Ekin ALTINBAS, Ceyda TETIK AYDOGDU, Suzan DEMIR PEKTAS, Emine Tugba ALATAS, Baris BAT
Journal of Experimental and Clinical Medicine - 2026;43(1):113-117
Erythroderma is a severe dermatological manifestation referring to diffuse erythema and scaling involving >=90% of the body surface area. The underlying etiology ranges widely, including psoriasis, atopic dermatitis, contact dermatitis, drugs, and malignancy. Up to 30% of the eryhtroderma cases are idiopathic. However, the underlying etiology of some of the idiopathic cases might be identified during the follow-up period by obtaining serial biopsies. Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma, accounting for almost 40% of the cutaneous lymphomas. MF can mimic many dermatoses by various presentations, making its diagnosis challenging. Rarely, it can present with eryhtroderma. Here, we present a 62-year-old male patient presenting with 6-month-long chronic desquamating plaques predilecting for flexural areas, trunk, neck, and hairy scalp. He had high total serum IgE and leonine-like facial features. He had no known skin disease; his medical history for atopy and malignancy was unremarkable. His initial histopathology report revealed adult-onset atopic dermatitis (AD), and he was treated accordingly. However, considering the lack of AD history and the fast recurrence of the lesions lead we re-biopsied the lesions. The second biopsy revealed mycosis fungoides. It is paramount not to disregard other possible causes of senile erythroderma in patients presenting with common features of atopic dermatitis, especially in the elderly without a history of atopic dermatitis, since they are not solely specific to AD. Immunesenesence and relative Th2 dominance observed as aging might explain the idiopathic eryhtroderma seen most frequently in elderly patients with no history of skin diseases. In addition to contributing to the AD-like clinic, it might also signal future risk for the development of MF, so close follow-up with serial biopsies is crucial.
