Skill Checkup: A 20-Year-Old Woman With Erythroderma and Pustules on Trunk, Limbs, and Nail Beds

David T. Robles, MD, PhD, FAAD


April 21, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 20-year-old woman presents with erythroderma and pustules on her trunk, limbs, and nail beds, which have been present for 2 days. The skin is very tender. She has a geographic tongue. This is not the first time she has had such symptoms, the erythema with crusting and pustules comes in waves, with periods of exacerbation and quiescence. She also has a fever of 102.3° Fahrenheit. She complains of headache, nausea, and loss of appetite, and has noted hair loss.

She is 5 feet 5 inches and weighs 130 lb (body mass index, 21.6). Physical examination yields no other abnormal findings.

She has had limited response to topical steroids, acitretin, and ustekinumab. She was administered pulsed methylprednisolone for many years, which led to secondary adrenal insufficiency. She is taking hydrocortisone tablets, 10 mg in the morning and 5 mg in the afternoon.


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