Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
2008:74:5;499-500
doi: 10.4103/0378-6323.44316
PMID: 19052417

A study of erythroderma: Clues from eosinophilia and elevated lactate dehydrogenase levels

Paula Torres-Camacho, Andres Tirado-Sanchez, Rosa Maria Ponce-Olivera
 Service of Dermatology, Hospital General de México, O.D, Mexico

Correspondence Address:
Andres Tirado-Sanchez
Servicio de Dermatología, Hospital General de México, Dr. Balmis 148, Col. Doctores, Deleg, Cuauhtemoc, C.P. 06720, D.F
Mexico
How to cite this article:
Torres-Camacho P, Tirado-Sanchez A, Ponce-Olivera RM. A study of erythroderma: Clues from eosinophilia and elevated lactate dehydrogenase levels. Indian J Dermatol Venereol Leprol 2008;74:499-500
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Erythroderma, first described by Hebra in 1868, is an inflammatory disorder characterized by erythema and scaling involving more than 90% of the body surface. It results from worsening of existing skin disease (psoriasis, atopic dermatitis), or may be caused by drugs or underlying neoplasm; or of unknown cause, with an acute or insidious onset. The prognosis is frequently related to the cause, time of evolution, onset, associated diseases, and laboratory findings. [1]

We studied records of 66 patients with erythroderma, admitted to the Department of Dermatology, Hospital General de Mexico, between 1996 and 2007. Data collected from the records comprised age at onset, time for evolution, symptoms, associated disorders, existing skin disease, drug intake, aggravating factors, and laboratory parameters (hemoglobin, total leukocyte count, erythrocyte sedimentation rate (ESR), serum proteins, serum creatinine, serum electrolytes, serum lactate dehydrogenase (LDH), blood glucose, liver function tests, urine examination, and chest x-ray). Skin biopsies were performed in all cases; lymph node biopsy, CT scan, and determination of β 2 microglobulin levels were undertaken when indicated.

All records selected fulfilled inclusion criteria. The mean age at onset was 44 years (range, 15-84 years). The sample consisted of 18 female and 44 male patients. In our study, erythroderma commonly showed a gradual onset, frequently related to gradual worsening of a preexisting dermatosis (time of evolution, 6.47 + 3.7 months). Itching and chills were the most common symptoms in 100% and 75% of the patients respectively. The most common causes of erythroderma were a) psoriasis (46%), b) carbamazepine which accounted for 69% of drug-related erythroderma and c) cutaneous T-cell lymphoma for underlying neoplasm.

The most important laboratory results were hypo-albuminemia (75%), eosinophilia (35%), and elevated ESR (30%). High levels of LDH were often related to an underlying neoplasm. We also performed a correlation analysis to check for a possible association of eosinophilia and high levels of LDH with paraneoplastic erythroderma (PE) and found that these parameters were frequently associated with this type of erythroderma (497.75 ± 264.64 vs. 99.55 ± 31.46 IU/L, P ≤ 0.05). There were statistically differences in the number of blood eosinophils between patients with and without PE (1.55 ± 0.826 vs. 0.829 ± 0.179 K/mm 3 , P ≤ 0.05).

In patients with erythroderma related to malignancy, LDH and eosinophils levels were higher than those found in patients with erythroderma secondary to other causes. Buechner [2] recognized that a high level of tissue eosinophils is a prognostic factor for death in erythroderma, because there is a greater probability of it being associated with malignancy, mainly T-cell lymphoma. Similar findings on high serum levels of LDH were arrived at by Vonderheid. [3]

A gradual onset is the most frequent pattern of evolution, probably because of the relation with a preexisting dermatosis. Clinical features of the syndrome were almost identical, despite of etiology, with similar data found in other studies. [4]

Nail disease was recorded in all patients, onychodystrophy and Beau´s lines being the most frequent manifestations, probably due to the large number of cases associated with psoriasis. Skin biopsy is a helpful tool, but it always needs to be performed at more than one site to achieve diagnostic accuracy, especially in patients with gradual onset of erythroderma.

Psoriasis was the most common underlying cause of erythroderma, in accordance with previous studies. [1],[4]

In the follow-up, 6 patients died, mainly because of a malignant neoplasm, which suggests that erythroderma does not increase the risk of death; nevertheless, it is a significant cause of distress for patients. We recommend performing a complete medical history to identify the underlying cause so that this cutaneous disease can be treated.

Finally, we conclude that LDH is a useful tool when erythroderma is associated with neoplasms and may be considered as a prognostic factor for death, although in the majority of cases, it is associated with a favorable prognosis.

References
1.
Pal S, Haroon TS. Erythroderma: A clinico-ethiologic study of 90 cases. Int J Dermatol 1998;37:104-7.
[Google Scholar]
2.
Buechner SA, Winkelmann RK. Sιzary syndrome: A clinicopathologic study of 39 cases. Arch Dermatol 1983;119:979-86.
[Google Scholar]
3.
Vonderheid EC, Pena J, Nowell P. Sιzary cell counts in erythrodermic cutaneous T-cell lymphoma: Implications for prognosis and staging. Leuk Lymph 2006;47:1841-56.
[Google Scholar]
4.
Hasan T, Jansen CT. Erythroderma: A follow up of 50 cases. J Am Acad Dermatol 1983;8:836-40.
[Google Scholar]

Fulltext Views
3,285

PDF downloads
1,538
Show Sections