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Erythroderma (Generalized Exfoliative Dermatitis) Differential Diagnoses

  • Author: Sanusi H Umar, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Mar 03, 2016
 
 
 
Contributor Information and Disclosures
Author

Sanusi H Umar, MD, FAAD Clinical Instructor of Medicine, Department of Medicine, Division of Dermatology, University of California, Los Angeles, David Geffen School of Medicine

Sanusi H Umar, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

A Paul Kelly, MD Chief, Clinical Professor, Department of Internal Medicine, Division of Dermatology, King/Drew Medical Center, Charles Drew University of Medicine and Science

A Paul Kelly, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, National Medical Association, Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

James W Patterson, MD Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

References
  1. Verma P, Bhattacharya SN, Banerjee BD, Khanna N. Oxidative stress and leukocyte migration inhibition response in cutaneous adverse drug reactions. Indian J Dermatol Venereol Leprol. 2012 Sep-Oct. 78(5):664. [Medline].

  2. Sarkar R, Garg VK. Erythroderma in children. Indian J Dermatol Venereol Leprol. 2010 Jul-Aug. 76(4):341-7. [Medline].

  3. Fraitag S, Bodemer C. Neonatal erythroderma. Curr Opin Pediatr. 2010 Aug. 22(4):438-44. [Medline].

  4. Yuan XY, Guo JY, Dang YP, Qiao L, Liu W. Erythroderma: A clinical-etiological study of 82 cases. Eur J Dermatol. 2010 May-Jun. 20(3):373-7. [Medline].

  5. Jusufbegovic D, Char DH. Clinical variability of ocular involvement in mycosis fungoides. JAMA Ophthalmol. 2015 Mar. 133(3):341-3. [Medline].

  6. Mateo S, García-Martínez FJ, Sánchez-Aguilar D, Amarelo J, Toribio J. Psoriasiform exfoliative erythroderma induced by golimumab. Clin Exp Dermatol. 2014 Aug 22. 39(7):813-15. [Medline].

  7. Nishizawa A, Igawa K, Teraki H, Yokozeki H. Diffuse disseminated lichenoid-type cutaneous sarcoidosis mimicking erythroderma. Int J Dermatol. 2014 Aug. 53(8):e369-70. [Medline].

  8. Doukaki S, Aricò M, Bongiorno MR. Erythroderma related to the administration of 99mTc-sestamibi: the first report. J Nucl Cardiol. 2010 Jun. 17(3):520-2. [Medline].

  9. Rolfes N, Lümmen G. Hypertension and palmar plantar erythroderma. Management of adverse events of angiogenetic inhibitors in the treatment of renal cell carcinoma. [Article in German]. Urologe A. 2011 Nov. 50(11):1387-91. [Medline].

  10. Huang HY, Luo XQ, Chan LS, Cao ZH, Sun XF, Xu JH. Cutaneous adverse drug reactions in a hospital based Chinese population. Clin Exp Dermatol. 2011 Mar. 36(2):135-41. [Medline].

  11. Zhang B, Bolognia J, Marks P, Podoltsev N. Enhanced skin toxicity associated with the combination of clofarabine plus cytarabine for the treatment of acute leukemia. Cancer Chemother Pharmacol. 2014 Aug. 74(2):303-7. [Medline].

  12. Zhang JC, Sun YT. Efavirenz-induced exfoliative dermatitis. Scand J Infect Dis. 2013 Jan. 45(1):70-2. [Medline].

  13. Ram-Wolf C, Mahé E, Saiag P. Escitalopram photo-induced erythroderma. J Eur Acad Dermatol Venereol. 2008 Aug. 22(8):1015-7. [Medline].

  14. Mumoli N, Luschi R, Camaiti A, Cei M, Bagnoni G, Biondi A. Severe exfoliative dermatitis caused by esomeprazole. J Am Geriatr Soc. 2011 Dec. 59(12):2377-8. [Medline].

  15. Dua R, Sindhwani G, Rawat J. Exfoliative dermatitis to all four first line oral anti-tubercular drugs. Indian J Tuberc. 2010 Jan. 57(1):53-6. [Medline].

  16. Lee HY, Tay LK, Thirumoorthy T, Pang SM. Cutaneous adverse drug reactions in hospitalized patients. Singapore Med J. 2010 Oct. 51(10):767-74. [Medline].

  17. Reynaud F, Giraud P, Cisterne JM, Verdier D, Kouchakipour Z, Hermelin A, et al. Acute immune allergic interstitial nephritis after treatment with fluindione. Seven cases. [Article in French]. Nephrol Ther. 2009 Jul. 5(4):292-8. [Medline].

  18. Tamer E, Gur G, Polat M, Alli N. Flare-up of pustular psoriasis with fluoxetine: possibility of a serotoninergic influence?. J Dermatolog Treat. 2009. 20(3):1-3. [Medline].

  19. Ozuguz P, Kacar SD, Ozuguz U, Karaca S, Tokyol C. Erythroderma secondary to gliclazide: a case report. Cutan Ocul Toxicol. 2014 Dec. 33(4):342-4. [Medline].

  20. Hulmani M, Nandakishore B, Bhat MR, Sukumar D, Martis J, Kamath G, et al. Clinico-etiological study of 30 erythroderma cases from tertiary center in South India. Indian Dermatol Online J. 2014 Jan. 5(1):25-9. [Medline].

  21. Kumar S, Mahajan BB, Kaur S, Banipal RP, Singh A. Imatinib mesylate induced erythroderma: A rare case series. J Cancer Res Ther. 2015 Oct-Dec. 11(4):993-6. [Medline].

  22. Markvardsen LH, Jakobsen J. Exfoliative dermatitis as a side effect of intravenous immunoglobulin treatment. [Article in Danish]. Ugeskr Laeger. 2011 Oct. 173(43):2725-6. [Medline].

  23. Igawa K, Konishi M, Moriyama Y, Fukuyama K, Yokozeki H. Erythroderma as drug eruption induced by intravesical mitomycin C therapy. J Eur Acad Dermatol Venereol. 2015 Mar. 29(3):613-4. [Medline].

  24. Choi CU, Rha SW, Suh SY, Kim JW, Kim EJ, Park CG, et al. Extensive exfoliative dermatitis induced by non-ionic contrast medium Iodixanol (Visipaque) used during percutaneous coronary intervention. Int J Cardiol. 2008 Feb. 124(2):e25-7. [Medline].

  25. Vaish AK, Tripathi AK, Gupta LK, Jain N, Agarwal A, Verma SK. An unusual case of DRESS syndrome due to leflunomide. BMJ Case Rep. 2011 Sep. 2011:[Medline].

  26. Sadeghpour M, Bunick CG, Robinson DM, Galan A, Tigelaar RE, Imaeda S. Midodrine-induced acute generalized exanthematous pustulosis. Cutis. 2014 May. 93(5):E17-20. [Medline].

  27. Arai S, Mukai H. Erythroderma induced by morphine sulfate. J Dermatol. 2011 Mar. 38(3):288-9. [Medline].

  28. Bhandarkar AP, Kop, PB, Pai VV. Nevirapine induced exfoliative dermatitis in an HIV-infected patient. Indian J Pharmacol. 2011 Nov-Dec. 43(6):738-739. [Medline].

  29. Sánchez-Borges M, González-Aveledo L. Exfoliative erythrodermia induced by pantoprazole. Allergol Immunopathol (Madr). 2012 May-Jun. 40(3):194-5. [Medline].

  30. Bilaç C, Müezzinoğlu T, Ermertcan AT, Kayhan TC, Temeltaş G, Oztürkcan S, et al. Sorafenib-induced erythema multiforme in metastatic renal cell carcinoma. Cutan Ocul Toxicol. 2009. 28(2):90-2. [Medline].

  31. Smith EV, Shipley DR. Severe exfoliative dermatitis caused by strontium ranelate: two cases of a new drug reaction. Age Ageing. 2010 May. 39(3):401-3. [Medline].

  32. Eyler JT, Squires S, Fraga GR, Liu D, Kestenbaum T. Two cases of acute generalized exanthematous pustulosis related to oral terbinafine and an analysis of the clinical reaction pattern. Dermatol Online J. 2012 Nov. 18(11):5. [Medline].

  33. Nakamura M, Tokura Y. Tocilizumab-induced erythroderma. Eur J Dermatol. 2009 May-Jun. 19(3):273-4. [Medline].

  34. Rowe CJ, Robertson I, James D, McMeniman E. Warfarin-induced erythroderma. Australas J Dermatol. 2015 Feb. 56(1):e15-7. [Medline].

  35. Byer RL, Bachur RG. Clinical deterioration among patients with fever and erythroderma. Pediatrics. Dec 2006. 118(6):2450-60. [Medline].

  36. Clark RA, Shackelton JB, Watanabe R, Calarese A, Yamanaka K, Campbell JJ, et al. High-scatter T cells: a reliable biomarker for malignant T cells in cutaneous T-cell lymphoma. Blood. 2011 Feb 10. 117(6):1966-76. [Medline].

  37. Kirsch IR, Watanabe R, O'Malley JT, Williamson DW, Scott LL, Elco CP, et al. TCR sequencing facilitates diagnosis and identifies mature T cells as the cell of origin in CTCL. Sci Transl Med. 2015 Oct. 7(308):308ra158. [Medline].

  38. Sbidian E, Battistella M, Rivet J, Flageul B, Molina JM, Joly P, et al. Remission of severe CD8(+) cytotoxic T cell skin infiltrative disease in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy. Clin Infect Dis. 2010 Sep. 51(6):741-8. [Medline].

  39. Griffiths TW, Stevens SR, Cooper KD. Acute erythroderma as an exclusion criterion for idiopathic CD4+ T lymphocytopenia. Arch Dermatol. 1994 Dec. 130(12):1530-3. [Medline].

  40. Bosseila M, Mahgoub D, El-Sayed A, Salama D, Abd El-Moneim M, Al-Helf F. Does fluorescence diagnosis have a role in follow up of response to therapy in mycosis fungoides?. Photodiagnosis Photodyn Ther. 2014 Dec. 11(4):595-602. [Medline].

  41. Scrivener Y, Cribier B, Le Coz C, Boehm N, Jelen G, Heid E, et al. Erythroderma with immunoglobulin deposits along the basal membrane. Pemphigoid erythroderma? [Article in French]. Ann Dermatol Venereol. 1998 Jan. 1. 25(1):13-7. [Medline].

  42. Ram-Wolff C, Martin-Garcia N, Bensussan A, Bagot M, Ortonne N. Histopathologic diagnosis of lymphomatous versus inflammatory erythroderma: a morphologic and phenotypic study on 47 skin biopsies. Am J Dermatopathol. 2010 Dec. 32(8):755-63. [Medline].

  43. Lee WK, Kim GW, Cho HH, Kim WJ, Mun JH, Song M, et al. Erythrodermic psoriasis treated with golimumab: a case report. Ann Dermatol. 2015 Aug. 27(4):446-9. [Medline].

  44. Wang J, Wang YM, Ahn HY. Biological products for the treatment of psoriasis: therapeutic targets, pharmacodynamics and disease-drug-drug interaction implications. AAPS J. 2014 Sep. 16(5):938-47. [Medline].

  45. Sanford M, McKeage K. Secukinumab: first global approval. Drugs. 2015 Feb. 75(3):329-38. [Medline].

  46. Alberti-Violetti S, Talpur R, Schlichte M, Sui D, Duvic M. Advanced-stage mycosis fungoides and Sézary syndrome: survival and response to treatment. Clin Lymphoma Myeloma Leuk. 2015 Jun. 15(6):e105-12. [Medline].

  47. Cather JC, Crowley JJ. Use of biologic agents in combination with other therapies for the treatment of psoriasis. Am J Clin Dermatol. 2014 Dec. 15(6):467-78. [Medline].

  48. Rosenbach M, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo BF Jr, et al. Treatment of erythrodermic psoriasis: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010 Apr. 62(4):655-62. [Medline].

  49. Armstrong AW, Bagel J, Van Voorhees AS, Robertson AD, Yamauchi PS. Combining biologic therapies with other systemic treatments in psoriasis: evidence-based, best-practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015 Apr. 151(4):432-8. [Medline].

  50. Al Hothali GI. Review of the treatment of mycosis fungoides and Sézary syndrome: A stage-based approach. Int J Health Sci (Qassim). 2013 Jun. 7(2):220-39. [Medline].

  51. Rupoli S, Canafoglia L, Goteri G, Leoni P, Brandozzi G, Federici I, et al. Results of a prospective phase II trial with oral low dose bexarotene plus photochemotherapy (PUVA) in refractory and/or relapsed patients with mycosis fungoides. Eur J Dermatol. 2015 Dec 16. [Epub ahead of print]. [Medline].

  52. Sokolowska-Wojdylo M, Florek A, Zaucha JM, Chmielowska E, Giza A, Knopinska-Posluszny W, et al. Polish Lymphoma Research Group experience with bexarotene in the treatment of cutaneous T-cell lymphoma. Am J Ther. 2014 Apr 11. [Epub ahead of print]. [Medline].

  53. Chung CG, Poligone B. Cutaneous T cell lymphoma: an update on pathogenesis and systemic therapy. Curr Hematol Malig Rep. 2015 Dec. 10(4):468-76. [Medline].

  54. Galper SL, Smith BD, Wilson LD. Diagnosis and management of mycosis fungoides. Oncology (Williston Park). 2010 May. 24(6):491-501. [Medline].

  55. Wilcox RA. Cutaneous T-cell lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 2016 Jan. 91(1):151-65. [Medline].

  56. Humme D, Nast A, Erdmann R, Vandersee S, Beyer M. Systematic review of combination therapies for mycosis fungoides. Cancer Treat Rev. 2014 Sep. 40(8):927-33. [Medline].

  57. Hughes CF, Khot A, McCormack C, Lade S, Westerman DA, Twigger R, et al. Lack of durable disease control with chemotherapy for mycosis fungoides and Sézary syndrome: a comparative study of systemic therapy. Blood. 2015 Jan. 125(1):71-81. [Medline].

  58. Duvic M, Olsen EA, Breneman D, Pacheco TR, Parker S, Vonderheid EC, et al. Evaluation of the long-term tolerability and clinical benefit of vorinostat in patients with advanced cutaneous T-cell lymphoma. Clin Lymphoma Myeloma. 2009 Dec. 9(6):412-6. [Medline].

  59. Prince HM, Dickinson M, Khot A. Romidepsin for cutaneous T-cell lymphoma. Future Oncol. 9(12). 2013 Dec.:1819-27. [Medline].

  60. Foss F, Advani R, Duvic M, Hymes KB, Intragumtornchai T, Lekhakula A, et al. A Phase II trial of Belinostat (PXD101) in patients with relapsed or refractory peripheral or cutaneous T-cell lymphoma. Br J Haematol. 2015 Mar. 168(6):811-9. [Medline].

  61. Guttman-Yassky E, Dhingra N, Leung DY. New era of biologic therapeutics in atopic dermatitis. Expert Opin Biol Ther. 2013 Apr. 13(4):549-61. [Medline].

  62. Lancrajan C, Bumbacea R, Giurcaneanu C. Erythrodermic atopic dermatitis with late onset--case presentation. J Med Life. 2010 Jan-Mar. 3(1):80-3. [Medline].

  63. Zackheim HS, Kashani-Sabet M, Hwang ST. Low-dose methotrexate to treat erythrodermic cutaneous T-cell lymphoma: results in twenty-nine patients. J Am Acad Dermatol. 1996 Apr. 34(4):626-31. [Medline].

  64. Sigurdsson V, Toonstra J, van Vloten WA. Idiopathic erythroderma: a follow-up study of 28 patients. Dermatology. 1997. 194(2):98-101. [Medline].

  65. Patel S, Patel T, Kerdel FA. The risk of malignancy or progression of existing malignancy in patients with psoriasis treated with biologics: case report and review of the literature. Int J Dermatol. 2015 Dec. [Epub ahead of print]. [Medline].

  66. Hsu L, Armstrong AW. Anti-drug antibodies in psoriasis: a critical evaluation of clinical significance and impact on treatment response. Expert Rev Clin Immunol. 2013 Oct. 9(10):949-58. [Medline].

  67. Zattra E, Belloni Fortina A, Peserico A, Alaibac M. Erythroderma in the era of biological therapies. Eur J Dermatol. 2012 Mar-Apr. 22(2):167-71. [Medline].

  68. Sigurdsson V, Toonstra J, Hezemans-Boer M, van Vloten WA. Erythroderma. A clinical and follow-up study of 102 patients, with special emphasis on survival. J Am Acad Dermatol. 1996 Jul. 35(1):53-7. [Medline].

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Exfoliative dermatitis diffuse skin involvement.
Exfoliative dermatitis close-up view showing erythema and scaling.
Table. Drugs Implicated in the Causation of Exfoliative Dermatitis
99mTC-sestamibi[8] ACE inhibitorsAllopurinolAminoglutethimideAmiodarone
AmitriptylineAmoxicillinAmpicillinAngiogenetic inhibitors[9] Arsenic
AspirinAtropineAuranofinAurothioglucoseBarbiturates
BenactyzineBeta-blockersBeta caroteneBumetanideBupropion
ButabarbitalButalbitalCaptoprilCarbamazepineCarbidopa
Cephalosporins[10] ChloroquineChlorpromazineChlorpropamideCimetidine
CiprofloxacinCisplatinClofarabine[11] ClofazimineClofibrate
Co-trimoxazoleCromolynCytarabineDapsoneDemeclocycline
DesipramineDiazepamDiclofenacDiflunisalDiltiazem
DoxorubicinDoxycyclineEfavirenz[12] EnalaprilEscitalopram[13]
Esomeprazole[14] Ethambutol[15] EtodolacFenofibrate[16] Fenoprofen
FluconazoleFluindione[17] Fluoxetine[18] FluphenazineFlurbiprofen
FurosemideGemfibrozilGliclazide[19] Glipizide[20] Gold
GriseofulvinHydroxychloroquineImatinib[21] ImipramineIndomethacin
Intravenous immunoglobulin[22] Intravesical mitomycin C[23] Iodixanol[24] IsoniazidIsosorbide
KetoconazoleKetoprofenKetorolacLeflunomide[25] Lithium
MeclofenamateMefenamic AcidMeprobamateMethylphenidate
Midodrine[26] MinocyclineMorphine sulfate[27] Nalidixic AcidNaproxen
Nevirapine[28] Nitrazepam[20] NifedipineNitrofurantoinNitroglycerin
NizatidineNorfloxacinOmeprazolePantoprazole[29] Penicillamine
PenicillinPentobarbitalPerphenazinePhenobarbitalPhenothiazines
PhenylbutazonePhenytoinPiroxicamPrimidoneProchlorperazine
PropranololPyrazinamide[15] PyrazolonesQuinaprilQuinidine
QuinineRetinoidsRifampinSorafenib[30] Streptomycin
Strontium ranelate[31] SulfadoxineSulfamethoxazoleSulfasalazineSulfisoxazole
SulfonamidesSulfonylureasSulindacTerbinafine[32] Tetracycline
TobramycinTocilizumab[33] TrazodoneTrifluoperazineTrimethoprim
VancomycinVerapamilWarfarin[34]
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