Histopathology in erythroderma: review of a series of cases by multiple observers

Abstract

This study examines the utility of objective histopathological studies in the evaluation of adult patients with erythroderma. A series of 56 skin biopsies, from 40 erythrodermic patients, was reviewed sequentially by 4 Canadian dermatopathologists who were unaware of clinical details of the cases. The final diagnosis (gold standard), in each instance, had already been determined by others, based on clinicopathologic data and response to therapy. Direct comparison revealed that the mean accuracy of the histopathological diagnoses was 53% (range: 48-66%), a favorable result in view of the difficulty of the task at hand. Additional points of information which evolved from the study are as follows: (i) identification, by microscopy alone, of spongiotic dermatitis, cutaneous T-cell lymphoma and psoriasis, as underlying causes of erythroderma was more successful than that of drug eruptions and pityriasis rubra pilaris; (ii) the epidermotropism which characterizes cutaneous T-cell lymphoma may be mistaken for inflammatory interface changes seen in drug eruptions and vice versa, thus constituting a pitfall in diagnosis; (iii) finally, it appears that submission of multiple simultaneous biopsies, rather than a single specimen, from patients with erythroderma would be likely to enhance the accuracy of histopathological diagnosis.

Erythroderma: A Clinical and Prognostic Study

“…We therefore regard skin biopsy as a useful investigatory tool in making the diagnosis. They are recommended to be carried out as soon as possible and sometimes should be repeated in a different area and a different stage of erythroderma for a final diagnosis [1,9]. In this and previous studies, lymph node biopsy usually demonstrated dermatopathic changes in patients with erythroderma.…”

Erythroderma as an Initial Presentation of Langerhans Cell Histiocytosis Involving the Sinus

“…2 Histology is nonspecific, and despite the presence of signs specific to the primary disease, etiologic diagnosis is often not achieved. 3 LCH is a relatively uncommon entity characterized by oligoclonal proliferation of Langerhans cells. Its incidence is unknown 4 and it is difficult to diagnose.…”

“…1,6 Treatment is indicated in cases that involve multiple or large lesions, persist for more than 6 months (chronic CL), or affect regions at risk of functional or aesthetic compromise, such as the ear lobe. 3,6 Localized forms are treated using local treatments such as intralesional MA (Case 2), the efficacy of which can be very high, albeit variable. 1,2,6 The treatment of choice for chronic forms is parenteral pentavalent antimonials, 3 which can be complemented with local treatments such as cryotherapy, as described in Case 1.…”

Neonatal and Infantile Erythrodermas

“…[23][24][25] The histological findings agreed with the final diagnosis in only 45% of cases, a percentage that is similar to those reported in other studies of adult erythroderma. 26,27 Histological examination can provide the diagnosis of graft-vs-host disease or Omenn syndrome in cases of significant lymphocytic infiltration and keratinocytic necrosis with satellite lymphocytes.…”