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December 1994

Acute Erythroderma as an Exclusion Criterion for Idiopathic CD4+ T Lymphocytopenia

Author Affiliations

From the Department of Dermatology, University of Michigan Medical Center, Ann Arbor.

Arch Dermatol. 1994;130(12):1530-1533. doi:10.1001/archderm.1994.01690120066009

Background:  Idiopathic CD4+ T lymphocytopenia is defined as a CD4+ T lymphocytopenia of less than 0.3X109/L that is not associated with human immunodeficiency virus, other immunodeficiency, or immunosuppressive therapy. The associated clinical course and laboratory findings are variable. We describe a subset of patients whose peripheral CD4+ T-lymphocytopenia was transient, and suggest a pathomechanism for this phenomenon.

Observations:  We describe three patients with cutaneous T-cell lymphoma, atopic dermatitis, or psoriasis in whom acute erythroderma was concomitant with a peripheral CD4+ T lymphocytopenia that normalized after resolution of the erythroderma. Immunoperoxidase staining of skin biopsy specimens and quantitative estimation of CD4+ T lymphocytes in the cutane- ous and peripheral blood compartments demonstrated that the peripheral CD4+ T lymphocytopenia in these cases most probably resulted from sequestration of CD4+ T lymphocytes in the skin. The skin of an erythrodermic patient appears capable of sequestering 1010 to 1011 CD4+ T lymphocytes, whereas the peripheral blood compartment contains in the range of 109 CD4+ T lymphocytes.

Conclusions:  We propose that CD4+ T lymphocytopenia can occur as a result of acute erythroderma of multiple causes and that acute erythroderma associated with transient CD4+ T lymphocytopenia be considered as an exclusion criterion for idiopathic peripheral blood CD4+ T lymphocytopenia.(Arch Dermatol. 1994;130:1530-1533)

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