A Clinicopathological, Etiological Analysis of 136 Cases of Erythroderma: A Single-Center Retrospective Study

Objective:Erythroderma is an uncommon and severe skin disorder with many underlying causes and identifying its etiology can facilitate further treatments.This study was performed to evaluate the clinical profile and etiology of erythroderma.Methods:We collected the data on 136 patients diagnosed with erythroderma with respect to the epidemiological,clinical,biological,and histological data,treatments,and outcomes in The First Affiliated Hospital of Ningbo University from 2011 to 2021.The analyses of qualitative data were performed with the chi-square test or Fisher’s exact test.The groups of quantitative data were compared using a t-test or analysis of variance.Results:The patients’mean age in this study was 65.00±16.51 years,with a male:female ratio of 5.8:1.0.Acute onset occurred in 27 patients(19.9%)and was associated with drug reactions(P=0.002).The mean length of stay was 19.18±9.75 days.Clinical characteristics were dominated by pruritus(135,99.3%),fever(44,32.4%),edema(82,60.3%),nail changes(14,10.3%),arrhythmia(16,11.8%),and superficial lymphadenopathy(57,41.9%).Combined with biopsy,history inquiry and laboratory testing,this study found that most common causative factor was pre-existing dermatoses(107,78.7%),followed by drug reactions(15,11.0%),malignancies(8,5.9%),and undetermined etiology(6,4.4%).Among the pre-existing dermatoses,eczema was the most common etiology(33.9%).We also found that psoriasis,solar dermatitis,hypereosinophilic syndrome,atopic dermatitis,scabies,pemphigus foliaceus,and pityriasis rubra pilaris were causes of erythroderma.In the drug-induced group,anticonvulsants were the most frequently implicated drug.Compared to other cause diseases,patients with psoriasis had a significant higher rate of fever(P=0.022),nail changes(P<0.001),arthralgia(P<0.001),and infection(P=0.007).Eosinophilia and an increased immunoglobulin E concentration were associated with hypereosinophilic syndrome(P=0.005)and eczema(P=0.032),respectively compared to other cause diseases.The infection rate was significantly higher in patients with abnormal liver function compared to the patients with normal liver function(P<0.001).Conclusion:Most of the clinical features of erythroderma are unspecific with the exception of fever,nail changes,and arthralgia,which were mostly found in patients with psoriasis.Clinicohistopathological examination helps to establish the etiology of erythroderma and reminder doctors to focus on high-risk populations.

Severe cutaneous adverse drug reactions： a review on epidemiology, etiology, clinical manifestation and pathogenesis

Purpose To review the current progress in epidemiology, etiology, clinical manifestation, and pathophysiology of severe cutaneous adverse drug reactions （SCADRs）. Data sources Data were acquired by using Blackwell-Synergy, PubMed, original articles published in the main Chinese journals and related medical textbooks materials. Study selection and data extraction Throughout the literature review 49 articles were selected. Results SCADRs cases are rare, however, the implication is life threatening with significant mortality rates. Epidemiology studies have shown various incidences from different regions, gender, age, race and concurrent illness. There are typical signs and symptoms for each type of SCADRs, but this is not always so. Drugs associated with inducing SCADRs are anticonvulsants, antibiotics, NSAIDs and antirheumatic drugs. In some countries, especially in Asia, traditional drugs are often the cause of SCADRs. Genetic polymorphisms and viral infections are predisposition factors of SCADRs. Patients with certain genetic alleles and underlying diseases are vulnerable to SCADRs. The exact pathogenesis of SCADRs is not well defined. Nonetheless, recent study showed that reactive metabolites and immunological processes have a significant role in SCADRs. Conclusions The different SCADRs reactions are attributed by different intrinsic factors, such as genetic polymorphisms, gender, age and race as well as extrinsic factors, such as underlying diseases. Different regions and culprit drugs also play a role in the various types of SCADRs.