Erythroderma: A clinicopathological, etiological study of 136 cases from 2011 to 2021 in East China

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 studied 136 consecutive patients with erythroderma with respect to the epidemiological, clinical, biological, and histological data; treatments; and outcomes from 2011 to 2021. The analyses of qualitative data were performed with the chi-squared 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 19.85% of the patients and was associated with drug reactions (P=0.002). The mean length of stay was 19.18 ± 9.75 days. Clinical findings were dominated by pruritus (99.26%), fever (32.35%), edema (60.29%), nail changes (10.29%), arrhythmia (11.76%), and superficial lymphadenopathy (41.91%). Skin biopsies revealed the cause in 25% of the patients. The most common causative factor was pre-existing dermatoses (78.68%), followed by drug reactions (11.03%), malignancies (5.88%), and undetermined etiology (4.41%). Among the pre-existing dermatoses, eczema was the most common etiology (33.88%). We also found that psoriasis (30.15%), solar dermatitis, hypereosinophilic syndrome, atopic dermatitis, scabies, pemphigus foliaceus, and pityriasis rubra pilaris could be causes of erythroderma. In the drug-induced group, anticonvulsants were the most frequently implicated drug in our study (26.67%). Fever was mostly found in patients with psoriasis (P=0.022). Nail changes and arthralgia were more prevalent among patients with psoriasis (P<0.001). Eosinophilia and an increased immunoglobulin E concentration were associated with hypereosinophilic syndrome (P = 0.005) and eczema (P = 0.032), respectively. Infection was mostly found in patients with psoriasis (P = 0.007). The infection rate was significantly higher in patients with abnormal liver function (P = 0.0005). 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.