Erythrodermic psoriasis de novo versus skin lesions in chronic lymphocytic leukaemia

Erythroderma is an inflammatory skin disease that affects over 90% of the body surface. It is usually associated with skin desquamation and pruritus [1]. This rare and severe form affects 1–2.25% of patients diagnosed with psoriasis [2]. Differential diagnosis for erythroderma includes inter alia dandruff, atopic dermatitis, drug eruption, seborrheic dermatitis, erythrodermic stage of cutaneous lymphoma or even skin manifestation of leukaemia, including chronic lymphocytic leukaemia (CLL) [2, 3]. Only 25% of erythroderma cases are caused by the psoriasis [4].
Skin lesions are present in 5–25% of CLL patients [5]. The most common type is a lump or wart associated with limited lymphocyte B skin infiltration. Exfoliative dermatitis, also manifested as erythroderma have been reported in CLL [6].
Skin lesions associated with CLL might develop primarily as a skin leukaemia (manifested as blisters, ulcerations, eczema and gingival overgrowth) or secondary to hematologic or autoimmune diseases associated with CLL (e.g. skin neoplasm, petechia, exfoliative dermatitis, erythroderma or pemphigoid) [7, 8].
A 56-year-old man diagnosed with psoriasis vulgaris was referred to our department due to scaly lesions on the elbows. The patient had a 1-year history of progressively deteriorating skin lesions, but no previous medical files were available for review. No co-morbidities, oral medication intake and significant family history was reported by the patient. Previous treatment of psoriatic skin lesions included topical prescription ointment, though no information regarding ointment composition were available. Also no general symptoms such as weight loss or fever were noted. At admission erythroderma associated with itch (without desquamation) and mild ankle oedema was reported (Figure 1). Apart from that, numerous, swollen, painless lymph nodes were noted in the following locations: right lateral cervical triangle, bilateral supraclavicular area, and bilateral axillary area. The lymph node in the right lateral cervical triangle was modelling shape of the neck, what was noted by the patient 1 year ago. Due to no associated pain the patient decided not to report this finding to his general physician, also no lymph node physical examination was carried out in the preceding year.
An elevated lymphocyte count (7.01 × 103/µl, cutoff level: 4.50 × 103/µl) and white blood cell count (12.48 × 103/µl, cutoff level: 11.00 × 103/µl) were found. Other...


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