RT Book, Section
A1 Henderson, David
A1 Wong, Tiffanie C.
A2 Usatine, Richard P.
A2 Smith, Mindy A.
A2 Mayeaux, Jr., E.J.
A2 Chumley, Heidi S.
SR Print(0)
ID 1164360709
T1 Erythroderma
T2 The Color Atlas and Synopsis of Family Medicine, 3e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259862045
LK accessmedicine.mhmedical.com/content.aspx?aid=1164360709
RD 2024/04/17
AB A  34-year-old  man  presented  with  red  skin  from  his  neck  to  his  feet  for  the  last  month  (Figure  162-1).  He  was  having  a  lot  of  itching,  and  his  skin  was  shedding  so  that  wherever  he  would  sit,  there  would  be  a  pile  of  skin  that  would  remain.  He  denied  fever  and  chills.  He  admitted  to  smoking  and  drinking  heavily.  The  patient's  vital  signs  were  stable  with  normal  blood  pressure,  and  he  preferred  not  to  be  hospitalized.  He  had  some  nail  pitting  but  no  personal  or  family  history  of  psoriasis.  The  presumed  diagnosis  was  erythrodermic  psoriasis,  but  a  punch  biopsy  was  performed  to  confirm  this.  A  complete  blood  count  (CBC)  and  chemistry  panel  were  ordered  in  anticipation  of  the  patient  requiring  systemic  medications.  A  purified  protein  derivative  (PPD)  was  also  placed  at  this  time.  The  patient  was  then  started  on  total  body  0.1%  triamcinolone  under  wet  wrap  overnight  and  given  a  follow-up  appointment  for  the  next  day.  The  patient  was  also  counseled  to  quit  smoking  and  drinking.  The  following  day  his  labs  only  revealed  mild  elevation  in  his  liver  function  tests  (LFTs).  Two  days  following  initial  presentation,  his  PPD  was  negative  and  he  was  already  feeling  a  bit  better  from  the  topical  triamcinolone.  Cyclosporine  was  promptly  initiated,  and  the  patient  improved  rapidly  as  a  result.