[Erythroderma induced by hypercalcitoninemia: two cases].
BACKGROUND
The most common cause of erythroderma is the extension of a previous cutaneous disease to the entire skin surface, as is the case in mycosis fungoides or drug reactions. Erythroderma related to endocrine disorders has only exceptionally been published. We report two cases of patients suffering from erythroderma probably induced by hypercalcitoninemia.


METHODS
Case 1. A 69 year-old man had a two year-history of fluctuating erythroderma, resistant to all topical or systemic therapy. After numerous unsuccessful investigations, a high serum calcitonin rate was detected. The pentagastrin test was highly positive, suggesting a medullar carcinoma of the thyroid. Thyroidectomy showed only hyperplasia of C cells. All skin signs disappeared within a few days after surgery. Two years later, there was no recurrence of the erythroderma and the serum calcitonin rate was normal. Case 2. A 58 year-old man suffered from congestive and pruriginous erythroderma for 2 1/2 months, which responded well to topical steroids. Biological investigations done for flushes, showed a raised calcitonin level and highly positive pentagastrin test. Thyroidectomy also revealed simple hyperplasia of the C cells. No recurrence of the erythroderma was noted during the 6 month follow-up.


CONCLUSIONS
These are the first cases of erythroderma associated with hypercalcitoninemia. The causal role of calcitonin is probable in the first case, because of 1) long duration of skin signs before the hypercalcitoninemia; 2) quick post-operative recovery, in parallel with the decrease in calcitonin level; 3) absence of recurrence after thyroidectomy; 4) absence of other proven causes. Erythroderma may have resulted from dilation of the skin vessels, since calcitonin and calcitonin gene related peptide are powerful vasodilators.
Scrivener
Y
Y
Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France. yannis.scrivener@noos.fr
Jeandidier
N
N
Asch
P H
PH
Le Coz
C J
CJ
Grosshans
E
E
Cribier
B
B
D000368:Aged; D002116:Calcitonin / Q000097:blood*; D003873:Dermatitis, Exfoliative / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D016606:Thyroid Nodule / Q000175:diagnosis / Q000601:surgery; D013965:Thyroidectomy; D013997:Time Factors
D002116:Calcitonin
Erythrodermie induite par une hypercalcitoninémie.