Practical Dermatology
A Practical Approach to the Diagnosis and Treatment of Adult Erythroderma
Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento
A. Cuellar-Barboza, J. Ocampo-Candiani, M.E. Herz-Ruelas
Corresponding author
Departamento de Dermatología, Universidad Autónoma de Nuevo León, Hospital Universitario «Dr. José E. González» y Facultad de Medicina, Monterrey, México
Read
31022
Timeswas read the article
7999
Total PDF
23023
Total HTML
Share statistics
array:24 [ "pii" => "S1578219018303536" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.05.033" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "2014" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:777-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018303302" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.05.011" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "2014" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:777-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1638 "formatos" => array:2 [ "HTML" => 1151 "PDF" => 487 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">DERMATOLOGÍA PRÁCTICA</span>" "titulo" => "Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "777" "paginaFinal" => "790" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A Practical Approach to the Diagnosis and Treatment of Adult Erythroderma" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1629 "Ancho" => 2083 "Tamanyo" => 610562 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A y B) Psoriasis eritrodérmica con eritema generalizado, descamación y pústulas. C) La histopatología revela paraqueratosis, acantosis, hipogranulosis y una pústula subcorneal (hematoxilina-eosina, x20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Cuellar-Barboza, J. Ocampo-Candiani, M.E. Herz-Ruelas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Cuellar-Barboza" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Ocampo-Candiani" ] 2 => array:2 [ "nombre" => "M.E." "apellidos" => "Herz-Ruelas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018303536" "doi" => "10.1016/j.adengl.2018.05.033" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303536?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018303302?idApp=UINPBA000044" "url" => "/00017310/0000010900000009/v1_201811020614/S0001731018303302/v1_201811020614/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219018303251" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.09.012" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "1962" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2018;109:791-800" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 20 "formatos" => array:2 [ "HTML" => 14 "PDF" => 6 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Paradoxical Reactions to Biologic Therapy in Psoriasis: A Review of the Literature" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "791" "paginaFinal" => "800" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reacciones paradójicas de los tratamientos biológicos utilizados en psoriasis: revisión de la literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 917 "Ancho" => 2503 "Tamanyo" => 120292 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pathogenic mechanisms proposed to explain paradoxical reactions.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In normal conditions, TNF-α inhibits pDCs, which produce IFN-α. Use of anti-TNF-α molecules leads to an excess of IFN-α which, in turn, promotes expression of CXCR3 in T cells, thereby allowing migration to the inflamed tissue. The use of other biologic agents with different mechanisms of action such as ustekinumab (anti-IL-12/23) and secukinumab and ixekizumab (anti-IL-17A) indirectly leads to a decrease in TNF-α concentrations, with the aforementioned consequences.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CXCR3: CXC3 chemokine receptor; IFN: interferon; IL: interleukin; pDC: plasmacytoid dendritic cell; Th cell: T helper cell; TNF: tumor necrosis factor.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Munera-Campos, F. Ballesca, J.M. Carrascosa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Munera-Campos" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Ballesca" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Carrascosa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101830200X" "doi" => "10.1016/j.ad.2018.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101830200X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303251?idApp=UINPBA000044" "url" => "/15782190/0000010900000009/v1_201811020640/S1578219018303251/v1_201811020640/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018303238" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.09.011" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "2040" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Actas Dermosifiliogr. 2018;109:771-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11 "formatos" => array:2 [ "HTML" => 7 "PDF" => 4 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Consensus Document</span>" "titulo" => "Algorithm for Treatment of Chronic Spontaneous Urticaria with Omalizumab" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "771" "paginaFinal" => "776" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Algoritmo de tratamiento con omalizumab en urticaria crónica espontánea" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1819 "Ancho" => 3083 "Tamanyo" => 264119 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Algorithm for the treatment of chronic spontaneous urticaria with omalizumab. Abbreviations: UAS7, weekly Urticaria Activity Score; UCT, Urticaria Control Test.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Spertino, L. Curto Barredo, E. Rozas Muñoz, I. Figueras Nart, E. Serra Baldrich, M. Bonfill-Ortí, V. Expósito-Serrano, A. Guilabert, G. Melé Ninot, M. Villar Buil, J. Garcias Ladaria, X. García Navarro, M. Vilavella, I. Bielsa Marsol, G. Aparicio Ortiz, C. Baliu Piqué, A. Álvarez Abella, N. Lamas Domenech, J.M. Mascaró, S. Gómez, J.I. Torné Gutiérrez, A. Vicente Villa, A. Gimenez Arnau" "autores" => array:23 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Spertino" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Curto Barredo" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Rozas Muñoz" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Figueras Nart" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Serra Baldrich" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Bonfill-Ortí" ] 6 => array:2 [ "nombre" => "V." "apellidos" => "Expósito-Serrano" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Guilabert" ] 8 => array:2 [ "nombre" => "G." "apellidos" => "Melé Ninot" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Villar Buil" ] 10 => array:2 [ "nombre" => "J." "apellidos" => "Garcias Ladaria" ] 11 => array:2 [ "nombre" => "X." "apellidos" => "García Navarro" ] 12 => array:2 [ "nombre" => "M." "apellidos" => "Vilavella" ] 13 => array:2 [ "nombre" => "I." "apellidos" => "Bielsa Marsol" ] 14 => array:2 [ "nombre" => "G." "apellidos" => "Aparicio Ortiz" ] 15 => array:2 [ "nombre" => "C." "apellidos" => "Baliu Piqué" ] 16 => array:2 [ "nombre" => "A." "apellidos" => "Álvarez Abella" ] 17 => array:2 [ "nombre" => "N." "apellidos" => "Lamas Domenech" ] 18 => array:2 [ "nombre" => "J.M." "apellidos" => "Mascaró" ] 19 => array:2 [ "nombre" => "S." "apellidos" => "Gómez" ] 20 => array:2 [ "nombre" => "J.I." "apellidos" => "Torné Gutiérrez" ] 21 => array:2 [ "nombre" => "A." "apellidos" => "Vicente Villa" ] 22 => array:2 [ "nombre" => "A." "apellidos" => "Gimenez Arnau" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018303594" "doi" => "10.1016/j.ad.2018.07.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018303594?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303238?idApp=UINPBA000044" "url" => "/15782190/0000010900000009/v1_201811020640/S1578219018303238/v1_201811020640/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermatology</span>" "titulo" => "A Practical Approach to the Diagnosis and Treatment of Adult Erythroderma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "777" "paginaFinal" => "790" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Cuellar-Barboza, J. Ocampo-Candiani, M.E. Herz-Ruelas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Cuellar-Barboza" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Ocampo-Candiani" ] 2 => array:4 [ "nombre" => "M.E." "apellidos" => "Herz-Ruelas" "email" => array:1 [ 0 => "mairaherz@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Universidad Autónoma de Nuevo León, Hospital Universitario «Dr. José E. González» y Facultad de Medicina, Monterrey, México" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1629 "Ancho" => 2083 "Tamanyo" => 610562 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A-B) Erythrodermic psoriasis with generalized erythema, desquamation and pustules. (C) Histopathology reveals parakeratosis, acanthosis, hypogranulosis and a subcorneal pustule (H&E, original magnification x20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Erythroderma is the clinical finding of generalized erythema and scaling of the skin. This condition, especially when fulminant, is potentially life-threatening and has been associated with high mortality in hospitalized patients.<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">1,2</span></a> The term erythroderma was first used by Ferdinand Von Hebra in 1868 in his work “On Diseases of the Skin” to describe generalized skin redness and scaling.<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">3</span></a> A variety of diseases and exogenous factors can cause this syndrome. Although rare, it remains a relevant and difficult for dermatologists to treat this disease. The objective of this article is to review the general principles, the clinical aspects and the pathogenesis of erythroderma in adults, as well as to provide a concise guide for its diagnostic and therapeutic approach.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Definition</span><p id="par0010" class="elsevierStylePara elsevierViewall">Erythroderma also called generalized exfoliative dermatitis or exfoliative erythroderma, is a severe inflammatory skin syndrome characterized by generalized erythema and desquamation comprising ≥ 90% of the body surface area.<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">4</span></a> Generally, erythroderma is the preferred term for this syndrome.<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">4,5</span></a> Previously, some authors used the term “red man syndrome” to refer to idiopathic erythroderma (which must not be confused with the cutaneous reaction associated to rapid intravenous infusion of vancomycin).<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Erythroderma is a rare condition. Most published studies are retrospective and do not address overall incidence.<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">7,8</span></a> A retrospective study from China reported that erythroderma accounted for 13 of every 100,000 dermatologic patients.<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">9</span></a> Recently, an incidence of 9.4 cases/year was reported in a retrospective study from Portugal.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">10</span></a> Excluding children, the average age of onset varies from 41 to 61 years; although it usually affects patients over 45 years of age.<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">11,12</span></a> Studies favor a male predominance with a male-to-female ratio of 2-4:1.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pathogenesis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Implicated fisiopathogenic mechanisms depend upon the underlying cause. Common pathogenic pathways among different etiologies are still a question of debate.<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">6</span></a> It is believed that this syndrome derives from a complex interaction between cytokines and cellular adhesion molecules. IL-1, IL-2, IL-8, intercellular adhesion molecule 1 (ICAM-1), tumor necrosis factor and interferon gamma have all been involved in the pathogenesis of erythroderma.<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">4,7,8</span></a> Interactions between these cytokines result in an increased epidermal cellular division. This increased mitotic rate shortens the transit time of cells through the epidermis, thus resulting in cutaneous exfoliation. Scales are normally retained by the skin and contain amino acids, proteins and nucleic acids which are lost during desquamation.<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">14,15</span></a> It has been calculated that this desquamative process may increase protein loss by 25-30% in psoriatic erythroderma and by 10-15% in other causes.<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Etiology</span><p id="par0025" class="elsevierStylePara elsevierViewall">Erythroderma represents a final clinical endpoint for many dermatological diseases.<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">16</span></a> As observed in a recent retrospective study, the relative incidence of different etiologies may vary among populations due to genetic, geographic, and social disparities.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">10</span></a> Most studies indicate that erythroderma is more commonly associated with an exacerbation of a pre-existing dermatosis; therefore, the patient's medical history is crucial for a correct diagnosis. Psoriasis is the most frequent cause of exfoliative dermatitis, which in some studies represents 25-50% of cases (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">10,17–19</span></a> Most patients have a history of localized disease before the onset of exfoliative dermatitis, which develops more frequently with long-standing psoriasis (more than 10 years after diagnosis).<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">9,10,20,21</span></a> Psoriatic erythroderma has been associated with certain triggers, including the sudden withdrawal of topical or systemic corticosteroids and methotrexate, phototoxicity, or systemic infection.<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">22</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">It has been reported that exfoliative dermatitis related to atopic dermatitis varies from 4.76 to 23.9% (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">19,23</span></a> A history of non-atopic eczema has been found in 5.12% to 25.3% of patients with erythroderma.<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">24–26</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In case series, drug-related reactions represent the second most frequent cause of erythroderma, ranging from 11.3 to 21.6% of cases.<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">9,10,20</span></a> The list of drugs that cause erythroderma is long and continuously grows. Previous authors have reported that drugs with the greatest erythroderma-inducing potential are anti-epileptic medications and allopurinol.<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">9,10,20,22</span></a> Carbamazepine is the most common anti-epileptic drug related to this syndrome and it has been postulated that this may be a result of genetic sensitivity or its frequent prescription.<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">11</span></a>Antifimic drugs have been associated with erythroderma in HIV-seropositive patients,<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">27,28</span></a> as well as with traditional Chinese herbs used as analgesics.<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">9,29</span></a> Other common drugs related to this condition are phenytoin, beta-lactam antibiotics, sulfonamides, phenobarbital, sulfasalazine and proton pump inhibitors.<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">10,30</span></a> Non-ionic contrast material has also been reported as an inducer of this syndrome.<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">31</span></a> Exfoliative dermatitis has been related to a severe form of pityriasis rubra pilaris in 1.25% to 8.2% of cases.<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">11,24</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Most series report 1% of erythroderma cases have a neoplasic or paraneoplastic etiology.<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">8,23,32,33</span></a> It has been implicated in laryngeal, thyroid, breast, lung, esophageal, gastric, hepatocellular, tongue, gallbladder, colon, fallopian tube and prostate cancers.<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">4,9,34–42</span></a> But it is more often related to hematologic malignancies and cutaneous T-cell lymphomas, which constitute 25 to 40% of cases.<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">4</span></a> Within this subgroup, mycosis fungoides (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>), and Sézary syndrome are more frequent.<a class="elsevierStyleCrossRefs" href="#bib0715"><span class="elsevierStyleSup">43,44</span></a> Acute and chronic leukemia, reticular cell sarcoma, and malignant histiocytosis have also been implicated.<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">10,45,46</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In 6.51% to 36% of patients, no precise etiology can be identified.<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">47</span></a> Some authors have described the progression of chronic idiopathic erythroderma to cutaneous T-cell lymphoma.<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">19</span></a> Uncommon causes of adult exfoliative dermatitis include congenital icthyoses,<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">6</span></a> staphylococcal scalded skin syndrome,<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">6</span></a> immunobullous diseases,<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">48</span></a> connective tissue diseases such as dermatomyositis,<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">49</span></a> chronic actinic dermatitis,<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">50</span></a> sarcoidosis,<a class="elsevierStyleCrossRef" href="#bib0755"><span class="elsevierStyleSup">51</span></a> Norwegian scabies,<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">52</span></a> Langerhans cell histiocytosis,<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">53</span></a> irradiation, graft-vs-host disease, Ofuji papulo-erythroderma and Omenns’ syndrome.<a class="elsevierStyleCrossRefs" href="#bib0590"><span class="elsevierStyleSup">18,54–58</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinical Manifestations</span><p id="par0050" class="elsevierStylePara elsevierViewall">Erythroderma has a gradual and insidious onset except for drug-induced cases.<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">24</span></a> This condition begins as patches of erythema that enlarge and coalesce to eventually affect most of the skin surface. It is associated with a variable degree of scaling that typically appears 2-6 days after the onset of erythema. The skin is usually bright red, dry, warm and indurated. Most patients complain of skin pain or pruritus. In acute phases, scales may appear large and crusted, whereas in chronic states they tend to be smaller and drier.<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">4,12</span></a> The type of scale may suggest the underlying etiology: fine scales are usually found in eczematous conditions, crusted scales in immunobullous diseases, exfoliative scales in drug reactions and bran-like scales in seborrheic dermatitis.<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">6</span></a> In chronic erythroderma, patients may develop crusted erosions and secondary lichenification because of severe scratching; hyper- or hypopigmentation may also be present. Nails may become thick, dry, brittle, shiny, and show ridging.<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">4,12</span></a> A recent clinical study by Mahabaleshwar et al. reported the following nail changes in erythroderma patients: discoloration (40%), ridges (36%), pitting (20%), onycholysis (18%), shiny nails (4%) and paronychia (2%).<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">20</span></a> Palmoplantar keratoderma appears in approximately 30% of patients. Classically, marked keratoderma is associated with pityriasis rubra pilaris, yet some reports have found that palmoplantar keratoderma and nail changes are predictive clinical signs of psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">6,9,10,22,25</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Rare hematologic syndromes may mimic clinical manifestations of erythrodermic psoriasis such as idiopathic hypereosinophilic syndrome.<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">59</span></a> Pityriasis rubra pilaris typically shows islands of sparing, orange-colored palmoplantar keratoderma and hyperkeratotic follicular papules on extensor surfaces.<a class="elsevierStyleCrossRef" href="#bib0800"><span class="elsevierStyleSup">60</span></a> Violaceous papules and reticulated buccal mucosal lesions may indicate an underlying diagnosis of lichen planus.<a class="elsevierStyleCrossRef" href="#bib0805"><span class="elsevierStyleSup">61</span></a> Patients with Norwegian scabies may develop heavy crusts on the palms and soles, as well as subungual hyperkeratosis.<a class="elsevierStyleCrossRefs" href="#bib0760"><span class="elsevierStyleSup">52,60</span></a> Gottron's papules, heliotrope rash, poikiloderma, periungual telangiectasias and muscle weakness may support the diagnosis of erythrodermic dermatomyositis.<a class="elsevierStyleCrossRefs" href="#bib0810"><span class="elsevierStyleSup">62,63</span></a> Moist and crusted lesions on the face and upper trunk can be an early manifestation of pemphigus foliaceous. Non-scarring alopecia may appear in 20% of patients with chronic erythroderma, and ocular complications such as bilateral ectropion and purulent conjunctivitis may be particularly prominent in chronic erythroderma secondary to Sézary syndrome.<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">6</span></a> Some studies have described sparing of the nose and paranasal areas, described as the “nose sign”.<a class="elsevierStyleCrossRef" href="#bib0820"><span class="elsevierStyleSup">64</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Systemic Manifestations</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients suffering exfoliative dermatitis will often shiver and complain of feeling cold. A recent literature analysis by Cesar et al. established pruritus as the most common symptom.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">10</span></a> Generalized peripheral lymphadenopathy may be present, prompting histologic and molecular examination to rule out hematologic malignancy. Other features described in this condition include facial, pedal or pretibial edema, hypothermia, cachexia, hepatomegaly, splenomegaly,<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">6,10</span></a> and fever in about half of the patients.<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">10,29</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The clinician must be aware of systemic manifestations that could potentially complicate disease evolution. Exfoliative dermatitis may lead to systemic complications including fluid and electrolyte imbalance, high-output cardiac failure, acute respiratory distress syndrome, and secondary infections (erythrodermic skin is commonly colonized by <span class="elsevierStyleItalic">Staphylococcus aureus</span>).<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">6,13,65–67</span></a> Staphylococcal sepsis may occur due to inflamed and excoriated skin, especially in HIV-positive patients or with an underlying hematological malignancy.<a class="elsevierStyleCrossRefs" href="#bib0840"><span class="elsevierStyleSup">68,69</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Histopathology</span><p id="par0070" class="elsevierStylePara elsevierViewall">In erytrhodermic patients clinical and histopathological correlation can be difficult to attain,<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">24</span></a> yet highly trained pathologists can provide a precise diagnosis.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">10</span></a> Skin samples are usually obtained with 4<span class="elsevierStyleHsp" style=""></span>mm punch biopsies and previous series report that multiple biopsies over time can enhance diagnostic accuracy.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">13</span></a> Previous studies report skin biopsies to be useful in 53-66% of erythroderma cases.<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">10,70,71</span></a> Frequent histopathologic findings in erythroderma include hyperkeratosis, acanthosis, spongiosis, and perivascular inflammatory infiltrate.<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">72</span></a> A recent retrospective study by Megna et al. on 82 erythrodermic patients reported a diagnosis of psoriasis in 23.2% of subjects, strongly supported by the presence of acanthosis, diffuse parakeratosis, diffuse hypogranulosis and the presence of neutrophils on epidermis and dermis. Spongiotic dermatitis was found in 20.7% of patients; encountered features included exocytosis, superficial lymphocytic infiltrate, spongiosis, irregular acanthosis and dermal eosinophilic infiltrate. Drug-induced erythroderma was diagnosed in 8.5% of subjects with biopsies showing lymphocytes and colloid bodies, in addition to hydropic degeneration within the epidermal basal layer. Cutaneous T-cell lymphoma (CTCL)/mycosis fungoides (8.5% in this study) biopsies showed lymphocytic microabscesses, in addition to epidermal and dermal atypical lymphocytes. It is important to highlight that in a considerable number of cases (39.1%), the diagnosis was inconclusive not matching the final diagnosis.<a class="elsevierStyleCrossRef" href="#bib0865"><span class="elsevierStyleSup">73</span></a> These results support the fact that skin biopsies are a mandatory first step in the required workup of erythrodermic patients.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The majority of studies report that nodal biopsies frequently demonstrate dermatopathic lymphadenopathy,<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">10,29,74</span></a> yet lymph node biopsies may be the key to diagnostic exclusion of lymphomas or uncommon diseases such as multicentric Castleman's disease.<a class="elsevierStyleCrossRef" href="#bib0875"><span class="elsevierStyleSup">75</span></a> The presence of atypical lymphocytes should prompt immunohistochemistry and T-cell receptor gene rearrangement studies. Sézary syndrome is supported by the presence of T-cells lacking mature T-cell antigens (CD3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>, CD4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>, CD7-) and T-cell receptor gene clonality.<a class="elsevierStyleCrossRef" href="#bib0880"><span class="elsevierStyleSup">76</span></a> Immunofluorescence should be considered if histopathology suggests immunobullous disease, graft-vs-host disease, and connective tissue disorders.<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Laboratory and Imaging</span><p id="par0080" class="elsevierStylePara elsevierViewall">Laboratory findings of erythrodermic patients are frequently nonspecific. Common laboratory abnormalities described in previous studies (in order of frequency) include an elevated erythrocyte sedimentation rate (96.1%), leukocytosis (48.5%), eosinophilia (39.8%), and anemia (30.1%).<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">10</span></a> Allergic conditions may present increased serum IgE. When suspecting drug-induced erythroderma, the eosinophil count is necessary in DRESS syndrome.<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">7,33,49,77,78</span></a> A recent study found a correlation between the presence of eosinophilia and malignancy-related erythroderma.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">10</span></a> Other findings include elevated uric acid and creatinine levels, as well as reduced serum protein levels.<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">19,24</span></a> Serum electrolytes can be used to monitor fluid loss. Liver and kidney function tests may be altered in erythroderma associated with severe drug reactions. Specific tests to diagnose Sézary syndrome include Sézary cell count analysis.<a class="elsevierStyleCrossRef" href="#bib0895"><span class="elsevierStyleSup">79</span></a> Possible screening tests for connective tissue diseases include antinuclear antibodies, extractable nuclear antigen, rheumatoid factor, anti-DNA antibodies and complement levels. HIV virus testing may be mandatory in high-risk populations with erythroderma.<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">80</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Multiple blood cultures may be necessary to exclude Staphylococcal sepsis based on the fact that blood cultures may be contaminated secondary to cutaneous Staphylococcal colonization.<a class="elsevierStyleCrossRef" href="#bib0830"><span class="elsevierStyleSup">66</span></a> When skin superinfections are suspected, fungal cultures, PCR for herpes simplex virus and the varicella-zoster virus can be useful. Diagnosis of crusted scabies can be made by examining scrapings obtained from burrows under the microscope.<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">52</span></a> Imaging studies such as a chest radiograph, computed tomography, and magnetic resonance may aid in the diagnosis of paraneoplastic erythroderma.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Diagnosis</span><p id="par0090" class="elsevierStylePara elsevierViewall">Being a syndromatic entity, the diagnosis of erythroderma is easily made with the clinical finding of generalized erythema and desquamation involving ≥ 90% of the skin surface area.<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">4</span></a> Defining the underlying disease represent a challenge for physicians and must include a profound clinicopathological correlation. We describe the characteristics of the main differential diagnoses in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">General Principles of Management</span><p id="par0095" class="elsevierStylePara elsevierViewall">Exfoliative dermatitis is a dermatological emergency and severe cases require in patient care.<a class="elsevierStyleCrossRefs" href="#bib0900"><span class="elsevierStyleSup">80,81</span></a> The initial diagnostic approach and general principles of management for erythrodermic patients are described in detail in <a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Treatment approach should include discontinuation of any unnecessary medications and appropriate workup to exclude an underlying malignancy. Bed rest and sedation should be used when necessary. Initial management of all types of erythroderma is similar, even without an etiologic diagnosis. Regulating environmental temperature is crucial since patients with this condition loose homeostatic body functions that prevent cooling or overheating.<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">80</span></a> Skin barrier function can be improved with colloid baths and wet compresses on not more than a quarter of the body at a time,<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">80</span></a> along with emollient creams and low-potency topical corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">82</span></a> High-potency topical corticosteroids and topical tacrolimus are not recommended since systemic absorption is enhanced by increased skin permeability.<a class="elsevierStyleCrossRefs" href="#bib0915"><span class="elsevierStyleSup">83,84</span></a> The initial approach to therapy must also include nutrition and fluid assessment as described in <a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Oral, intramuscular or intravenous sedative antihistamines can alleviate scratching, thus preventing secondary skin infections while relieving pruritus and anxiety (eg, hydroxyzine hydrochloride, 25–50<span class="elsevierStyleHsp" style=""></span>mg P.O. QID).<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">82</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">There is scarce high evidence-based data to determine treatment recommendations regarding erythrodermic psoriasis. A panel of experts suggested cyclosporine (Evidence IIB) or infliximab (Evidence IIB) might be the most rapidly acting agents. Other first-line choices are acitretin (Evidence IB) or methotrexate (Evidence III), although they usually work more slowly. A second-line treatment based on case series is Etanercept (Evidence IIB). Use of systemic steroids is controversial as withdrawal may precipitate an erythrodermic flare. Evidence for these recommendations was graded using levels of evidence developed by Shekelle et al.<a class="elsevierStyleCrossRef" href="#bib0925"><span class="elsevierStyleSup">85</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">First-line treatment choices for adults with severe atopic dermatitis, particularly after failure with topical treatment, include narrow-band UVB phototherapy (Evidence IIB) or systemic immunosuppressant. Oral cyclosporine has been evaluated in randomized trials and systematic reviews showing to be an adequate short-term treatment (Evidence I-IIB). The evidence grading scale used in these recommendations was the Strength of Recommendation Taxonomy (SORT).<a class="elsevierStyleCrossRef" href="#bib0930"><span class="elsevierStyleSup">86</span></a> Recent randomized clinical trials with dupilumab, an interleukin (IL)-4 receptor alpha antagonist, indicate it may be an alternative systemic therapy for long-standing severe atopic dermatitis in adults.<a class="elsevierStyleCrossRef" href="#bib0935"><span class="elsevierStyleSup">87</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Treatment recommendations for pityriasis rubra pilaris are based merely on case reports and small case series, to date no randomized controlled trials are available. First-line therapies are oral retinoids and methotrexate. Second-line therapies may include TNF-alpha inhibitors, systemic steroids, cyclosporine or azathioprine.<a class="elsevierStyleCrossRefs" href="#bib0940"><span class="elsevierStyleSup">88,89</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Patients with idiopathic erythroderma who fail to respond to topical treatments may be treated with empiric regimens such as systemic corticosteroids or other immunosuppressants such as methotrexate and cyclosporine; however, evidence for this approach is scarce.<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">9,11,22,47</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Specific treatment regimens for common causes of erythroderma are described in detail in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Natural Course of Disease and Prognosis</span><p id="par0135" class="elsevierStylePara elsevierViewall">Erythroderma secondary to drug reactions improves or resolves within 2-6 weeks of drug discontinuation. Exfoliative dermatitis associated with psoriasis and eczema may improve within several weeks or months, yet lesions may recur after the first episode in15% of patients. When related to CTCL or another malignancy, erythroderma may persist and be refractory. Thirty percent of subjects with idiopathic erythroderma can exhibit complete remission or 50% partial remission.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">13</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Prognostic studies are scarce and show conflicting results. Early studies report significant mortality secondary to systemic complications.<a class="elsevierStyleCrossRefs" href="#bib0665"><span class="elsevierStyleSup">33,45</span></a> Low mortality has been reported in studies from recent decades, probably as a result of advances in hospital care and more therapeutic options.<a class="elsevierStyleCrossRefs" href="#bib0715"><span class="elsevierStyleSup">43,90</span></a> However, a recent retrospective population-based cohort study from Denmark found that 30.8% of patients with erythrodermic psoriasis and 39.6% with erythroderma, died within the first 3 years following hospital admission.<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">2</span></a> This high mortality was comparable with older studies.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Erythroderma is a syndromatic entity and determining its etiology may be a challenge for dermatologists. Clinical features are frequently nonspecific and the dermatologist must search for cause-oriented clues. Multiples biopsies along the course of the disease could potentially enhance diagnostic accuracy. The initial management of erythroderma must include nutrition expert evaluation, fluid imbalance assessment, maintaining skin barrier function, sedative antihistamines and exclusion of secondary bacterial infection. This condition can be life-threatening and may require hospitalization.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of Interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:19 [ 0 => array:3 [ "identificador" => "xres1102721" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1043211" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1102722" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1043212" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Definition" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Epidemiology" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Pathogenesis" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Etiology" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Manifestations" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Systemic Manifestations" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Histopathology" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Laboratory and Imaging" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Diagnosis" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "General Principles of Management" ] 15 => array:2 [ "identificador" => "sec0060" "titulo" => "Natural Course of Disease and Prognosis" ] 16 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusion" ] 17 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of Interest" ] 18 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-11-30" "fechaAceptado" => "2018-05-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1043211" "palabras" => array:4 [ 0 => "Erythroderma" 1 => "Exfoliative dermatitis" 2 => "Erythema" 3 => "Desquamation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1043212" "palabras" => array:4 [ 0 => "Eritrodermia" 1 => "Dermatitis exfoliativa" 2 => "Eritema" 3 => "Descamación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythroderma is an inflammatory skin syndrome that involves desquamation and erythema of more than 90% of the body surface area. It represents a final clinical endpoint for many adult dermatological conditions. The most frequent cause of erythroderma is psoriasis followed by eczematous conditions, drug-induced reactions, pityriasis rubra pilaris and cutaneous T-cell lymphomas. Diagnostic approach must include a thorough history and clinical examination. If the etiology of erythroderma is uncertain multiple skin biopsies may enhance diagnostic accuracy. The initial management of erythroderma must include a nutrition expert evaluation, fluid imbalance assessment, maintaining skin barrier function, sedative antihistamines and exclusion of secondary bacterial infection. We present a practical review of the etiology, diagnosis, and treatment of this entity.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La eritrodermia es un síndrome inflamatorio de la piel caracterizado por descamación y eritema en más del 90% de la superficie corporal. Representa la etapa final de muchas enfermedades dermatológicas en el adulto. La causa más frecuente es la psoriasis, le siguen las enfermedades eccematosas, las reacciones medicamentosas, la pitiriasis rubra pilaris y los linfomas cutáneos de células T. El abordaje diagnóstico debe incluir una historia y examen físicos exhaustivos. Si se desconoce la etiología de la eritrodermia es posible que múltiples biopsias a lo largo del curso de la enfermedad aumenten las posibilidades de un diagnóstico correcto. El abordaje inicial de la eritrodermia debe incluir la evaluación de un experto en nutrición, la valoración del balance hidroelectrolítico, medidas para mantener la función de barrera de la piel, antihistamínicos con efecto sedante y la exclusión de infecciones bacterianas secundarias. Presentamos una revisión práctica de la etiología, diagnóstico y tratamiento de esta entidad.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cuellar-Barboza A, Ocampo-Candiani J, Herz-Ruelas ME. Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento. Actas Dermosifiliogr. 2018;109:777–790.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1629 "Ancho" => 2083 "Tamanyo" => 610562 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A-B) Erythrodermic psoriasis with generalized erythema, desquamation and pustules. (C) Histopathology reveals parakeratosis, acanthosis, hypogranulosis and a subcorneal pustule (H&E, original magnification x20).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1507 "Ancho" => 2083 "Tamanyo" => 474180 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A-B) Erythrodermic atopic dermatitis with generalized erythema, fine scale and increased severity in flexural creases. (C) Histopathology reveals parakeratosis, acanthosis and mild spongiosis (H&E, original magnification x20).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1360 "Ancho" => 2083 "Tamanyo" => 362662 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Erythrodermic micosis fungoides. (B) Histopathology reveals epidermotropism of atypical lymphocytes, Pautrier's microabscesses and dermal infiltration of neoplasic cells (H&E, original magnification x40).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3440 "Ancho" => 2508 "Tamanyo" => 767981 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Initial diagnostic approach and general principles of management for erythrodermic patients.</span> BSA: Body surface area; BMI: Body mass index; CBC: complete blood count; ie: for example; PO: Per os (taken orally); QID: Quarter in die (4 times a day); QD: Quaque die (once a day); BID: Bis in die (twice a day); PET-CT: positron emission tomography-computed tomography; HIV: Human immunodeficiency virus; ANAs: Antinuclear antibodies; IFF: Indirect immunofluorescence. <span class="elsevierStyleBold">Sources and comments:</span> 1.- Scarisbrick et al<a class="elsevierStyleCrossRef" href="#bib0955"><span class="elsevierStyleSup">91</span></a>; 2.- NICE: Clinical guideline for nutrition support in adults (2017 uptdate)<a class="elsevierStyleCrossRef" href="#bib0960"><span class="elsevierStyleSup">92</span></a>; 3.- Hypovolaemia criteria: Sistolic blood pressure < 100<span class="elsevierStyleHsp" style=""></span>mmHg, Heart rate<span class="elsevierStyleHsp" style=""></span>> 90 BPM, Capillary refill time<span class="elsevierStyleHsp" style=""></span>> 2<span class="elsevierStyleHsp" style=""></span>seconds, respiratory rate<span class="elsevierStyleHsp" style=""></span>> 20 breaths per minute, passive leg raising suggests fluid responsiveness<a class="elsevierStyleCrossRef" href="#bib0965"><span class="elsevierStyleSup">93</span></a>; 4.- For further management of IV fluids: NICE: Clinical guideline for intravenous fluid therapy in adults in hospital (2013)<a class="elsevierStyleCrossRef" href="#bib0965"><span class="elsevierStyleSup">93</span></a>; 5.- Martínez-Morán et al<a class="elsevierStyleCrossRef" href="#bib0905"><span class="elsevierStyleSup">81</span></a>; 6.- Kanthraj et al<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">15</span></a>; 7.- Eichenfield et al<a class="elsevierStyleCrossRef" href="#bib0970"><span class="elsevierStyleSup">94</span></a>; 8.- Stevens et al.<a class="elsevierStyleCrossRef" href="#bib0975"><span class="elsevierStyleSup">95</span></a></p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Source: Grant-Kels et al.,<a class="elsevierStyleCrossRef" href="#bib0980"><span class="elsevierStyleSup">96</span></a> Errichetti et al.,<a class="elsevierStyleCrossRef" href="#bib0985"><span class="elsevierStyleSup">97</span></a> Quay et al.,<a class="elsevierStyleCrossRef" href="#bib0990"><span class="elsevierStyleSup">98</span></a> Gupta et al.<a class="elsevierStyleCrossRef" href="#bib0995"><span class="elsevierStyleSup">99</span></a></p>" "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Etiology \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reported frequency \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical clues \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnostic hints \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dermoscopy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histopathology \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 - 50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Previous psoriatic plaques, palmoplantar keratoderma, nail changes, arthritis, scalp involvement, seborrheic dermatitis-like features \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-Most common cause<br>-Long-standing psoriasis (more than 10 years from diagnosis)<br>-Withdrawal of systemic or topical (extensive long-term use) corticosteroids, methotrexate or cyclosporine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Whitish scales, dotted vessels, regularly arranged homogeneous reddish background \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psoriasiform epidermal hyperplasia with confluent parakeratosis layered with neutrophils, hypogranulosis, and dilated tortuous papillary blood vessels, Munro microabscesses, spongiform pustules of Kogoj \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spongiotic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.12% - 25.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fine scales, lichenification, severe pruritus, oozing skin, erythematous papules and plaques \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Look for a history of:<br>-Atopic dermatitis (9%)<br>-Contact dermatitis (6%)<br>-Seborrhoeic dermatitis (4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atopic dermatitis: yellowish scales/serocrusts,<br>Patchily distributed dotted vessels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superficial perivascular dermal infiltrate with eosinophils, overlying spongiosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drug-induced \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.3 - 21.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exfoliative scale preceded by morbilliform eruption, face edema, pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-Look for intake of antiepileptics, allopurinol, beta-lactamics, sulfonamides, Chinese herbs, NSAIDs<br>-Commonly resolves 2-6 weeks after discontinuation of offending drug<br>-Eosinophilia<br>-Liver enzyme elevation<br>-Creatinine elevation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perivascular infiltrate with eosinophils, interface dermatitis with necrotic keratinocytes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pityriasis rubra pilaris \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.25% - 8.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hyperkeratotic follicular papules, islands of sparing, orange-colored palmoplantarkeratoderma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-Cephalocaudal spread<br>-Acute onset<br>-Sixth decade of life<br>-Ectroprion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Whitish scaling, orange blotches, scattered dotted vessels, islands of non-erythematous skin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Epidermal hyperplasia with horizontal and vertical alternating orthokeratosis and parakeratosis, follicular plugs with “shoulder parakeratosis” \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T-cell lymphomas (Sézary syndrome and Mycosis fungoides) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fissured painful palmoplantarkeratoderma,<br>severe pruritus, hepatosplenomegaly, nail hypertrophy, ectropion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-Lymphadenopathy<br>-Alopecia<br>-Leonine facies<br>-Hepatosplenomegaly<br>-Periphereal blood: sezary cells (cerebriform nuclei), CD4:CD8 ratio of 10 or more \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mycosis fungoides: serpiginous vessels with spermatozoon-like shape, whitish–pinkish background \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nuclear atypia in lymphocytes, clustering of atypical cells within epidermis, clonal T-cell population, minimal spongiosis, may show unspecific inflammatory infiltrate \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1886514.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other etiologies</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dermatophytosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Look for chronic use of topical corticosteroids.<br>Hyphae within stratum corneum \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Scabies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Burrows, nodules on the genitalia, scale in the webspaces, widespread crusted plaques, thick nails, ketaoderma. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lichen planus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Look for pruritic, violaceous papules that favor the extremities. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immunobullous disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilsters, erosions and ulcers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dermatomyositis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gottron papules, heliotrope sign, poikiloderma<br>Muscle weakness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paraneoplasic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Failure to thrive \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1886512.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Features of common causes of erythroderma in adults.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CHF: congestive heart failure; TB: tuberculosis.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Source: Patrizi et al.<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">82</span></a> and Wolverton et al.<a class="elsevierStyleCrossRef" href="#bib1000"><span class="elsevierStyleSup">100</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Etiology \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute contraindications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Important relative contraindications \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="9" align="left" valign="top">Psoriasis</td><td class="td" title="table-entry " align="left" valign="top">Cyclosporine<br>(First line) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Initial mean dose 4 mg/kg/day slowly reduced after remission by 0.5 mg/kg every 2 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased renal function, uncontrolled hypertension, hypersensitivity, active malignancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Controlled hypertension, age <18 years or<span class="elsevierStyleHsp" style=""></span>>64 years, active infection, live attenuated vaccine, immunodeficiency, pregnancy (C), concomitant immunosuppressive drug \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infliximab<br>(First line) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 mg/kg i.v. at week 0, 2, 6, and later every 8 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypersensitivity, active infections, concurrent use of anakinra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congestive heart failure, family history of demyelinating diseases, increased risk of malignancy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acitretin<br>(First line, slow acting) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3–0.75 mg/kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy (X), lactation, non-compliance with contraception \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leukopenia, hepatic or renal dysfunction, dyslipidemia, hypoithyroidism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Methotrexate<br>(First line, slow acting) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.5–15 mg/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy (X) and lactation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hepatic disease, decreased renal function, immunodeficiency, severe hematologic abnormality, active infectious disease or potential reactivation of TB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>mg subcutaneous injection twice a week, reduce 50 mg/week after 3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypersensitivity, active or chronic infections, concurrent use of anakinra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congestive heart failure, family history of demyelinating disease, increased risk of malignancy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Phototherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UVB-NB: Initial dosing according to skin type (130-400 mJ/cm2) or MED (50% of MED). Subsequent dosage increase by 15-65 mJ/cm2 or ≤10% of initial MED. Treatment 3-5 times/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pemphigus and pemphigoid, lupus erythematosus with photosensitivity, xeroderma pigmentosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Photosensitivity/photosensitizing medication, history of skin cancer, history or family history of melanoma, physical impairment, history of arsenic intake or ionizing radiation therapy, poor compliance (Menter et al) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80<span class="elsevierStyleHsp" style=""></span>mg at week 0, 40<span class="elsevierStyleHsp" style=""></span>mg at week 1, later 40<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypersensitivity, active infections, concurrent use of anakinra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congestive heart failure, family history of demyelinating disease, increased risk of malignancy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45/90<span class="elsevierStyleHsp" style=""></span>mg (according to the weight) at week 0.4 and later every 12 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypersensitivity, active serious infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increased risk of malignancy, avoid pregnancy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systemic corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Avoid, as their withdrawal can result in a pustular flare or erythroderma that may be life-threatening \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="7" align="left" valign="top">Atopic dermatitis</td><td class="td" title="table-entry " align="left" valign="top">Cyclosporin<br>(FIrst line) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Initial mean dose 5 mg/kg/day, slowly reduced after remission by 0.5 mg/kg every 2 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased renal function, uncontrolled hypertension, hypersensitivity, active malignancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Controlled hypertension, age <18 years or<span class="elsevierStyleHsp" style=""></span>>64 years, active infection, live attenuated vaccine, immunodeficiency, pregnancy (C), concomitant immunosuppressive drug \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Phototherapy<br>(First line) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Narrowband UVB (311–313 nm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pemphigus and pemphigoid, lupus erythematosus with photosensitivity, xeroderma pigmentosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Photosensitivity/photosensitizing medication, history of skin cancer, history or family history of melanoma, physical impairment, history of arsenic intake or ionizing radiation therapy, poor compliance \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Methotrexate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10–25 mg/week slowly reduced after remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy (X) and lactation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hepatic disease, decreased renal function, immunodeficiency, severe hematologic abnormality, active infectious disease or potential reactivation of TB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mycophenolate mofetil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1–2 g/day slowly reduced after remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy (D), drug allergy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lactation, peptic ulcer, hepatic/renal disease, concomitant use of azathioprine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Azathioprine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100–200 mg/day slowly reduced after remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy (D), hypersensitivity, active infection, myelosuppression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Use of allopurinol, prior use of alkylating agents, hepatic disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intravenous immunoglobulins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 g/kg/month for 3–6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anaphylaxis secondary to previous infusions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congestive heart failure, renal failure, IgA deficiency, rheumatoid arthritis. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systemic corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prednisone 1 mg/kg/24 h, then gradually decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Systemic fungal infections, herpes simplex keratitis, hypersensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypertension, CHF, prior psychosis, active TB, positive tuberculin test, osteoporosis, cataracts, glaucoma, pregnancy (C), diabetes mellitus, gastric disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Drug-induced</td><td class="td" title="table-entry " align="left" valign="top">Systemic corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prednisone 1 mg/kg/24 h, then gradually decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Systemic fungal infections, herpes simplex keratitis, hypersensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypertension, CHF, prior psychosis, active TB, positive tuberculin test, osteoporosis, cataracts, glaucoma, pregnancy (C), diabetes mellitus, gastric disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intravenous immunoglobulins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High dose (1 g/kg/day for 3 days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anaphylaxis secondary to previous infusions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Congestive heart failure, renal failure, IgA deficiency, rheumatoid arthritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Pityriasis rubra pilaris</td><td class="td" title="table-entry " align="left" valign="top">Acitretin<br>(First line) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3–0.75 mg/kg/day slowly reduced after remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy (X), lactation, non-compliance with contraception \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leukopenia, hepatic or renal dysfunction, dyslipidemia, hypothyroidism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Methotrexate<br>(First line) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10–25 mg/week slowly reduced after remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pregnancy (X) and lactation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hepatic disease, asses for active infectious disease or potential reactivation of TB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systemic corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prednisone 1 mg/kg/24 h, then gradually decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Systemic fungal infections, herpes simplex keratitis, hypersensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypertension, CHF, prior psychosis, active TB, positive tuberculin test, osteoporosis, cataracts, glaucoma, pregnancy (C), diabetes mellitus, gastric disease \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1886513.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Specific treatment regimens for erythroderma with known etiology.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:100 [ 0 => array:3 [ "identificador" => "bib0505" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Treatment of skin disease: Comprehensive therapeutic strategies" "paginaInicial" => "234" "paginaFinal" => "238" "edicion" => "4.<span class="elsevierStyleHsp" style=""></span>th ed." "serieFecha" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0510" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis after hospitalization for erythroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Acta Derm Venereol." "fecha" => "2014" "volumen" => "96" "paginaInicial" => "0" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0515" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Hebra FR. On Diseases of the skin. Vol. 2. En: Tay W, editor. London: TNSS; 1868. 69 p." ] ] ] 3 => array:3 [ "identificador" => "bib0520" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma/exfoliative dermatitis: A synopsis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "2004" "volumen" => "43" "paginaInicial" => "39" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0525" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic disease and the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Textbook of Dermatology." "paginaInicial" => "2703" "paginaFinal" => "2758" "edicion" => "6.<span class="elsevierStyleHsp" style=""></span>th ed" "serieFecha" => "1998" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0530" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Dermatology." "paginaInicial" => "171" "paginaFinal" => "181" "edicion" => "3rd ed." "serieFecha" => "2012" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0535" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma and exfoliative dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Life-threatening dermatoses and emergencies in dermatology." "fecha" => "1993" "volumen" => "11" "paginaInicial" => "67" "paginaFinal" => "72" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0540" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Fam Physician" "fecha" => "1999" "volumen" => "22" "paginaInicial" => "625" "paginaFinal" => "630" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0545" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: A clinical and prognostic study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000342365" "Revista" => array:6 [ "tituloSerie" => "Dermatology." "fecha" => "2012" "volumen" => "225" "paginaInicial" => "154" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0550" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma. A clinical and etiological study of 103 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3315/jdcr.2016.1222" "Revista" => array:6 [ "tituloSerie" => "J Dermatol Case Rep" "fecha" => "2016" "volumen" => "10" "paginaInicial" => "1" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0555" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: a clinical study of 97 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-5945-5-5" "Revista" => array:5 [ "tituloSerie" => "BMC Dermatol." "fecha" => "2005" "volumen" => "5" "paginaInicial" => "5" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0560" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis a prospective study of 80 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatologica." "fecha" => "1986" "volumen" => "173" "paginaInicial" => "278" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0565" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis: Patterns of clinical presentation in a tropical rural and suburban dermatology practice in Nigeria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2011.05400.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "2012" "volumen" => "51" "paginaInicial" => "1086" "paginaFinal" => "1089" "link" => array:1 [ …1] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0570" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantitative estimation and recommendations for supplementation of protein lost through scaling in exfoliative dermatitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "1999" "volumen" => "38" "paginaInicial" => "91" "paginaFinal" => "95" "link" => array:1 [ …1] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0575" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Dermatological signs of systemic disease." "paginaInicial" => "104" "paginaFinal" => "108" "edicion" => "Fth Edit" "serieFecha" => "2016" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0580" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eritrodermia: Estudo clínico-laboratorial e histopatológico de 170 casos" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Bras Dermatol." "fecha" => "2008" "volumen" => "83" "paginaInicial" => "526" "paginaFinal" => "532" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0585" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: A clinico-etiologic study of 90 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "1998" "volumen" => "37" "paginaInicial" => "104" "paginaFinal" => "107" "link" => array:1 [ …1] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0590" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinico-pathologic study of exfoliative dermatitis in patients visiting a tertiary care centre in South India" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Sci Study." "fecha" => "2016" "volumen" => "3" "paginaInicial" => "119" "paginaFinal" => "123" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0595" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: review of 82 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "South Med J." "fecha" => "1986" "volumen" => "79" "paginaInicial" => "1210" "paginaFinal" => "1215" "link" => array:1 [ …1] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0600" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired erythroderma in adults: A clinical and prognostic study" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Eur Acad Dermatology Venereol." "fecha" => "2010" "volumen" => "24" "paginaInicial" => "781" "paginaFinal" => "788" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0605" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis: Clinical and etiologic study of 58 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Bras Dermatol." "fecha" => "2006" "volumen" => "81" "paginaInicial" => "233" "paginaFinal" => "237" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0610" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma. Clinico-pathological study of 56 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1994" "volumen" => "130" "paginaInicial" => "1503" "paginaFinal" => "1507" "link" => array:1 [ …1] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0615" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma in adults: A report of 80 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2004.02100.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "2005" "volumen" => "44" "paginaInicial" => "731" "paginaFinal" => "735" "link" => array:1 [ …1] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0620" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: review of a potentially life-threatening dermatosis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.48976" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol." "fecha" => "2009" "volumen" => "54" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ …1] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0625" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dapsone hypersensitivity syndrome among leprosy patients in China" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Lepra." "fecha" => "2012" "paginaInicial" => "370" "paginaFinal" => "377" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0630" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: A comparison between HIV positive and negative patients" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "1999" "volumen" => "38" "paginaInicial" => "895" "paginaFinal" => "900" "link" => array:1 [ …1] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0635" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: A clinical-etiological study of 82 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Dermatology." "fecha" => "2010" "volumen" => "20" "paginaInicial" => "373" "paginaFinal" => "377" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0640" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe erythrodermic reactions to the proton pump inhibitors omeprazole and lansoprazole" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "The British journal of dermatology. England" "fecha" => "1999" "volumen" => "141" "paginaInicial" => "173" "paginaFinal" => "175" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0645" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extensive exfoliative dermatitis induced by non-ionic contrast medium Iodixanol (Visipaque) used during percutaneous coronary intervention" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Cardiol Heart Vasc." "fecha" => "2008" "volumen" => "124" "paginaInicial" => "e25" "paginaFinal" => "e27" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0650" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphoma as a cause of exfoliative dermatitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol." "fecha" => "1983 Jul" "volumen" => "28" "paginaInicial" => "121" "paginaFinal" => "123" "link" => array:1 [ …1] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0655" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis. A clinicopathologic study of 135 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol." "fecha" => "1973" "volumen" => "108" "paginaInicial" => "788" "paginaFinal" => "797" "link" => array:1 [ …1] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0660" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis: presenting sign of fallopian tube carcinoma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Obstet Gynecol." "fecha" => "1988" "volumen" => "71" "numero" => "6 Pt 2" "paginaInicial" => "1045" "paginaFinal" => "1047" "link" => array:1 [ …1] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0665" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma secondary to esophageal carcinoma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1985" "volumen" => "13" "paginaInicial" => "311" "paginaFinal" => "313" "link" => array:1 [ …1] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0670" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An unusual association between erythroderma and an occult gastric carcinoma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol." "fecha" => "1984" "volumen" => "79" "paginaInicial" => "921" "paginaFinal" => "923" "link" => array:1 [ …1] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0675" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gallbladder carcinoma presenting as exfoliative dermatitis (erythroderma)" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1385/IJGC:35:2:153" "Revista" => array:6 [ "tituloSerie" => "Int J Gastrointest Cancer." "fecha" => "2005" "volumen" => "35" "paginaInicial" => "153" "paginaFinal" => "155" "link" => array:1 [ …1] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0680" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[An unusual paraneoplastic manifestation in lung cancer: eosinophilic erythroderma]" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pneumo.2008.11.001" "Revista" => array:6 [ "tituloSerie" => "Rev Pneumol Clin." "fecha" => "2009" "volumen" => "65" "paginaInicial" => "32" "paginaFinal" => "35" "link" => array:1 [ …1] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0685" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of erythroderma accompanied by hyperparathyroidism and thyroid cancer" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ski Res." "fecha" => "1997" "volumen" => "39" "paginaInicial" => "59" "paginaFinal" => "63" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0690" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma as the first manifestation of colon cancer" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SMJ.0b013e318191b8c0" "Revista" => array:6 [ "tituloSerie" => "South Med J." "fecha" => "2009" "volumen" => "102" "paginaInicial" => "334" "paginaFinal" => "335" "link" => array:1 [ …1] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0695" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case report breast cancer presenting as paraneoplastic erythroderma: an extremely rare case" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Case Rep Med." "fecha" => "2014" "volumen" => "2014" "paginaInicial" => "8" "paginaFinal" => "12" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0700" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic erythroderma in a prostate cancer patient" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Strahlentherapie und Onkol Organ der Dtsch Rontgengesellschaft." "fecha" => "2002" "volumen" => "178" "paginaInicial" => "393" "paginaFinal" => "395" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0705" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Causes and features of erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Acad Med Singapore." "fecha" => "2014" "volumen" => "43" "paginaInicial" => "391" "paginaFinal" => "394" "link" => array:1 [ …1] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0710" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathologic Variants of Mycosis Fungoides" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2016.08.009" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2017" "volumen" => "108" "paginaInicial" => "192" "paginaFinal" => "208" "link" => array:1 [ …1] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0715" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "101 Cases of exfoliative dermatitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol." "fecha" => "1963" "volumen" => "87" "paginaInicial" => "96" "link" => array:1 [ …1] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0720" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant histiocytosis presenting as erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "1990" "volumen" => "29" "paginaInicial" => "214" "paginaFinal" => "216" "link" => array:1 [ …1] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0725" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The red man syndrome. Exfoliative dermatitis of unknown etiology: a description and follow-up of 38 patients" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1988" "volumen" => "18" "paginaInicial" => "1307" "paginaFinal" => "1312" "link" => array:1 [ …1] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0730" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bullous pemphigoid presenting as exfoliative erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1998" "volumen" => "39" "numero" => "5 Pt 2" "paginaInicial" => "827" "paginaFinal" => "830" "link" => array:1 [ …1] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0735" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic dermatomyositis presenting as erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1998" "volumen" => "39" "numero" => "4 Pt 1" "paginaInicial" => "653" "paginaFinal" => "654" "link" => array:1 [ …1] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0740" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythrodermic chronic actinic dermatitis responding only to topical tacrolimus" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Photodermatol Photoimmunol Photomed." "fecha" => "2004" "volumen" => "20" "paginaInicial" => "59" "paginaFinal" => "61" "link" => array:1 [ …1] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0745" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired ichthyosiform erythroderma and sarcoidosis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1996" "volumen" => "35" "numero" => "5 Pt 2" "paginaInicial" => "826" "paginaFinal" => "828" "link" => array:1 [ …1] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0750" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Norwegian scabies: Rare cause of erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2229-5178.148951" "Revista" => array:6 [ "tituloSerie" => "Indian Dermatol Online J." "fecha" => "2015" "volumen" => "6" "paginaInicial" => "52" "paginaFinal" => "54" "link" => array:1 [ …1] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0755" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma as an initial presentation of langerhans cell histiocytosis involving the sinus" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2013.08.010" "Revista" => array:6 [ "tituloSerie" => "Actas dermo-sifiliograficas." "fecha" => "2014" "volumen" => "105" "paginaInicial" => "630" "paginaFinal" => "632" "link" => array:1 [ …1] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0760" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: Analysis of 247 cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Saude Publica." "fecha" => "1995" "volumen" => "29" "paginaInicial" => "177" "paginaFinal" => "182" "link" => array:1 [ …1] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0765" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Papuloerythroderma of Ofuji associated with CD3,(+) CD4, (+) and CD8(-) cutaneous T-cell lymphoma and monoclonal gammopathy of undetermined significance" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2014.11.001" "Revista" => array:6 [ "tituloSerie" => "Actas dermo-sifiliograficas." "fecha" => "2015" "volumen" => "106" "paginaInicial" => "435" "paginaFinal" => "437" "link" => array:1 [ …1] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0770" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma as the initial presentation of the acquired immunodeficiency syndrome" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatologica." "fecha" => "1991" "volumen" => "183" "paginaInicial" => "143" "paginaFinal" => "145" "link" => array:1 [ …1] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0775" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous graft-versus-host disease - Clinical considerations and management" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transplant Dermatology." "fecha" => "2012" "volumen" => "43" "numero" => "Dli" "paginaInicial" => "101" "paginaFinal" => "115" ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0780" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Omenn's syndrome: differential diagnosis in infants with erythroderma and immunodeficiency" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Dev Pathol." "fecha" => "2001" "volumen" => "4" "paginaInicial" => "237" "paginaFinal" => "245" "link" => array:1 [ …1] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0785" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-irradiation erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clinical oncology (Royal College of Radiologists)." "fecha" => "2000" "volumen" => "12" "paginaInicial" => "336" ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0790" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic hypereosinophilic syndrome: A rare cause of erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3315/jdcr.2014.1185" "Revista" => array:6 [ "tituloSerie" => "J Dermatol Case Rep." "fecha" => "2014" "volumen" => "8" "paginaInicial" => "108" "paginaFinal" => "114" "link" => array:1 [ …1] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0795" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic options for erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis." "fecha" => "1992" "volumen" => "49" "paginaInicial" => "424" "paginaFinal" => "426" "link" => array:1 [ …1] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0800" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichenoid erythrodermic bullous pemphigoid of the African patient" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1998" "volumen" => "39" "numero" => "5 Pt 1" "paginaInicial" => "691" "paginaFinal" => "697" "link" => array:1 [ …1] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0805" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of erythrodermic dermatomyositis associated with gastric cancer" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2009.21.4.435" "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol." "fecha" => "2009" "volumen" => "21" "paginaInicial" => "435" "paginaFinal" => "439" "link" => array:1 [ …1] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0810" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythrodermic dermatomyositis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1993" "volumen" => "28" "paginaInicial" => "136" "link" => array:1 [ …1] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0815" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nose sign of exfoliative dermatitis: a possible mechanism" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol." "fecha" => "1992" "volumen" => "128" "paginaInicial" => "704" "link" => array:1 [ …1] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0820" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Life-threatening erythroderma: Diagnosing and treating the «red man.»" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2004.06.018" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol." "fecha" => "2005" "volumen" => "23" "paginaInicial" => "206" "paginaFinal" => "217" "link" => array:1 [ …1] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0825" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infectious complications of erythrodermic psoriasis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1996" "volumen" => "34" "numero" => "5 Pt 2" "paginaInicial" => "911" "paginaFinal" => "914" "link" => array:1 [ …1] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0830" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistent bacteraemia due to methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin in a patient with erythrodermic psoriasis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365540601105780" "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis." "fecha" => "2007" "volumen" => "39" "paginaInicial" => "457" "paginaFinal" => "460" "link" => array:1 [ …1] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0835" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-output cardiac failure from skin disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet." "fecha" => "1963" "volumen" => "1" "paginaInicial" => "1338" "paginaFinal" => "1340" "link" => array:1 [ …1] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0840" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staphylococcal sepsis in HIV antibody seropositive psoriasis patients" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1991" "volumen" => "24" "numero" => "6 Pt 1" "paginaInicial" => "970" "paginaFinal" => "972" "link" => array:1 [ …1] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0845" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of erythrodermic cutaneous T-cell lymphoma, superantigen-positive Staphylococcus aureus, and oligoclonal T-cell receptor V beta gene expansion" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Blood." "fecha" => "1997" "volumen" => "89" "paginaInicial" => "32" "paginaFinal" => "40" "link" => array:1 [ …1] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0850" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The specificity of histopathology in erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol." "fecha" => "1993" "volumen" => "20" "paginaInicial" => "393" "paginaFinal" => "398" "link" => array:1 [ …1] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0855" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathology in erythroderma: review of a series of cases by multiple observers" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol." "fecha" => "1994" "volumen" => "21" "paginaInicial" => "419" "paginaFinal" => "423" "link" => array:1 [ …1] ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0860" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriatic erythroderma: a histopathologic study of forty-five patients" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000246075" "Revista" => array:6 [ "tituloSerie" => "Dermatology." "fecha" => "1997" "volumen" => "194" "paginaInicial" => "102" "paginaFinal" => "106" "link" => array:1 [ …1] ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib0865" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of histological presentation in erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Dermatol." "fecha" => "2017" "paginaInicial" => "11" "paginaFinal" => "15" ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib0870" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatopathic lymphadenopathy: is our diagnostic approach correct?" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2017" ] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib0875" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual case of multicentric mixed-type Castleman's disease presenting with exfoliative dermatitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "2004" "volumen" => "43" "paginaInicial" => "202" "paginaFinal" => "205" "link" => array:1 [ …1] ] ] ] ] ] ] 75 => array:3 [ "identificador" => "bib0880" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Defining early mycosis fungoides" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2005.08.057" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2005" "volumen" => "53" "paginaInicial" => "1053" "paginaFinal" => "1063" "link" => array:1 [ …1] ] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib0885" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma as presentation form of visceral leishmaniasis in a patient with human immunodeficiency virus infection" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Clin Esp." "fecha" => "1992" "volumen" => "191" "paginaInicial" => "454" "link" => array:1 [ …1] ] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib0890" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis due to immunologically confirmed carbamazepine hypersensitivity" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol." "fecha" => "1996" "volumen" => "13" "paginaInicial" => "316" "paginaFinal" => "320" "link" => array:1 [ …1] ] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib0895" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Ca" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2007-03-055749" "Revista" => array:6 [ "tituloSerie" => "Blood." "fecha" => "2007" "volumen" => "110" "paginaInicial" => "1713" "paginaFinal" => "1722" "link" => array:1 [ …1] ] ] ] ] ] ] 79 => array:3 [ "identificador" => "bib0900" "etiqueta" => "80" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Review of the Diagnosis and Management of Erythroderma (Generalized Red Skin)" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ASW.0000463573.40637.73" "Revista" => array:6 [ "tituloSerie" => "Adv Skin Wound Care." "fecha" => "2015" "volumen" => "28" "paginaInicial" => "228" "paginaFinal" => "236" "link" => array:1 [ …1] ] ] ] ] ] ] 80 => array:3 [ "identificador" => "bib0905" "etiqueta" => "81" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitalization of Dermatologic Patients: Why, When, and Where?" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2017.01.013" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2017" "volumen" => "108" "paginaInicial" => "395" "paginaFinal" => "399" "link" => array:1 [ …1] ] ] ] ] ] ] 81 => array:3 [ "identificador" => "bib0910" "etiqueta" => "82" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "European handbook of dermatological treatments." "paginaInicial" => "287" "paginaFinal" => "302" "serieFecha" => "2015" ] ] ] ] ] ] 82 => array:3 [ "identificador" => "bib0915" "etiqueta" => "83" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantifying systemic absorption of topical hydrocortisone in erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "1995" "volumen" => "133" "paginaInicial" => "403" "paginaFinal" => "408" "link" => array:1 [ …1] ] ] ] ] ] ] 83 => array:3 [ "identificador" => "bib0920" "etiqueta" => "84" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased topical tacrolimus absorption in generalized leukemic erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1345/aph.1D082" "Revista" => array:6 [ "tituloSerie" => "Ann Pharmacother." "fecha" => "2003" "volumen" => "37" "paginaInicial" => "1444" "paginaFinal" => "1447" "link" => array:1 [ …1] ] ] ] ] ] ] 84 => array:3 [ "identificador" => "bib0925" "etiqueta" => "85" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of erythrodermic psoriasis: from the medical board of the National Psoriasis Foundation" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.05.048" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2010" "volumen" => "62" "paginaInicial" => "655" "paginaFinal" => "662" "link" => array:1 [ …1] ] ] ] ] ] ] 85 => array:3 [ "identificador" => "bib0930" "etiqueta" => "86" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.03.030" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2014" "volumen" => "71" "paginaInicial" => "327" "paginaFinal" => "349" "link" => array:1 [ …1] ] ] ] ] ] ] 86 => array:3 [ "identificador" => "bib0935" "etiqueta" => "87" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet (London, England)." "fecha" => "2017" "volumen" => "389" "numero" => "10086" "paginaInicial" => "2287" "paginaFinal" => "2303" ] ] ] ] ] ] 87 => array:3 [ "identificador" => "bib0940" "etiqueta" => "88" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methotrexate treatment for pityriasis rubra pilaris: a case series and literature review" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Acta Derm Venereol." "fecha" => "2018" ] ] ] ] ] ] 88 => array:3 [ "identificador" => "bib0945" "etiqueta" => "89" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment options for pityriasis rubra pilaris including biologic agents: a retrospective analysis from an academic medical center" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2013.4773" "Revista" => array:6 [ "tituloSerie" => "JAMA dermatology." "fecha" => "2014" "volumen" => "150" "paginaInicial" => "92" "paginaFinal" => "94" "link" => array:1 [ …1] ] ] ] ] ] ] 89 => array:3 [ "identificador" => "bib0950" "etiqueta" => "90" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythroderma: a follow-up of fifty cases" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "1983" "volumen" => "8" "paginaInicial" => "836" "paginaFinal" => "840" "link" => array:1 [ …1] ] ] ] ] ] ] 90 => array:3 [ "identificador" => "bib0955" "etiqueta" => "91" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How big is your hand and should you use it to score skin in cutaneous T-cell lymphoma?" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.12403" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2013" "volumen" => "169" "paginaInicial" => "260" "paginaFinal" => "265" "link" => array:1 [ …1] ] ] ] ] ] ] 91 => array:3 [ "identificador" => "bib0960" "etiqueta" => "92" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Nutrition support in adults Oral nutrition support, enteral tube feeding and parenteral nutritiontle [Internet]. National Collaborating Centre for Acute Care, London. 2006 [consultado 1 Jun 2018]. Disponible en: www.rcseng.ac.uk." ] ] ] 92 => array:3 [ "identificador" => "bib0965" "etiqueta" => "93" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous fluid therapy for adults in hospital: summary of NICE guidance" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.f7073" "Revista" => array:5 [ "tituloSerie" => "BMJ." "fecha" => "2013" "volumen" => "347" "paginaInicial" => "f7073" "link" => array:1 [ …1] ] ] ] ] ] ] 93 => array:3 [ "identificador" => "bib0970" "etiqueta" => "94" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.03.023" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2014" "volumen" => "71" "paginaInicial" => "116" "paginaFinal" => "132" "link" => array:1 [ …1] ] ] ] ] ] ] 94 => array:3 [ "identificador" => "bib0975" "etiqueta" => "95" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciu444" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "2014" "volumen" => "59" "paginaInicial" => "e10" "paginaFinal" => "e52" "link" => array:1 [ …1] ] ] ] ] ] ] 95 => array:3 [ "identificador" => "bib0980" "etiqueta" => "96" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exfoliative dermatitis" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Fitzpatrick's Dermatology in General Medicine." "paginaInicial" => "266" "paginaFinal" => "279" "edicion" => "8.<span class="elsevierStyleHsp" style=""></span>th ed." "serieFecha" => "2011" ] ] ] ] ] ] 96 => array:3 [ "identificador" => "bib0985" "etiqueta" => "97" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy as an auxiliary tool in the differentiation of the main types of erythroderma due to dermatological disorders" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.13322" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol." "fecha" => "2016" "volumen" => "55" "paginaInicial" => "e616" "paginaFinal" => "e618" "link" => array:1 [ …1] ] ] ] ] ] ] 97 => array:3 [ "identificador" => "bib0990" "etiqueta" => "98" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An important cause of erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Bmj [Internet]." "fecha" => "2017" "volumen" => "1205" "paginaInicial" => "j1205" ] ] ] ] ] ] 98 => array:3 [ "identificador" => "bib0995" "etiqueta" => "99" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus presenting as erythroderma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Indian J Dermatology, Venereol Leprol." "fecha" => "2012" "volumen" => "78" "paginaInicial" => "409" ] ] ] ] ] ] 99 => array:3 [ "identificador" => "bib1000" "etiqueta" => "100" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comprehensive dermatologic drug therapy" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "3rd ed." "fecha" => "2012" "editorial" => "Elsevier" "editorialLocalizacion" => "Philadelphia" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000009/v1_201811020640/S1578219018303536/v1_201811020640/en/main.assets" "Apartado" => array:4 [ "identificador" => "6151" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000009/v1_201811020640/S1578219018303536/v1_201811020640/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303536?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 53 | 36 | 89 |
| 2024 October | 596 | 164 | 760 |
| 2024 September | 607 | 120 | 727 |
| 2024 August | 679 | 214 | 893 |
| 2024 July | 686 | 219 | 905 |
| 2024 June | 606 | 186 | 792 |
| 2024 May | 705 | 251 | 956 |
| 2024 April | 448 | 161 | 609 |
| 2024 March | 526 | 179 | 705 |
| 2024 February | 541 | 168 | 709 |
| 2024 January | 551 | 210 | 761 |
| 2023 December | 486 | 221 | 707 |
| 2023 November | 627 | 189 | 816 |
| 2023 October | 694 | 206 | 900 |
| 2023 September | 577 | 214 | 791 |
| 2023 August | 528 | 142 | 670 |
| 2023 July | 452 | 179 | 631 |
| 2023 June | 407 | 212 | 619 |
| 2023 May | 544 | 190 | 734 |
| 2023 April | 426 | 146 | 572 |
| 2023 March | 389 | 126 | 515 |
| 2023 February | 420 | 111 | 531 |
| 2023 January | 336 | 117 | 453 |
| 2022 December | 245 | 112 | 357 |
| 2022 November | 168 | 143 | 311 |
| 2022 October | 137 | 96 | 233 |
| 2022 September | 200 | 81 | 281 |
| 2022 August | 81 | 86 | 167 |
| 2022 July | 100 | 100 | 200 |
| 2022 June | 91 | 98 | 189 |
| 2022 May | 321 | 173 | 494 |
| 2022 April | 464 | 151 | 615 |
| 2022 March | 456 | 193 | 649 |
| 2022 February | 448 | 126 | 574 |
| 2022 January | 392 | 175 | 567 |
| 2021 December | 356 | 98 | 454 |
| 2021 November | 389 | 106 | 495 |
| 2021 October | 924 | 133 | 1057 |
| 2021 September | 355 | 112 | 467 |
| 2021 August | 374 | 141 | 515 |
| 2021 July | 507 | 124 | 631 |
| 2021 June | 753 | 135 | 888 |
| 2021 May | 419 | 179 | 598 |
| 2021 April | 907 | 254 | 1161 |
| 2021 March | 571 | 152 | 723 |
| 2021 February | 485 | 142 | 627 |
| 2021 January | 420 | 99 | 519 |
| 2020 December | 271 | 121 | 392 |
| 2020 November | 212 | 132 | 344 |
| 2020 October | 181 | 83 | 264 |
| 2020 September | 192 | 69 | 261 |
| 2020 August | 182 | 72 | 254 |
| 2020 July | 159 | 108 | 267 |
| 2020 June | 143 | 108 | 251 |
| 2020 May | 102 | 73 | 175 |
| 2020 April | 77 | 28 | 105 |
| 2020 March | 52 | 31 | 83 |
| 2020 February | 5 | 4 | 9 |
Show all
