Hypothermic Coma and Exfoliative Dermatitis

To the Editor:—  In The Journal (206:1087, 1968) Drs. Zak and Pai urge the reader to consider the systemic effects of generalized exfoliative dermatitis and erythroderma. They cited the excellent work of Dr. Shuster and reported a case. Another more recent example was that of Grice et al (Arch Derm98:263, 1968). A still further incident is presented here.

Report of a Case:—  A 70-year-old woman with a history of sensitivity to sunlight, contact dermatitis, scleroderma, and psoriasis presented with generalized exfoliative erythroderma. The patient had taken small intermittent doses of dexamethasone for the preceding five years for "localized psoriasis."Upon admission to a hospital the steroids were withdrawn, and she was found to have mild adrenal suppression based upon lowered 17-ketosteroid and blood cortisol values. Two weeks later borderline low values were normal. A muscle biopsy specimen revealed dermatomyositis.One morning the patient became sluggish and finally