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A Study of Correlation Between Clinical and Histopathological ORIGINAL ARTICLE A Study of Correlation Between Clinical and Histopathological Findings of Erythroderma in North Bengal Population Sabyasachi Banerjee, Swarup Ghosh1, Rajesh Kumar Mandal2 Abstract From the Department of Background: Erythroderma is a reaction pattern characterized by erythema and Dermatology, STD and Leprosy desquamation of 90% or more body surface area along with some metabolic alterations. Malda Medical College, 1 Materials and Methods: Here we studied 32 patients of erythroderma at of North Bengal Medical Department of Pathology, Asansol SD Hospital, Burdwan, 2Department College for a period of 1 year to find the etiology, clinical features and histological changes. of Dermatology, STD, and Leprosy, Detailed history was taken from all the patients followed by relevant biochemical investigations North Bengal Medical College, and histological examination. To correlate the clinical and histopathological findings chi square Darjeeling, West Bengal, India test was used. Results: Male preponderance was present and most of them were in the 4th or 5th decade. Etiologically the patients were divided into secondary erythroderma developing over pre-existing dermatoses, and idiopathic erythroderma. Secondary erythroderma (n = 24) Address for correspondence: cases outnumbered the idiopathic cases (n = 8). Among the pre-existing dermatoses, psoriasis Dr. Rajesh Kumar Mandal, was found to be the most common etiologic agent. Apart from erythema the other common Department of Dermatology, STD, presenting features were scaling and itching. Histopathological categorization was possible in and Leprosy, North Bengal Medical 59.3% cases, rest of the cases showed non-specific dermatitis. The most common histopathologic College, Darjeeling, West Bengal, diagnosis was psoriasis (21.8% of cases). Conclusions: Our study of clinicopathological India. E-mail: drrajeshkumar. correlation of erythroderma patients among north bengal population corroborates with most [email protected] of the previous studies done in other areas. As ours is a cross-sectional study in a undefined population so we could not determine the true incidence of erythroderma in north bengal population. We might have missed lymphoma as a cause of erythroderma in idiopathic cases due to lack of long follow-up, so we understand that further studies over a defined population with long follow-up is needed to determine the true incidence and causes of idiopathic erythroderma. Key Words: Clinical, correlation, erythroderma, histopathology What was known? Erythroderma is a reaction pattern characterized by erythema and desquamation of 90% or more body surface area along with some metabolic alterations. It mostly occurs secondary to psoriasis but can be primary also. As it is a serious disease and the treatment is mainly based on the etiology, diagnosing the cause is very important which relies mostly on histopathology. Introduction necessary for cells to mature and travel through the epidermis is decreased. This compressed maturation Erythroderma, first described by Hebra in 1868, is process results in an overall greater loss of epidermal a reaction pattern characterized by generalized and material, which is manifested clinically as severe scaling confluent erythema with desquamation affecting more and shedding. than 90% of body surface area [Figure 1a and 1b] and Exfoliative dermatitis accounts for about 1% of all is usually accompanied by other systemic manifestations hospital admissions for dermatologic conditions.[3] Overall resulting in hemodynamic and metabolic incidence is 1 to 2 patients per 100,000 populations.[5] [1-4] derangements. In Indian subcontinent, one large prospective study has Erythroderma is the result of a dramatic increase in the epidermal turnover rate. In patients with this disorder, the mitotic rate and the absolute number of germinative skin cells are higher than normal. Moreover, the time Access this article online Quick Response Code: Website: www.e‑ijd.org DOI: 10.4103/0019‑5154.169124 a b Figure 1: (a) Erythroderma (psoriatic). (b) Erythroderma (non-specific) 549 Indian Journal of Dermatology 2015; 60(6) Banerjee, et al.: Clinicopathological correlation of erythroderma patients shown that overall incidence of erythroderma is 35 per wherever indicated. A punch biopsy was done under 100,000 dermatological patients.[6] sterile environment for histological examination. Primary erythroderma develops in normal skin and Data were analyzed using standard statistical tools. etiological factors are drug reactions, lymphomas and Patients with bleeding disorders (contraindicated for hematological malignancies or may be idiopathic (25%).[7,8] punch biopsy) and seriously ill moribund patients were On the other hand, secondary erythroderma develops excluded from the study due to non-availability of through generalization of existing dermatoses such as informed consent. Ethical approval was taken from the eczema, psoriasis, pityriasis rubra pilaris, lichen planus, Institutional Ethics Committee. etc.[7] Correlation of clinical diagnosis with histological findings Since erythroderma is a serious disease due to its ability was thoroughly studied. Data were analyzed using to cause metabolic derangement, optimal therapy is very standard statistical tools. important, which again depends upon the establishment Results and Analysis of the causes.[9] Most of the erythroderma patients were in the age group Laboratory findings are typically unhelpful in of 4th and 5th decades (31.25% each, n = 10) [Table 1]. The [10] establishing etiology of erythroderma. A skin biopsy is minimum age of the patient with clinical presentation of the only relevant investigation as the histopathological erythroderma was 16 years and the maximum age was features of the underlying disorders are recognizable 69 years with a mean age of 41.81 years and median [11,12] in more than half of the cases. A comprehensive value was 42 years. The ratio between male and female clinicopathological correlation is of substantial in this study was 1.66:1. importance to render the diagnosis of the cause.[13] Psoriatic erythroderma was more common in 4th and Etiological factors depend largely on the population 5th decades of life [Table 1]. Seborrheic dermatitis as studied, though clinical presentations may essentially a cause of erythroderma was seen in the age group of [14] be the same. As no earlier published study was 3rd and 4th decade. Erythroderma due to atopic dermatitis found even after diligent search regarding frequency was seen in younger populations (before 5th decade of of underlying causes of erythroderma in North Bengal life). Idiopathic erythroderma cases seen in this study population, this study might be helpful to asses any were in the age group of 5th and 6th decades of life. variation in clinical, etiological and histopathological profiles among these patients. The majority (68.75%, n = 22) of erythroderma cases had chronic onset whereas 31.25% (n = 10) cases had acute The aims of the study were to do histopathological onset. Out of 20 erythroderma cases due to pre-existing categorization of clinically diagnosed erythroderma dermatoses, 17 cases (85%) presented with chronic onset. patients among North Bengal population and to observe All 4 cases with drug-induced erythroderma presented correlation between clinical and histopathological with acute onset, whereas 37.5% (3 out of 8) cases with diagnosis. idiopathic erythroderma presented with acute onset and Materials and Methods remaining 62.5% cases presented with chronic onset. Cases with more than 6 weeks of duration were considered Clinically diagnosed cases of erythroderma attending as chronic erythroderma as an operational definition. OPD and IPD of dermatology and medicine department of North Bengal Medical College for a period of Apart from erythema and scaling which was seen 1 year were evaluated by detailed history taking and in all erythroderma patients, itching was found in clinical examinations after informed consent. All the 22 (68.7%) out of 32 cases [Table 2]. Nail changes findings were recorded in case data sheet. All required were evident only in cases secondary to psoriasis, biochemical tests were performed. HIV screening was with 7 (63.6%) out of 11 cases of psoriasis presented done in all patients. Radiological tests like X-ray, with nail changes. Eight (25%) cases presented with echocardiography and ultrasonography were performed hair changes including crusting within hair shaft Table 1: Age wise distribution of erythroderma cases with different clinical etiologies Etiological diagnosis 10-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years Total (%) Psoriasis - - 05 03 03 - 11 (34.37) Seborrheic dermatitis - 01 02 - - - 03 (9.37) Atopic dermatitis 01 02 01 - - - 04 (12.5) Contact dermatitis - - 01 - 01 - 02 (6.25) Drug induced - - 01 03 - - 04 (12.5) Idiopathic - - - 04 03 01 08 (25) Indian Journal of Dermatology 2015; 60(6) 550 Banerjee, et al.: Clinicopathological correlation of erythroderma patients Table 2: Correlation of clinical features and etiological types Etiological types Scaling Plaque/ Itching Nail Hair Oozing Mucosal Lymph Associated papules changes changes lesion nodes systemic features Psoriasis 11 02 08 07 05 07 - 01 09 Atopic dermatitis 04 02 04 - - 02 - 01 Seborrheic dermatitis 03 01 02 - 03 01 - 02 02 Contact dermatitis 02 02 02 - - - - 01 - Drug induced 04 01 01 - - - 03 - Idiopathic 08 03 05 - - 01 - 03 Total 32 11 22 07 08 11 03 04 15 100% 34.3% 68.7% 21.8% 25% 34.3%
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