RT Book, Section
A1 Usatine, Richard P.
A1 Smith, Mindy A.
A1 Chumley, Heidi S.
A1 Mayeaux, E.J.
SR Print(0)
ID 57680459
T1 Chapter 156. Erythroderma
T2 The Color Atlas of Family Medicine, 2e
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-176964-8
LK accessmedicine.mhmedical.com/content.aspx?aid=57680459
RD 2024/10/05
AB A  34-year-old  man  presented  with  red  skin  from  his  neck  to  his  feet  for  the  last  month  (Figure  156-1).  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  done  to  confirm  this.  A  complete  blood  count  (CBC)  and  chemistry  panel  were  ordered  in  anticipation  of  the  patient  needing  systemic  medications.  A  purified  protein  derivative  (PPD)  was  also  placed.  The  patient  was  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  showed  mild  elevation  in  his  liver  function  tests  (LFTs)  only.  The  following  day  his  PPD  was  negative  and  he  was  already  feeling  a  bit  better  from  the  topical  triamcinolone.  Cyclosporine  was  started  and  the  patient  improved  rapidly.