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The Red Man Mystery

Dr. Mona Abdel-Halim


One of the challenging situations that face dermatologists is how to solve the case of the mysterious Red Man??!! Do you know who the Red Man is??!!

The Red Man is a term used to describe patients with erythroderma or exfoliative dermatitis. Erythroderma is not a disease by itself, but a severe state of skin irritation that represents morphologic presentation of a variety of cutaneous and systemic diseases including both inflammatory and malignant conditions. The great challenge in such conditions is how to unravel the disguising disease?!!

Unraveling the disguising disease is very important to determine the line of management and to avoid possible complications and morbidities. The process is a complex one that necessitate constellation of history, general examination, cutaneous examination, laboratory investigations, histopathological examination and in sometimes immunohistochemical studies are needed.

Dermatologists should pay great attention to the history of pre-existing dermatoses, recent drug intake or drug allergies. Lymph node examination is important and generalized firm lymph nodes may represent a clue to lymphoma. Dermatologists should be careful in picking clues from cutaneous examination. Clues may be hidden in the color of erythema, type of scales, presence of oozing and crustations, presence of infiltrated areas and presence of areas of free skin. Clues also may be hidden in hair, nails and palmoplantar skin. Complete blood count may provide important clues of drug induced erythroderma or lymphoma.

The role of dermatopathologists is very important. Although most cases usually present with non specific histopathologic features, one should look for specific histopathological clues of pre-existing dermatoses, drug reaction or lymphoma. Immunohistochemistry may be of help in differentiating between inflammatory and neoplastic causes.

Wish you all luck in solving the Red Man mystery whenever you are confronted with him!!!


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Dr. Phillip McKee


Very nice blog. Sezary syndrome can be very difficult to diagnose microscopically as so often, the changes are not specific. Frequently multiple biopsies are necessary. As with so much dermatopathology, clinicopathological correlation is critical particularly as erythroderma can be fatal as you mention. It is so important to identify the cause.
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Dr. Hafeez Diwan


A very good post indeed. The "red man" can cause a great deal of angst, particularly because of the Sezary situation, alluded to above. But good dermatopathologic evaluation, as you note, can make a big difference.
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