The histological patterns of inflammation in erythroderma

Zaslavsky D.V., Chuprov I.N., Nasyrov R.A., , Sidikov A.A., Maksimova M.D., Wenzel J., Tatarskaya O.B.

1 St.Petersburg State Pediatric Medical University, St.Petersburg, 194100, Russian Federation
2 North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, 191015, Russian Federation
3 Leningrad Regional Center of specialized types of medical care, St. Petersburg, 190020, Russian Federation
4 University clinic of Bonn, Sigmund Freud Str. 25, D 53105 Bonn, Germany

Background: Erythroderma is a serious medical condition characterized by inflamed red skin, involving over 90% of the body. It can be a common presentation of different diseases, therefore clinical diagnosis can be problematic. Controversial data are reported regarding the diagnostic value of histological examination in erythroderma subjects.
Methods: A retrospective study on histological skin specimens of patients admitted with a clinical diagnosis of erythroderma at the Department of Pathological anatomy with course of department of forensic medicine of State Pediatric Medical University, Saint-Petersburg, and derpatment of dermatolopathology of University clinic of Bonn from 2001 to 2014, was performed. Histopathology examination was performed in each case by a pathologist with a special interest in the skin disease who was blind to any clinical information as well as to final diagnosis.
Results: Blinded histopathology examination alone was able to give the correct diagnosis in 61% (n=50/82) of cases when compared to final diagnosis. A diagnosis of psoriasis was made in 23.2% (n=19/82) of subjects, spongiotic dermatitis/eczema in 20.7% (n=17/82), mycosis fungoides in 8.5% (n=7/82) and drug eruption in 8.5%; histological diagnosis was inconclusive or not matching the final diagnosis when available in the remaining 39.1% of cases (n=32/82).
Conclusion: Erythroderma remains a condition difficult to study and treat. We showed that a correct judgment about its cause can be based on objective histopathological criteria in up to 60% of cases. More studies are needed to try to find out further histological and/or immunohistochemical and molecular-genetic markers which could help the clinician in erythroderma aetiololgy diagnostic process.