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

Abstract

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.