INTERNATIONAL MULTIDISCIPLINARY JOURNAL FOR
RESEARCH & DEVELOPMENT
SJIF 2019: 5.222 2020: 5.552 2021: 5.637 2022:5.479 2023:6.563 2024: 7,805
eISSN :2394-6334 https://www.ijmrd.in/index.php/imjrd Volume 12, issue 02 (2025)
226
HISTOLOGICAL PATTERNS OF INFLAMMATION IN ERYTHRODERMA
Kapizova Dilafruz Rakhmonjonovna
Andijan State Medical Institute
Abstract:
Based on blinded histopathological examination, the diagnosis was established in 61%
(n=50/82) of cases compared with the final diagnosis. At the same time, the diagnosis of psoriatic
erythroderma was confirmed in 23.2% of cases (n=19/82), spongiotic dermatitis/atopic
erythroderma in 20.7% of cases (n=17/82), erythrodermic form of mycosis fungoides/Sezary
syndrome in 8.5% of cases (n=7/82), and drug-induced erythroderma in 8.5% of cases; the
histological diagnosis was not definitively established or did not correspond to the final diagnosis
in 39.1% of cases (n=32/82).
Kеywоrds:
erythroderma, histological signs of erythroderma, histology, psoriatic erythroderma.
INTRОDUСTIОN
Erythroderma is described as a diffuse reddening of the skin with varying degrees of involvement,
affecting more than 90% of the div surface. Despite the fact that it is a potentially life-
threatening disease with a high mortality rate due to metabolic disorders and other complications,
its causes are still poorly understood in the literature. Erythroderma does not represent a specific
disease, but rather is a clinical manifestation of many different diseases [1,2].
MАTЕRIАLS АND MЕTHОDS
Histological diagnostic method is one of the main ones for differential diagnostics of
erythroderma. However, histology of skin biopsy samples of patients with erythroderma may be
non-specific and manifest only by such histological signs as hyperkeratosis/parakeratosis,
acanthosis, chronic inflammatory infiltrate with or without eosinophils [3]. There are conflicting
opinions about the diagnostic value of skin biopsy in the study of patients with erythroderma [4].
Earlier in the literature, the possibility of not performing diagnostic skin biopsy in patients with
erythroderma, which was preceded by dermatosis, was emphasized [2], since clinical and
pathological correlation will be a difficult task [4]. Wilson et al. believe that in patients with
erythroderma who have a history of various dermatoses, histological examination may not be
informative enough [1].
Inflammatory cells in the epidermis or dermis (number of cells in four fields of view) were
assessed according to the following criteria: 0–20 – mild infiltrate, 21–49 – moderate infiltrate, >
50 – severe infiltrate. In each case, the blind (latent) histological diagnosis was compared with the
clinical diagnosis.
RЕSULTS АND DISСUSSIОN
The study population consisted of 82 patients (55 men and 27 women) with an average age of 73
years (range 25-95 years). Isolated (“blind”, hidden) histopathological examination made it
possible to establish the correct diagnosis in 61% (n=50/82) of cases, compared with the final
diagnosis established on the basis of a combination of clinical, laboratory data and response to
therapy. In particular, the diagnosis of psoriatic erythroderma was made in 23.2% of cases
(n=19/82), atopic erythroderma in 20.7% (n=17/82), erythrodermic form of mycosis
fungoides/Sezary syndrome in 8.5% (n=7/82) and drug-induced erythroderma in 8.5% (n=7/82).
The histological diagnosis did not match the final diagnosis in the remaining 39.1% of cases
(n=32/82). Along with this, the most frequent histological signs of the first group of patients with
psoriatic erythroderma (n=19, mean age 70.2 years, 18 men and 1 woman) were psoriasiform
acanthosis (n=17/19; 89%). Another histological sign in the first group of patients was
hypogranulosis (n=11/19; 58%). Among the cellular composition of the infiltrate in patients with
INTERNATIONAL MULTIDISCIPLINARY JOURNAL FOR
RESEARCH & DEVELOPMENT
SJIF 2019: 5.222 2020: 5.552 2021: 5.637 2022:5.479 2023:6.563 2024: 7,805
eISSN :2394-6334 https://www.ijmrd.in/index.php/imjrd Volume 12, issue 02 (2025)
227
psoriatic erythroderma, in addition to lymphocytes, neutrophilic granulocytes prevailed in the
dermis. These cells were found in quantities of > 50 both in the epidermis and in the dermis
(n=16/19; 84%). At the same time, diffuse parakeratosis and diffuse hypogranulosis were detected
in 58% of cases (n=11/19).
The second largest group was patients with the erythrodermic form of atopic eczema (n = 17,
mean age 74.2 years, 10 men and 7 women). Exocytosis and superficial perivascular infiltrate
mainly of lymphocytes were recorded in all patients (n = 17/17, 100%). Other histological
features of this group of patients were represented by irregular acanthosis (n = 14/17; 82%), the
presence of eosinophils in the amount of <50 cells in the dermis (n = 13/17; 76%) and diffuse
spongiosis (n = 9/17; 53%). However, these features were detected in all cases without taking into
account the difference between local and diffuse spongiosis.
The third study group consisted of 7 patients with the erythrodermic form of mycosis fungoides
(n=7, mean age 77.8 years, 6 men and 1 woman). The histological criteria for selecting patients in
this group were lymphocytic microabscesses, linear arrangement of lymphocytes in the basal layer
of the epidermis, atypical lymphocytes in both the epidermis and dermis in an amount of > 50
cells and epidermotropism, which were detected in all cases. Superficial and deep infiltrate in the
dermis was detected in 4 of 7 skin biopsies (57%) cases, while in 3 patients (28%) the infiltrate
was moderate. At the same time, signs of eczematous inflammation of the skin were absent in
these histological preparations.
СОNСLUSIОN
Erythroderma remains a difficult disease to diagnose and treat. Histological examination may be
sufficient for correct diagnosis and treatment in most cases. However, the need for multiple skin
biopsies, as well as a combination of clinicopathological parameters and response to treatment,
represent the mainstay of the entire diagnostic process.
Thus, based on our results, we have shown that the correct conclusion about the cause of
erythroderma can be based on objective histological criteria in up to 60% of cases.
Further studies are needed to try to identify additional histological and/or immunohistochemical
markers (e.g. interleukin-36 Υ for confirmation of psoriasis) that could help clinicians in the
diagnosis of the etiologic factors of erythroderma.
RЕFЕRЕNСЕS:
1. Khaled A., Sellami A., Fazaa B. et al. Acquired erythroderma in adults: a clinical and
prognostic study. J. Eur. Acad. Dermatol. Venereol. 2010; 24: 781-8.
2. César A., Cruz M., Mota A. et al. Erythroderma. A clinical and etiological study of 103
patients. J Dermatol Case Rep 2016; 10: 1-9.
3. Abrahams I., McCarthy J.T., Sanders S.L. 101 cases of exfoliative dermatitis. Arch. Dermatol.
2017; 63:96-101.
4. Botella-Estrada R., Sanmarin O., Oliver V., et al. Erythroderma: A clinicopathological study of
56 cases. Arch. Dermatol. 2014; 130:1503.
