Clinical Etiology and Histopathologic Correlation of Exfoliative Erythroderma at the Kenyatta National Hospital

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.