Distribution – Specific Differentials


Fig. 3.1 Pityriasis rubra pilaris. From Schwarzenberger K, Werchniak AE, Ko C. General Dermatology. London: Saunders, 2009.


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Fig. 3.2 Psoriasis, erythrodermic. Courtesy, Yale Dermatology Residents’ Slide Collection.

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Fig. 3.3 Congenital ichthyosiform erythroderma (autosomal recessive congenital ichthyosis). A–C, Courtesy, Britt Craiglow, MD; D, Courtesy, Leonard Milstone, MD.

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Fig. 3.4 Sézary syndrome. Courtesy, Rein Willemze, MD. From Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3e. London: Saunders, 2012, with permission.

Atopic dermatitis and other eczematous processes as well as other diseases can also present with erythroderma (Figs 3.5–3.6).


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Fig. 3.5 Pemphigus foliaceus. Courtesy, NYU Slide Collection. From Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3e. London: Saunders, 2012, with permission.

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Fig. 3.6 Toxic epidermal necrolysis-like presentation of acute lupus erythematosus (acute syndrome of apoptotic pan-epidermolysis [ASAP]). Courtesy, Yale Dermatology Residents’ Slide Collection. From Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3e. London: Saunders, 2012, with permission.



Photodistribution


Once a photodistribution is determined (see Fig. 1.16A, Fig. 3.7), the primary involvement of the epidermis versus dermis and the morphology of primary lesions aid in narrowing the differential; for example, epidermal reactions including acute to chronic eczematous/spongiotic changes (Fig. 3.8), epidermal vesiculation (Fig. 3.9), erythematous papules and plaques (Fig. 3.10), and pigmented patches (Fig. 3.11).



Table 3.2


Photoreactions





























Entity Morphology Histopathology
Epidermal photoreactions
Photoallergic reaction

• Acute spongiotic/eczematous process

• Vesicles


• Eosinophils

Phototoxic reaction (e.g. sunburn)

• Depending on severity, erythema to blistering

• Necrotic keratinocytes

Pellagra

• Flaky paint scale and erythema

• Parakeratosis and/or necrosis of the upper epidermis

Chronic actinic dermatitis

• Lichenification and erythema

• Mild spongiosis, acanthosis, hyperkeratosis

Hydroa vacciniforme

• Vesicles and erythema

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Mar 5, 2017 | Posted by in Dermatology | Comments Off on Distribution – Specific Differentials

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