The lesion persisted and cholestatic jaundice developed. Graft-versus-host disease of the skin and liver was diagnosed. The patient stiU required immunosuppressive therapy and prednisolone 18 months after the event. 

In one study, severe erythroderma and a dramatic proliferation of blast cells after each dose of hM-CSF were the only significant severe adverse effects, reported in one patient each (SEDA-19, 345). 

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