Importance of histopathology in erythroderma

ABSTRACT

The main challenge in erythroderma is to find the underlying cause. Skin biopsy is one of the important investigations in this inflammatory disorder. Our aim was to evaluate the diagnostic value of skin biopsy in determining the aetiology of erythroderma. Between January 97 and May 99, fifty skin biopsies were performed in 48 patients of erythroderma in the Department of Dermatology, Mayo Hospital, Lahore. Histological findings in each case were correlated with the clinical diagnosis. Except for 3 cases, all the patients were adults. Twenty-seven [54%] biopsy sections were rewarding helping us to reach a diagnosis regarding the aetiology of erythroderma. In 52% sections there was a good clinicopathological correlation. These included diseases like psoriasis, eczema, pemphigus foliaceous, pityriasis rubra pilaris and bullous ichthyosiform erythroderma. In those cases where a diagnosis was possible, the histopathological features of the underlying disorder was retained. Sixteen [33.33%] patients with erythroderma had non-specific findings on histopathology. Five clinically undetermined cases [10% of the sections] had typical eczematous changes. In conclusion, skin biopsy is a very useful investigation in cases of erythroderma since the histopathological features of the underlying disorder are recognizable in more than half the cases. Biopsies if repeated at intervals may prove to be useful. Two-third cases of psoriatic erythroderma can be confidently diagnosed on histopathology