[Severe erythrodermic psoriasis in a patient with 22q11 deletion syndrome].
BACKGROUND
Erythrodermic psoriasis is a severe manifestation of psoriasis and can be triggered by several factors.


METHODS
A 35-year-old man was admitted with severe, almost generalized exfoliative, oozing erythrodermic psoriasis, fever, and cramping of hands and legs. He was under systemic treatment with acitretin. Laboratory examination revealed a marked hypocalcemia as a consequence of primary hypopara thyroidism as well as hypalbuminemia. After normalization of the serum calcium and albumin levels, cutaneous symptoms and fever rapidly improved. No infectious etiology could be found. Hypoparathyroidism together with a right-sided aorta was caused by a 22q11 deletion syndrome.


CONCLUSIONS
Epidermal cell proliferation and formation of intercellular junctional components of the epidermis are strongly calcium-dependent. Furthermore, carriers like albumin are necessary for the transportation of acitretin in the peripheral tissue. This case report suggests that calcium can be involved in psoriasis pathogenesis at least in a subgroup of patients and that systemic retinoids exhibit insufficient effectiveness under low serum albumin levels.
Preiss
Jan C
JC
Medizinische Klinik I (Gastroenterologie, Infektiologie, Rheumatologie), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin.
Zouboulis
Christos C
CC
Zeitz
Martin
M
Duchmann
Rainer
R
D000328:Adult; D002872:Chromosome Deletion; D002892:Chromosomes, Human, Pair 22; D003873:Dermatitis, Exfoliative / Q000175:diagnosis / Q000235:genetics*; D003937:Diagnosis, Differential; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000235:genetics; D007011:Hypoparathyroidism / Q000175:diagnosis / Q000235:genetics; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D011565:Psoriasis / Q000175:diagnosis / Q000235:genetics*; D013577:Syndrome; D013746:Tetany / Q000175:diagnosis / Q000235:genetics