Erythroderma

Last Updated on by FRCEM Intermediate

Erythroderma is the term used to describe intense and widespread reddening of the skin due to inflammatory disease. It often precedes or is associated with exfoliation (skin peeling off in scales or layers), when it may also be known as exfoliative dermatitis (ED). Idiopathic erythroderma (about 30% of cases) is sometimes called the ‘red man syndrome’. Erythroderma is rare. It can arise at any age and is about three times more common in men than women.

The most common skin conditions to precede erythroderma are: drug eruption, atopic dermatitis, psoriasis an pityriasis rubra pilaris. Erythroderma may also be a clinical feature of a systemic disease e.g. haematological malignancy, internal malignancy, graft-versus-host disease, HIV infection.

In erythroderma, generalised erythema and oedema affects 90% or more of the skin surface. The skin is warm to the touch, and itchy. Eyelid swelling may result in ectropion. Scaling begins 2 – 6 days after onset of erythema; scalp scaling may be associated with hair loss. Palms and soles may develop yellowish, diffuse keratoderma. Nails may become ridged, thickened or develop onycholysis. Systemic symptoms include lymphadenopathy, hepatosplenomegaly, abnormal liver function and fever. Leg oedema may occur due to inflamed skin, high output cardiac failure and/or hypoalbuminaemia.

Complications include:

  • Temperature dysregulation – hypothermia
  • Fluid loss with electrolyte disturbance and dehydration
  • High output cardiac failure
  • Secondary skin infection
  • Oedema secondary to hypoalbuminaemia from protein loss and increased metabolic rate

Diagnosis is usually clinical. Blood count may show anaemia, white cell count abnormalities, and eosinophilia. Skin biopsies from several sites may be taken if the cause is unknown.

Erythroderma is potentially serious, and may be life-threatening and most patients require hospitalisation.

Treatment involves:

  • Stopping any unnecessary medications
  • Monitoring and managing 􀃘uid and electrolyte imbalance
  • Monitoring and managing body temperature
  • Maintaining skin moisture with wet wraps and dressings
  • Antibiotics for secondary bacterial infection
  • Antihistamines to treat itch
  • Speciflc treatment if a cause is identifled

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