CAUSES :
1. Idiopathic in up to 20% or more of cases
2. Up to 80% may occur in response to one of the following:
. Atopic dermatitis
. Colon carcinoma
. Contact dermatitis (5-10%)
. Drug eruptions (14%)
. Fungal disease with id reaction
. HIV infection
. Ichthyosiform dermatoses
. Leukemia
. Lichen planus
. Lung carcinoma
. Lymphoma - 15% of cases overall and 35-50% of patients over age 40
. Medications - sulfonamides and sulfones, penicillins, cephalosporins, anticonvulsants, NSAIDs, codeine, heavy metals, INH, quinidine, captopril, iodine, antimalarials, Phenothiazines, methotrexate
. Multiple myeloma
. Mycosis fungoides
. Pemphigus foliaceus
. Photosensitivity reaction
. Pityriasis rosea
. Pityriasis rubra pilaris
. Psoriasis
. Pyoderma with id reaction
. Reiter syndrome
. Scabies
. Seborrheic dermatitis
. Sezary syndrome
. Staphylococcal scalded skin syndrome
. Stasis dermatitis
. Systemic lupus erythematosus
. Toxic epidermal necrolysis
--------------------------------------------------------------------------
DIFFERENTIAL DIAGNOSIS : Acutely
eczematous dermatoses such as contact dermatitis and drug eruptions should be considered
* None diagnostic. May have elevated WBC with eosinophilia, anemia, elevated ESR, decreased albumin and electrolyte abnormalities
IMAGING : Chest x-ray and other imaging procedures as indicated to investigate any underlying disease process
DIAGNOSTIC PROCEDURES :
β’ Careful history and physical exam
β’ Skin biopsy; lymph node biopsy and bone marrow biopsy as indicated to investigate an underlying disease process