Abstract:
Exfoliative erythroderma is a dermatologic emergency characterized by diffuse skin
redness and scaling involving at least 70% of the body surface area. It is a clinical
presentation that usually indicates an underlying primary process. Once a clinical
diagnosis of EE was made, prompt supportive measures were instituted while efforts
were undertaken to identify the underlying cause of the presentation. These causes
were determined clinically and/or through histopathological evaluation following a
skin biopsy. Identifying the underlying cause was important for reducing recurrences,
complications associated with skin failure, and mortality risk. The correlation between
clinical and histopathological diagnoses had not been determined for the Kenyan
population. The purpose of the study was to assess the frequency of causes of EE and
their histopathologic correlation at Kenyatta National Hospital. This was an
ambispective study that included both prospective and retrospective components
conducted in the wards and clinics of Kenyatta National Hospital. All adult patients
with EE who met the study criteria were included. This study assessed 94 cases of EE
at KNH to determine the frequency of skin biopsies and clinicopathologic correlation.
Descriptive analysis was used to summarize clinical and pathological findings.
Correlation analysis was conducted using Kappa statistics, and sensitivity analysis was
also performed to determine the accuracy of clinical findings. A p-value of <0.05 was
considered statistically significant at a 95% confidence interval. Data analysis was
performed using SPSS version 27. While clinical assessments frequently identified
psoriasis and malignancies, the leading histopathologic causes were malignancies
(kappa=0.73) and immunobullous diseases (kappa=0.89). To prevent clinical
misdiagnosis of the underlying cause of EE, a biopsy-first protocol was recommended
for all new EE presentations to ensure diagnostic accuracy and guide next management
steps.
