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Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 98-99

Erythroderma: How to know if it is drug induced?


Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India

Date of Web Publication28-Dec-2017

Correspondence Address:
Dr. Sudip Das
Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdd.ijdd_39_17

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How to cite this article:
Das S, Sharma N. Erythroderma: How to know if it is drug induced?. Indian J Drugs Dermatol 2017;3:98-9

How to cite this URL:
Das S, Sharma N. Erythroderma: How to know if it is drug induced?. Indian J Drugs Dermatol [serial online] 2017 [cited 2022 Sep 28];3:98-9. Available from: https://www.ijdd.in/text.asp?2017/3/2/98/221753

Exfoliative dermatitis/erythroderma is a generalized inflammatory disorder of the skin manifesting with erythema and scaling affecting >90% of the skin surface.[1] Primary erythroderma arises on normal-looking skin due to an underlying systemic disorder or because of drug reaction, and secondary erythroderma arises from a preexisting dermatosis. There is an increase in the rate of epidermal cell turnover, and transit time of the cells through the epidermis is shortened. Greater amount of cell components are lost in the form of scales, estimated to be 20–30 gm/day. Males, aged above 30 years of age, are affected more often. Erythema is initially localized, scaling usually accompanies or follows erythema. Scales may be fine or large.[2] Large scales are seen in acute cases and small ones in chronic cases [Figure 1] and [Figure 2]. [Table 1] enlists differences between the two so as to help physicians differentiate between the two. Diffuse and fine scaling is usually seen in non -drug induced erythroderma [Figure 2]. Patient complains of pruritus and irritation, more common is feeling of tightness. Apart from these, patient may experience shivering or fever due to temperature dysregulation. Nail changes and lymphadenopathy along with ascites and hepatomegaly can also be seen. Laboratory findings include anemia, hypoproteinemia, raised erythrocyte sedimentation rate, eosinophilia, atypical lymphocytosis. Although it is not easy to pinpoint the etiology, it is very important to differentiate drug induced erythroderma from non drug induced erythroderma. A thorough assessment of signs and symptoms, meticulous history taking and laboratory findings along with histopathology can help in the correct management of patients of erythroderma.
Figure 1: Scaly plaques in a patient of drug-induced erythroderma (picture Courtesy Dr. Yashpal Manchanda, Senior Consultant, AL farwaaniya hospital, Kuwait)

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Figure 2: Diffuse fine scaling and erythema in a patient of psoriatic erythroderma

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Table 1: Differentiating features between Non drug-induced erythroderma and drug-induced erythroderma

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  References Top

1.
César A, Cruz M, Mota A, Azevedo F. Erythroderma. A clinical and etiological study of 103 patients. J Dermatol Case Rep 2016;10:1-9.  Back to cited text no. 1
    
2.
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;5:25-9.  Back to cited text no. 2
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3.
Yacoub MR, Berti A, Campochiaro C, Tombetti E, Ramirez GA, Nico A, et al. Drug induced exfoliative dermatitis: State of the art. Clin Mol Allergy 2016;14:9.  Back to cited text no. 3
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