![]() They listed the following conditions to consider in differential diagnosis of erythrodermic PRP: psoriasis, atopic dermatitis, CTCL, generalized hypersensitivity reactions, immunobullous diseases, acquired ichthyosis, and erythrokeratoderma variabilis. "Some patients with PRP type V have an autosomal dominantly-acquired or sporadic genetic variant of caspase recruitment domain family, member 14 (CARD14), which is an activator of a signaling pathway involved in inflammation," the case authors wrote. The physiological process that gives rise to PRP is not known, Vleugels and co-authors noted, adding that in some cases, bacterial or viral infections have been thought to trigger the condition. In the U.S., fewer than 5,000 people have currently been diagnosed with PRP, according to the NIH's Genetic and Rare Diseases Information Center. In addition, numerous medications, including antibiotics and anticonvulsants, have been noted to cause erythroderma in some patients. ![]() And because it damages the skin barrier, erythroderma is linked with an increased risk of cellulitis.Įrythroderma typically occurs in patients with psoriasis or eczema, but may also develop in patients with an infection such as HIV, or scabies, in those with a malignancy such as cutaneous T-cell lymphoma (CTCL), and those with an inherited skin disease. It is considered a dermatologic emergency because it can result in excessive loss of fluid and heat, thus putting the patient at risk of hypothermia and rigors, inadequate hydration, low blood pressure, and high-output cardiac failure. The case authors explained that erythroderma, or exfoliative dermatitis, involves widespread reddening and scaling of the skin, affecting more than 90% of the body surface area. ![]() ![]() Three years after his initial presentation, the patient's skin had returned to normal, and he continued to receive treatment with infliximab (5 mg/kg every 6 weeks) and methotrexate (12.5 mg weekly). He received oculoplastic surgery to repair his drooping lower eyelid. The medical team applied topical triamcinolone ointment (0.1%) daily to the patient's trunk, arms, and legs, which were wrapped with warm, damp gauze and covered with dry, cotton pajamas.Ī follow-up examination 6 months later showed that the patient's erythroderma had resolved. The patient was admitted to hospital, where he received intravenous fluids. His lower eyelid had turned outward, so he was unable to completely close his eyes.Ĭlinicians referred the patient to the emergency department for blood tests, which showed normal levels for both complete blood cell count and lactate dehydrogenase level. ![]() The volar aspect of the patient's hands and feet were affected by waxy, peeling scaling, and his nails were thickened and separated from the nail bed. On physical examination, clinicians observed "confluent salmon-colored plaques composed of folliculocentric scaly papules across his body." On his trunk, these were mixed with areas of unaffected skin. When he presented to the dermatology clinic, his temperature was 37.1° C (98.8° F), his blood pressure was 128/86 mm Hg, his heart rate was 110/min, and his respiratory rate was 30/min. ![]()
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