Derm AM Report 10/16: Erythroderma and Oral ulcers

We presented two great derm cases today and had our attending dermatologist come to help us walk through these cases (one was eczema causing erythroderma, the other was ?mycoplasma associated oral mucositis). Here are the major learning points from today.
Take-home teaching point: when seeing a patient with an “eczema flare” or a history of “eczema,” make sure to get more history of how the diagnosis of eczema since it is a term used widely in the general public to mean many things. When seeing an eczema flare, consider the following possibilities (1) wrong dx, not actually eczema and you should think of other etiologies (2) superinfection of eczema (3) under-treated eczema or (4) itching and excoriations by the patient due to eczema
Additional derm pearls learning:
  • Erythroderma framework/DDx: red everywhere!
    • Infectious: toxin-mediated, viral exanthem, scabies
    • Drug reaction: morbilliform drug eruption, DRESS, AGEP, TEN
    • Idiopathic
    • Primary dermatologic disease: psoriasis, atopic dermatitis, seborrheic dermatitis
    • Malignancy (leukemia, lymphoma, cutaneous T-cell lymphoma)
    • Contact dermatitis: usually needs to be aerosolized process to cover the whole body unless something like a lotion covers head-to-toe
    • Misc: connective tissue disease, GVHD
  • Isolated oral ulcers framework
    • Oral manifestation of a systemic disease (e.g. IBD, rheum)
    • Drug reaction: SJS
    • Infectious: think enterovirus, mycoplasma, other viruses
    • Autoimmune blistering disease (e.g. pemphigus)
    • Presenting sign of a hematologic malignancy
  • Crusting: when you see crusting of a rash, think of a process that pulls the cells in the skin apart and allows serosanguinous drainage that will cause crusting
    • Infection (e.g. impetigo)
    • Inflammatory skin diseases

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