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Chapter 054. Skin Manifestations of Internal Disease (Part 3)

Drug-induced erythroderma (exfoliative dermatitis) may begin as an exanthematous (morbilliform) eruption (Chap. 56) or may arise as diffuse erythema. A number of drugs can produce an erythroderma, including penicillins, sulfonamides, carbamazepine, phenytoin, gold, allopurinol, and zalcitabine. Fever and peripheral eosinophilia often accompany the eruption, and there may also be facial swelling, hepatitis, and allergic interstitial nephritis; this constellation is frequently referred to as drug reaction with eosinophilia and systemic symptoms (DRESS). In addition, reactions to anticonvulsants can lead to a pseudolymphoma syndrome (with adenopathy and circulating atypical lymphocytes), while reactions to allopurinol may be accompanied by gastrointestinal bleeding. . | Chapter 054. Skin Manifestations of Internal Disease Part 3 Drug-induced erythroderma exfoliative dermatitis may begin as an exanthematous morbilliform eruption Chap. 56 or may arise as diffuse erythema. A number of drugs can produce an erythroderma including penicillins sulfonamides carbamazepine phenytoin gold allopurinol and zalcitabine. Fever and peripheral eosinophilia often accompany the eruption and there may also be facial swelling hepatitis and allergic interstitial nephritis this constellation is frequently referred to as drug reaction with eosinophilia and systemic symptoms DRESS . In addition reactions to anticonvulsants can lead to a pseudolymphoma syndrome with adenopathy and circulating atypical lymphocytes while reactions to allopurinol may be accompanied by gastrointestinal bleeding. The most common malignancy that is associated with erythroderma is CTCL in some series up to 25 of the cases of erythroderma were due to CTCL. The patient may progress from isolated plaques and tumors but more commonly the erythroderma is present throughout the course of the disease Sezary syndrome . In the Sezary syndrome there are circulating atypical T lymphocytes pruritus and lymphadenopathy. In cases of erythroderma where there is no apparent cause idiopathic longitudinal follow-up is mandatory to monitor for the possible development of CTCL. There have been isolated case reports of erythroderma secondary to some solid tumors lung liver prostate thyroid and colon but it is usually in a late stage of the disease. Alopecia Table 54-4 The two major forms of alopecia are scarring and nonscarring. In scarring alopecia there are associated fibrosis inflammation and loss of hair follicles. A smooth scalp with a decreased number of follicular openings is usually observed clinically but in some cases the changes are seen only in biopsy specimens from the affected areas. In nonscarring alopecia the hair shafts are gone but the hair follicles are preserved explaining the .