Fiery red erythema, or what has been described as deep red to salmon pink erythema 13, has been considered as a sign favoring psoriasis and as a cause of erythroderma. In contrast, we noticed a peculiar dusky erythema in our CTCL cases, a finding not reported before up to our knowledge. Hair fall was previously reported in all cases of longstanding erythroderma; cicatricial alopecia was said to be present mainly in cases of MF 25; however, in our CTCL cases, we found diffuse alopecia with some cicatricial areas.
All our cases that presented with peripheral blood eosinophilia were cases of drug-induced erythroderma. Pal and Haroon 26 reported these laboratory finding to be significantly associated with drug-induced erythroderma, whereas others reported eosinophilia as a nonspecific finding in 20% of the erythrodermic patients 10 and in cases of eczema and MF 21.
An integral part of the general examination in erythrodermic patients that provides important clues to the underlying cause is lymph node examination. Six (20%) of our cases had generalized lymphadenopathy, and three (50%) of them had lymphoma. It has been reported that 50% of the erythrodermic patients may have dermatopathic lymphadenopathy, and a lymph node biopsy is advised only when lymph nodes exhibit lymphomatous characteristics (large size and rubbery consistency) or when the cause of erythroderma is undetermined 25,27.
Another reported problematic issue is the differentiation between late-onset atopic dermatitis presenting as erythroderma and MF 34. This was encountered in one of our cases: a young male patient was clinically favored to have late-onset atopic dermatitis, but on the histopathological level, a few lymphocytes in the dermal infiltrate were perceived as atypical cells. Immunophenotyping revealed an inflammatory immunoprofile 29 that favored a benign nature. It is noteworthy here to mention that the characteristic cerebriform nucleus of atypical lymphocytes found in MF can also be found under benign dermatologic conditions such as atopic dermatitis and others 35 and loss of CD2 and CD5 (pan T-cell markers) can be detected in benign erythrodermas 36,37.
The authors thank all residents of the Dermatology Department, Faculty of Medicine, Cairo University, for their significant help in the collection of cases.
There are no conflicts of interest.
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