Case Studies

Case 1 - A man with generalised erythema

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This 55-year-old man presented with a few weeks' history of feeling generally unwell with associated dry red skin affecting most of his body. His past medical history was unremarkable except for some scaly pink patches of skin on his elbows, knees and scalp. His brother also apparently had similar scaly patches on his knees.

• (a) What skin sign is being described in this patient?

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  Erythroderma

• (b) What is the most likely underlying cause of his skin problem?

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  Psoriasis. The previous history of skin lesions typical of psoriatic plaques makes this the most likely underlying cause.

• (c) What clinical features would you expect to find in this patient’s nails?

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  Pitting, subungual hyperkeratosis, onycholysis.

• (d) Is this patient’s family history relevant?

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  Yes. Patients with psoriasis often give a family history of psoriasis.

• (e) What are the potential complications of the present state of this patient’s skin?

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  Erythroderma occurs as a result of skin failure and results in loss of skin function. Therefore, erythrodermic patients are susceptible to skin infections and septicaemia, hypothermia, peripheral oedema, high-output cardiac failure and renal failure.

• (f) How would you manage this patient during this acute presentation?

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  Regular application of topical emollients, sedating anti-histamines if the patient is itching, fluid and electrolyte replacement, nutritional support, monitor for and treat infections with antibiotics.

• (g) What other underlying causes should be considered in a similar presentation to this patient?

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  Drugs (e.g. allopurinol, anti-convulsants, antibiotics), other inflammatory skin diseases (e.g. atopic dermatitis, pityriasis rubra pilaris), blistering skin diseases (e.g. pemphigus), malignancies (e.g. cutaneous T-cell lymphoma, Sézary syndrome)..