Give differential diagnois of paoriasiform lesions a long list with different types of paoriasis seperately
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I now have sufficient information from Fitzpatrick's and Dermatology 5e to compile a comprehensive answer. Let me now write the full response.
Differential Diagnosis of Psoriasiform Lesions
Psoriasiform disorders share a common histopathologic pattern - regular elongation of the rete ridges (epidermal hyperplasia) - producing thickened, scaly papules and plaques clinically. The group is broad and includes psoriasis itself (with its many variants) plus numerous other conditions that mimic it.
PART 1: TYPES OF PSORIASIS (Psoriasis Proper)
1. Psoriasis Vulgaris (Chronic Plaque Psoriasis)
- Most common form (~90% of cases)
- Well-demarcated, raised, erythematous plaques with silvery-white scale
- Symmetric distribution: elbows, knees, scalp, lumbosacral region, umbilicus, intergluteal cleft
- Auspitz sign: punctate bleeding on scale removal
- Koebner phenomenon: induction at sites of trauma
- Subvariants based on morphology:
- Rupioid psoriasis - cone/limpet-shaped lesions
- Ostraceous psoriasis - oyster shell-like, ring-shaped hyperkeratotic concave lesions
- Elephantine psoriasis - thickly scaling large plaques, usually lower extremities
- Annular psoriasis - ring-like lesions with central clearing
- Gyrate psoriasis - circinate/gyrate plaques from confluence
2. Guttate Psoriasis
- Sudden eruption of small (0.5-1.5 cm) teardrop-shaped papules
- Usually triggered by streptococcal pharyngitis (Group A Strep)
- Predominantly on trunk and proximal extremities
- Common in children and young adults
- Often self-limiting; may progress to chronic plaque disease
3. Pustular Psoriasis
- Generalized pustular psoriasis (von Zumbusch type) - acute onset of sterile pustules on erythematous skin, systemic features (fever, leukocytosis), potentially life-threatening
- Annular pustular psoriasis - pustules arranged in annular/circinate patterns
- Localized pustular psoriasis:
- Palmoplantar pustulosis (PPP) - crops of sterile pustules on palms/soles; classified by some as distinct entity
- Acrodermatitis continua of Hallopeau - persistent pustules on distal digits, nail involvement
4. Erythrodermic Psoriasis
- Near-universal (>90% BSA) erythema and scaling
- Acute form: rapid generalization, fever, hemodynamic instability
- Chronic form: gradual spread
- High-output cardiac failure, hypothermia, protein loss, electrolyte imbalance may occur
5. Inverse (Flexural) Psoriasis
- Affects skin folds: axillae, groin, inframammary, intergluteal, perianal areas
- Smooth, shiny, erythematous plaques - scale minimal due to moisture
- More susceptible to Candida superinfection
6. Scalp Psoriasis
- Diffuse, thick, adherent scale; often extends beyond hairline
- Sebopsoriasis: overlap between scalp psoriasis and seborrhoeic dermatitis
7. Nail Psoriasis
- Pitting (most common), onycholysis, subungual hyperkeratosis, oil drop sign, Beau's lines, leukonychia, splinter hemorrhages
8. Palmoplantar Psoriasis
- Hyperkeratotic, fissured plaques on palms and soles
- Overlap with hyperkeratotic eczema
9. Psoriatic Arthritis (PsA)
- Present in 10-25% of psoriasis patients
- Multiple subtypes: oligoarticular, polyarticular, DIP-predominant, spondylitis, arthritis mutilans
10. Linear Psoriasis
- Follows lines of Blaschko; rare
- May represent postzygotic somatic mutation
11. Photosensitive Psoriasis
- Lesions preferentially or exclusively on sun-exposed skin; paradoxical since UV is usually therapeutic
PART 2: DIFFERENTIAL DIAGNOSIS OF PSORIASIFORM LESIONS
Organized by clinical context, drawn from Fitzpatrick's Table 28-3 and broader psoriasiform dermatitis classification:
A. Conditions Mimicking Psoriasis Vulgaris (Chronic Plaque)
| Condition | Key Distinguishing Features |
|---|---|
| Discoid/Nummular Eczema | Coin-shaped, weeping/crusted plaques; no Auspitz sign; prominent spongiosis histologically |
| Cutaneous T-cell Lymphoma (CTCL / Mycosis Fungoides) | Patch/plaque/tumor stages; atypical lymphocytes; CD4+ T cells; skin biopsy essential |
| Tinea Corporis | Active scaly border, central clearing; positive KOH/fungal culture |
| Pityriasis Rubra Pilaris (PRP) | Follicular hyperkeratotic papules, salmon-colored plaques, islands of sparing, palmoplantar keratoderma |
| Seborrhoeic Dermatitis | Greasy yellow scale; face, scalp, central chest (sebaceous areas); associated with Malassezia |
| Subacute Cutaneous Lupus Erythematosus (SCLE) | Annular or papulosquamous plaques; photodistributed; anti-Ro/SSA antibodies |
| Discoid (Chronic Cutaneous) Lupus Erythematosus | Atrophic scarring, follicular plugging, dyspigmentation |
| Lichen Simplex Chronicus | Lichenified plaques from chronic rubbing/scratching; single sites; prominent pruritus |
| Hypertrophic Lichen Planus | Hyperkeratotic plaques on shins; violaceous lesions elsewhere; Wickham striae |
| Contact Dermatitis (Chronic) | Exposure history; geometric distribution; spongiosis on biopsy |
| Erythrokeratoderma (Fixed plaques of EKV/PSEK) | Genetic; fixed erythematous hyperkeratotic plaques; variants include keratoderma variabilis and progressive symmetric erythrokeratoderma |
| Inflammatory Linear Verrucous Epidermal Nevus (ILVEN) | Follows Blaschko's lines; present from childhood; pruritic |
| Hailey-Hailey Disease (Flexural) | Familial; moist erosive plaques in folds; acantholysis on biopsy |
| Candida Infection (Flexural) | Satellite pustules; KOH positive; moist skin folds |
| Intertrigo | Skin fold inflammation; no classic scale |
B. Conditions Mimicking Guttate Psoriasis
| Condition | Key Distinguishing Features |
|---|---|
| Pityriasis Rosea | Herald patch; oval lesions following skin cleavage lines ("Christmas tree" pattern); self-limited; collarette scale |
| Pityriasis Lichenoides Chronica (PLC) | Small papules with adherent mica-like scale; centrofacial; slower evolution |
| Pityriasis Lichenoides et Varioliformis Acuta (PLEVA) | Polymorphic: papules, vesicles, necrotic lesions; systemic symptoms possible |
| Lichen Planus | Flat-topped polygonal purple papules; Wickham striae; oral involvement |
| Small Plaque Parapsoriasis | Finger-like plaques; often precursor to CTCL |
| Drug Eruption | Temporal relation to drug exposure; eosinophils on biopsy |
| Secondary Syphilis | MUST ALWAYS BE RULED OUT - palmoplantar involvement, mucous patches, condylomata lata, positive RPR/VDRL/TPHA |
C. Conditions Mimicking Erythrodermic Psoriasis
| Condition | Key Distinguishing Features |
|---|---|
| Drug-induced Erythroderma | Drug history; resolves on withdrawal |
| Atopic/Chronic Eczema (Erythrodermic) | History of atopy; pruritus prominent; IgE elevated |
| Sézary Syndrome / CTCL | Erythroderma + circulating Sézary cells; CD4+/CD8+ ratio elevated; lymphadenopathy |
| Pityriasis Rubra Pilaris (Erythrodermic) | Characteristic follicular papules; islands of normal skin; orange-red hue |
| Pemphigus Foliaceus | Superficial erosions with scale-crust; not true plaques; anti-desmoglein 1 antibodies |
| Staphylococcal Scalded Skin Syndrome | Children; Nikolsky sign; superficial desquamation around orifices |
| Norwegian (Crusted) Scabies | Hyperkeratotic crusted plaques; immunocompromised; mites/eggs on scraping |
D. Conditions Mimicking Pustular Psoriasis
| Condition | Key Distinguishing Features |
|---|---|
| Impetigo | Bacterial (Staph/Strep); honey-crusted; positive culture |
| Superficial Candidiasis | Satellite pustules; flexural; KOH positive |
| Reactive Arthritis (Reiter Syndrome) | Keratoderma blennorrhagica (hyperkeratotic plaques on soles); circinate balanitis; urethritis, arthritis, conjunctivitis triad |
| Superficial Folliculitis | Perifollicular pustules; bacterial or Pityrosporum |
| Pemphigus Foliaceus | Superficial blistering; immunofluorescence positive |
| IgA Pemphigus | Subcorneal or intraepidermal pustules; anti-IgA antibodies |
| Sneddon-Wilkinson Disease (Subcorneal Pustular Dermatosis) | Sterile subcorneal pustules; annular/circinate grouping; flaccid, easily ruptured |
| Acute Generalized Exanthematous Pustulosis (AGEP) | Drug-triggered; acute fever; sterile superficial pustules on erythematous background; rapid onset and resolution |
| Migratory Necrolytic Erythema | Glucagonoma syndrome; perioral/acral/intertriginous; high glucagon levels |
| Transient Neonatal Pustular Melanosis | Neonates; resolves spontaneously; hyperpigmented macules follow |
| Acropustulosis of Infancy | Palmar/plantar pruritic pustules in infants |
E. Other Psoriasiform Dermatoses (Broader Category)
These are conditions with histological psoriasiform epidermal hyperplasia that may not always be clinically confused with psoriasis but belong to the psoriasiform dermatitis pattern:
| Condition | Notes |
|---|---|
| Chronic Spongiotic Dermatitis | Long-standing eczema develops psoriasiform change |
| Mycosis Fungoides (Plaques) | Epidermotropic T-cell lymphoma; Pautrier microabscesses |
| Lichen Psoriasis (Lichenoid Psoriasiform overlap) | Features of both lichen planus and psoriasis |
| Parapsoriasis (Large Plaque) | Precursor to MF; atrophy; biopsy required |
| Reactive Arthritis Skin Lesions | Keratoderma blennorrhagica histologically identical to pustular psoriasis |
| Pellagra | Niacin deficiency; Casal necklace; photodistributed; psoriasiform change |
| Glucagonoma Syndrome | Migratory necrolytic erythema; elevated plasma glucagon |
| Acrodermatitis Enteropathica | Zinc deficiency (or acquired); perioral/acral psoriasiform plaques |
| Chronic Arsenical Dermatosis | Arsenical keratoses; psoriasiform plaques |
| Bowen's Disease (Erythematous Type) | Squamous cell carcinoma in situ; well-demarcated erythematous scaly plaque |
| Lamellar Ichthyosis | Congenital; large, plate-like scale; ectropion, eclabion |
| Psoriasiform Drug Eruption | Triggered by beta-blockers, lithium, antimalarials, TNF-alpha inhibitors (paradoxical), IFN |
| HIV-associated Psoriasiform Dermatitis | Severe, atypical psoriasis or psoriasiform eruption in HIV |
| Dermatophytosis (Tinea Incognito) | Modified by steroids; atypical psoriasiform plaques |
| Lichen Striatus | Linear along Blaschko's lines; children; self-resolving |
| Chronic Cutaneous Graft-versus-Host Disease | Post-transplant; lichenoid to psoriasiform spectrum |
| Pityriasis Amiantacea | Scalp-specific; thick scale binding hair shafts; may be psoriasiform or seborrhoeic |
F. Systemic/Infectious Causes with Psoriasiform Skin Involvement
| Condition | Notes |
|---|---|
| Secondary Syphilis | Palmoplantar papulosquamous lesions; mucous patches; serology positive |
| Tertiary Syphilis | Psoriasiform plaques among cutaneous manifestations |
| Mycosis Fungoides | Chronic plaque phase mimics psoriasis closely |
| Adult T-cell Leukemia/Lymphoma (HTLV-1) | Psoriasiform lesions; geographic distribution |
| Norwegian Scabies | Hyperkeratotic crusted psoriasiform plaques; mite-laden |
| Chromoblastomycosis | Verrucous/psoriasiform plaques; trauma-associated fungal infection |
Quick Summary Table: Key Distinguishing Clues
| Feature | Points Toward Psoriasis | Points Away |
|---|---|---|
| Auspitz sign | Present | Absent in most mimics |
| Koebner phenomenon | Present | Also in lichen planus, vitiligo |
| Silvery mica-like scale | Classic | PRP has more follicular scale |
| Symmetrical extensor distribution | Classic psoriasis vulgaris | - |
| Palmoplantar + serology | - | Secondary syphilis |
| Follicular plugging + scarring | - | DLE |
| Islands of normal skin | - | PRP |
| Satellite pustules | - | Candidiasis |
| Positive KOH | - | Tinea/Candida |
Sources:
- Fitzpatrick's Dermatology, 9th Edition - Table 28-3: Differential Diagnosis of Psoriasis; Chapter 28 (Psoriasis); Chapter 31 (Pityriasis Rosea)
- Dermatology 2-Volume Set, 5th Edition (Bolognía et al.) - Chapter on Psoriasiform Dermatitis patterns
Give differentials of eruthroderma
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I now have comprehensive data from three major textbooks. Let me compile the full answer.
Differential Diagnosis of Erythroderma
Definition: Erythema and scaling involving >80% (commonly >90%) of the body surface area. It is not a diagnosis in itself but a clinical reaction pattern arising from many underlying diseases. Also called exfoliative dermatitis.
Epidemiology: Incidence ~1 per 100,000. Men affected 2-4x more than women. Average age of onset is 55-60 years (rarely neonates/infants).
CLASSIFICATION BY CAUSE
1. Pre-existing (Secondary) Dermatoses - Most Common (~50%)
A. PSORIASIS (~23-25% of all erythroderma)
- Most common single underlying cause in adults
- History of plaques on elbows, knees, scalp, lumbosacral region
- Often spares the central face
- Nail changes: oil-drop sign, pitting, onycholysis
- Inflammatory arthritis may be present
- Subcorneal pustules; migratory waves of erythema with pustules in pustular type
- Triggers: drug withdrawal (steroids, methotrexate), infection, stress, phototherapy overdose
- Histology: confluent parakeratosis, elongated rete ridges, tortuous papillary dermal vessels, Munro microabscesses
B. ATOPIC DERMATITIS (~15-20%)
- Severe pruritus (often most prominent symptom)
- Lichenification, including eyelids
- History of atopy (asthma, allergic rhinitis, eczema)
- Fine scale; prurigo nodularis may develop
- Horizontal nail ridging
- Personal/family history of atopy
- Secondary S. aureus infection common
- IgE often elevated; eosinophilia
C. CONTACT DERMATITIS (Allergic or Irritant)
- Allergic contact: delayed hypersensitivity; patch testing positive
- Irritant contact: history of exposure to chemicals/irritants
- Initial lesions at site of contact, then autosensitization leads to generalization
- Systemic contact dermatitis (after systemic exposure to prior cutaneous sensitizer)
D. STASIS DERMATITIS WITH AUTOSENSITIZATION (Id Reaction)
- Lower extremity edema, varicosities, hemosiderin deposits
- Autosensitization (dissemination) follows localized stasis eczema
- Often pruritic
E. SEBORRHOEIC DERMATITIS
- Common cause in infants (Leiner's disease phenotype)
- Rare in adults as sole cause
- Pink-orange greasy scale; nasolabial folds, scalp, intertriginous zones
- Associated with HIV, Parkinson's disease
F. PITYRIASIS RUBRA PILARIS (PRP)
- Salmon-colored erythema with characteristic "islands of sparing" (nappes claires)
- Waxy/orange palmoplantar keratoderma (early sign, ~30%)
- Follicular hyperkeratotic papules ("nutmeg grater" on dorsal fingers)
- Perifollicular accentuation of scale
- Types I-VI (adult classic, adult atypical, juvenile classic, juvenile circumscribed, HIV-associated, CARD14-associated)
- Histology: alternating orthokeratosis and parakeratosis in both vertical and horizontal directions ("checkerboard" pattern)
G. LICHEN PLANUS (Erythrodermic - Rare)
- May follow widespread lichen planus
- Residual violaceous flat-topped papules; oral involvement
- Wickham striae
- Nail destruction; scarring alopecia possible
H. BULLOUS DERMATOSES
- Pemphigus foliaceus - superficial erosions with scale-crust; anti-desmoglein 1 antibodies; DIF positive
- Bullous pemphigoid - erythroderma before blisters; tense blisters; anti-BP180/BP230; eosinophilia
- IgA pemphigus - subcorneal or intraepidermal pustules; IgA deposits on DIF
- Erosions, crust, secondary bacterial infection may mask primary lesions
I. ICHTHYOSES (Congenital/Acquired)
- Lamellar ichthyosis - large plate-like scales; ectropion, eclabion; autosomal recessive
- Non-bullous congenital ichthyosiform erythroderma (NBCIE) - fine white scale on erythematous base
- Bullous ichthyosiform erythroderma (Epidermolytic hyperkeratosis) - blistering at birth, then hyperkeratosis
- Netherton syndrome - ichthyosis linearis circumflexa + trichorrhexis invaginata ("bamboo hair") + atopy
- Sjögren-Larsson syndrome - ichthyosis + spastic diplegia + intellectual disability
- Keratitis-ichthyosis-deafness (KID) syndrome - sensorineural deafness, keratitis, erythrokeratoderma
- Neutral lipid storage disease (Chanarin-Dorfman) - ichthyosis + myopathy + hepatomegaly
2. Drug-induced Erythroderma (~20%)
May begin as a morbilliform exanthem that generalizes. Drug-induced erythroderma may be part of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) / DIHS.
Common causative drugs (from Dermatology 5e, Table 10.3):
| Frequency | Drugs |
|---|---|
| Common | Allopurinol, beta-lactam antibiotics, carbamazepine/oxcarbazepine, gold, phenobarbital, phenytoin, sulfasalazine, sulfonamides (including furosemide) |
| Less common | Captopril/lisinopril, carboplatin/cisplatin, cytarabine, cytokines (IL-2, GM-CSF), dapsone, hydroxychloroquine, immune checkpoint inhibitors (ipilimumab, nivolumab, pembrolizumab), isoniazid, isotretinoin/acitretin, lithium, minocycline, omeprazole, ribavirin, thalidomide, tocilizumab, vancomycin |
| Rare | Amiodarone, beta-blockers, chlorpromazine, cimetidine, ciprofloxacin, fluorouracil, imatinib, lamotrigine, methotrexate, nifedipine, other NSAIDs, penicillamine, rifampin, terbinafine, vinca alkaloids, zidovudine, abacavir, other antiretrovirals |
Features suggesting drug cause: Facial edema, purpura in dependent areas, eosinophilia, hepatitis, nephritis, onset 1-6 weeks after starting drug, fever, scarlatiniform pattern initially.
DRESS syndrome features: Fever + skin rash + lymphadenopathy + internal organ involvement (hepatitis, nephritis, myocarditis, pneumonitis) + atypical lymphocytes + eosinophilia. Associated particularly with aromatic anticonvulsants and allopurinol.
3. Systemic/Malignant Causes (~10-15%)
A. CUTANEOUS T-CELL LYMPHOMA (CTCL)
- Sézary Syndrome - the classic erythrodermic CTCL
- Deep purple-red hue; melanoerythroderma (hyperpigmented)
- Intense pruritus with excoriations; lichenification or prurigo nodularis
- Infiltration/edema of skin; leonine facies
- Painful fissured palmoplantar keratoderma
- Alopecia (30-60%)
- Generalized lymphadenopathy (dermatopathic lymphadenopathy)
- Nail dystrophy; ectropion
- Diagnostic criteria: absolute Sézary cell count ≥1000/mm³; CD4:CD8 ratio ≥10; T-cell clone by PCR/Southern blot
- Erythrodermic Mycosis Fungoides - same features but without circulating tumor cells meeting Sézary criteria
- Poor prognosis; similar to nodal CTCL involvement
B. OTHER LYMPHOMAS
- Hodgkin Lymphoma - fever, lymphadenopathy, splenomegaly, hepatomegaly; elevated ESR
- Non-Hodgkin Lymphoma - B-cell lymphomas rarely
- Adult T-cell Leukemia/Lymphoma (HTLV-1) - especially in endemic regions (Japan, Caribbean, Africa)
C. SOLID TUMORS (Rare/Late-stage)
- Paraneoplastic erythroderma - melanoerythroderma pattern; cachexia
- Associated with: lung, colon, thyroid, pharynx carcinomas; renal cell carcinoma
- Mechanism: immune-mediated paraneoplastic reaction
D. AUTOIMMUNE BULLOUS DISEASES (Severe Cases)
- Pemphigus vulgaris/foliaceus - erosions + scale-crust
- Bullous pemphigoid - erythroderma may precede blistering
4. Infectious Causes
| Organism | Condition | Key Features |
|---|---|---|
| Staphylococcus aureus | Staphylococcal Scalded Skin Syndrome (SSSS) | Neonates/children (rarely immunocompromised adults); Nikolsky sign; perioral/perinasal crusting; desquamation around orifices; toxin-mediated (exfoliatin) |
| Group A Streptococcus | Scarlet fever / Streptococcal toxic shock | Sandpaper rash; "strawberry tongue"; circumoral pallor; Pastia's lines; desquamation in convalescence |
| S. aureus | Toxic Shock Syndrome (TSS) | Diffuse macular erythema + shock + multiorgan failure; desquamation of palms/soles 1-2 weeks later |
| Treponema pallidum | Secondary syphilis | Palmoplantar papulosquamous lesions; mucous patches; condylomata lata; positive RPR/VDRL |
| Congenital syphilis | Early congenital syphilis | Desquamative dermatitis/vesiculobullous eruption in neonates |
| Dermatophytes | Generalized tinea / hyperkeratotic dermatophytosis | Immunocompromised; KOH positive; may mimic ichthyosiform erythroderma |
| Crusted (Norwegian) Scabies | Sarcoptes scabiei | Hyperkeratotic crusted plaques; immunocompromised; mite-laden; extremely pruritic |
| HIV | HIV-associated erythroderma | Drug reactions most common in HIV+; also seborrhoeic dermatitis, CTCL risk |
| Candida | Generalized candidiasis | Satellite pustules; Candida paronychia; immunocompromised |
5. Idiopathic Erythroderma (~25%)
- Diagnosis of exclusion after thorough evaluation
- Also called "red man syndrome" (distinct from vancomycin infusion reaction)
- More common in older men
- Chronic, relapsing course
- Severe pruritus; palmoplantar keratoderma; dermatopathic lymphadenopathy
- Important: ~30% of initially idiopathic erythroderma cases eventually diagnosed as CTCL on follow-up - repeat biopsies and T-cell receptor gene rearrangement studies are mandatory
6. Special Populations: Neonatal & Infantile Erythroderma
A separate set of causes applies in neonates/infants:
| Category | Conditions |
|---|---|
| Immunodeficiency (~30%) | SCID (severe combined immunodeficiency), IPEX syndrome (immune dysregulation, polyendocrinopathy, enteropathy, X-linked), Omenn syndrome, DiGeorge syndrome |
| Congenital ichthyosis (~24%) | Lamellar ichthyosis, NBCIE, bullous ichthyosiform erythroderma, Netherton syndrome, KID syndrome, Sjögren-Larsson, neutral lipid storage disease (Chanarin-Dorfman) |
| Inflammatory dermatoses (~20%) | Seborrhoeic dermatitis, infantile psoriasis, juvenile PRP, atopic/nonatopic eczema |
| Metabolic/nutritional | Holocarboxylase synthetase deficiency, biotinidase deficiency (multiple carboxylase deficiency) - also seizures, lethargy; essential fatty acid deficiency; zinc deficiency (acrodermatitis enteropathica pattern) |
| Infectious | SSSS, early congenital syphilis, candidiasis |
| Genetic/desmosomal | Ectodermal dysplasia with skin fragility syndromes (CARD14 gain-of-function = PSORS2; DIRA; DITRA) |
SYSTEMATIC DIAGNOSTIC APPROACH
| Clue | Suggests |
|---|---|
| Prior psoriatic plaques (elbows, knees) + nail pits | Erythrodermic psoriasis |
| Severe pruritus + atopic history + lichenification | Atopic dermatitis |
| Islands of sparing + follicular papules + orange PPK | Pityriasis rubra pilaris |
| Recent drug exposure + facial edema + eosinophilia | Drug-induced / DRESS |
| Deep purple-red hue + leonine facies + lymphadenopathy + Sézary cells | Sézary syndrome |
| Nikolsky sign + perioral crusting + children | SSSS |
| Superficial erosions + scale-crust + DIF positive | Pemphigus foliaceus |
| Tense bullae before erythroderma + eosinophilia | Bullous pemphigoid |
| Cachexia + melanoerythroderma | Paraneoplastic |
| Neonatal onset + collodion membrane | Congenital ichthyosis |
| Neonatal onset + failure to thrive + infections | Primary immunodeficiency |
| Fine bran-like scale; no prior lesions | Seborrhoeic dermatitis |
| Palmoplantar hyperkeratosis + mites on scraping | Crusted scabies |
Sources:
- Dermatology 2-Volume Set, 5th Ed. (Bolognía et al.) - Chapter 10: Erythroderma; Tables 10.2, 10.3
- Harrison's Principles of Internal Medicine, 22nd Ed. (2025) - Table 61-2 & 61-3: Causes of Erythroderma
- Andrews' Diseases of the Skin, Clinical Dermatology - Chapter 11: Exfoliative Dermatitis
- Fitzpatrick's Dermatology, 9th Ed. - Chapter on Neonatal/Infantile Erythroderma
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