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Italian Journal of Dermatology and Venereology 2021 Apr 29

DOI: 10.23736/S2784-8671.21.06891-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Erythroderma: psoriasis or lymphoma? A diagnostic challenge and therapeutic pitfall

Alba GUGLIELMO 1, 2, Annalisa PATRIZI 1, 2 , Federico BARDAZZI 1, Alessandro PILERI 1, 2

1 Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2 Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy


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BACKGROUND: Psoriasis and lymphoma risk is widely debated, but few is known about misdiagnosis risk between erythrodermic psoriasis and lymphoma . In fact erythroderma might represent a clinical presentation of psoriasis, cutaneous T cell lymphomas and skin dissemination of systemic lymphomas.
METHODS: All patients referred to psoriasis outpatient service with a diagnosis of erythrodermic psoriasis were re-examined. Among them, all the patients with a subsequent lymphoma diagnosis were included. For each patient data concerning age, gender, age at erythroderma onset, age at lymphoma diagnosis, immune-suppressive therapy, type of lymphoma and relative stage, lymphoma treatment and outcome were obtained.
RESULTS: Twenty-five patients (15 females and 10 males) with a diagnosis of erythrodermic psoriasis were retrieved. Among them, 9 patients (5 males and 4 females) were affected by erythrodermic lymphoma, including 4 patients with Sèzary syndrome, 3 with mycosis fungoides, and 2 with peripheral T-cell lymphoma not otherwise specified. Prior to lymphoma diagnosis all the patients (9/9) received cyclosporine, two (2/9) of them methotrexate, one (1/9) azatioprine, and two (2/9) systemic corticosteroids. The prognosis of our patients was poor, due to immune-suppressive drugs administration in patients with undiagnosed lymphoma. The only exception was one (1/9) patient with Sèzary syndrome still alive with disease after 120 months of follow up.
CONCLUSIONS: In case of patients with erythroderma, multiple skin biopsies and specific peripheral blood studies like flow cytometry and T-cell receptor gene rearrangement analysis are required in order to avoid misdiagnosis risk between psoriasis and lymphoma.


KEY WORDS: Lymphoma; Psoriasis; Cutaneous T-cell lymphoma

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