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A patient with bilateral ectropion and superior punctate corneal erosions caused by eritrodermic psoriasis

Poster Details

First Author: M.Kosker TURKEY

Co Author(s):    M. Acar   C. Ergin   C. Gurdal              

Abstract Details

Purpose:

Erythrodermic psoriasis is an uncommon but severe and disabling variant of psoriasis occurring in less than 1.5% of cases and it usually develops gradually or acutely from any type of psoriasis. Infections, drugs or skin trauma are frequent precipitating factors in erythrodermic flares of psoriasis. The ophthalmologic involvement occurs in about 10% of patients with psoriasis. Herein, we aimed to present the management of a patient with bilateral ectropion and superior punctate corneal erosions caused by eritrodermic psoriasis precipitated by skin trauma. Although bilateral ectropion is common in patients with eritrodermi, it has not been emphasized enough in the literature.

Setting:

Departments of Ophthalmology and Dermatology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

Methods:

A 62-year-old man with a history of chronic plaque psoriasis presented with scaly erythematous plaques with itching and burning that covered his entire body 1 day after rubbing with a coarse bath-glove in a Turkish bath. He had no systemic and ocular disease history except psoriasis. Laboratory examinations were all unremarkable and no history or clinical evidence of precipitating factors except trauma was detected. A skin biopsy was also performed to exclude the mycosis fungoides. Physical examination revealed diffuse burning erythema, crusts and scaling involving all of the body surface area.

Results:

The patient referred to our ophthalmology clinic with complaints of diminution of vision, foreign body sensation, watering and discharge in both of his eyes. Visual acuity was 20/20 in both eyes and intraocular and fundus examinations were normal. There were bilateral superior punctate erosions on central and inferior one third of the cornea. Cicatricial ectropion was seen in both the lower eyelids. Scaling and excessive dryness of entire body skin was noticed. A diagnosis of erythrodermic psoriasis was made based on the clinical findings including scaling and excessive dryness of the entire body skin and was confirmed by skin biopsy. Patient was then treated with topical salicylic acid, calcipotriene, preservative free lubricants and jells for 12 weeks with complete remission.

Conclusions:

Treatment of erythrodermic psoriasis can be difficult. Management includes hospitalisation for supportive care including intravenous fluids and temperature regulation, bland emollients and cooling wet dressings and bed rest. In patients with cicatricial ectropion and dry eye secondary to eritrodermic psoriasis, corneal health should be also closely monitored because of probable perforation risk.

Financial Disclosure:

NONE

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