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Abstract
Erythroderma is an uncommon, potentially life-threatening condition, which has many causes, including uncontrolled psoriasis. We present a 58-year-old woman with psoriasis who, after an abrupt discontinuation of systemic corticosteroids, developed erythrodermic psoriasis with extensive body surface involvement requiring hospital admission. Erythrodermic psoriasis requires a high index of suspicion to diagnose it in a timely fashion and treat it to prevent complications.
Keywords:
Erythroderma is characterized by generalized erythema of the skin and frequently involves >80% to 90% of body surface area (BSA).1-3 It is a dramatic presentation that can arise from psoriasis, atopic dermatitis, cutaneous T-cell lymphoma, or drug reactions, but is idiopathic in about 25% of cases.1,2 Acute erythroderma can lead to complications such as water-electrolyte imbalance, hypothermia, cardiac failure, and secondary infections.1,4 The differential diagnosis includes other potentially life-threatening dermatologic conditions: drug reactions, erythema multiforme, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).5
CASE DESCRIPTION
A 58-year-old woman presented with a 2-month history of rash initially involving her left lower extremity, which became more diffuse. At an outside clinic, the patient told the provider that she had a history of psoriasis, and oral prednisone was prescribed and continued for 5 months. During this time, the dosage was up-titrated but symptoms persisted. The prednisone was stopped due to hematemesis and concern for gastritis. Over the following 2 weeks, the rash involved >90% of her total BSA. The rash was erythematous and exfoliative with significant sloughing of skin, accompanied by pruritus, burning pain, occasional clear discharge, and xerophthalmia. Notably, there was no mucosal membrane involvement. A punch biopsy was obtained, revealing...