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Erythroderma
Aka: Erythroderma, Exfoliative Erythroderma Syndrome, Exfoliative Dermatitis
- See Also
- Desquamation
- Red Scaling Skin
- Definition
- Erythroderma (Exfoliative Dermatitis)
- Serious to life-threatening dermatosis with generalized skin erythema and Scaling
- Epidemiology
- Age over 40-50 years old most common
- More common in males
- Pathophysiology
- Generalized cutaneous vasodilation with inflammatory cell leakage into Dermis
- Generalized Edema and inflammation ensues
- Scaling follows inflammation after 5 days
- Symptoms
- Diffuse Pruritus
- Constitutional symptoms (generalized weakness, malaise, chills)
- Signs
- Ill or toxic appearance
- Diffuse, generalized bright erythematous skin (typically including palms and soles)
- Diffuse Scaling of skin (within 5 days of onset)
- Onycholysis
- Alopecia
- Causes
- Preexisting dermatosis in 50% of cases (typically more gradual onset)
- Eczema
- Psoriasis
- Seborrheic Dermatitis
- Pityriasis rubra pilaris
- Ichthyosis
- Lichen Planus
- Drug Reaction (rapid onset)
- See Life-Threatening Drug-Induced Rashes
- See Fixed Drug Eruption
- Most common causes
- Antibiotics
- Seizure medications
- Cardiac medications
- Infection
- HIV Infection
- Toxic Shock Syndrome
- Norwegian crusted Scabies
- Staphylococcal Scalded Skin Syndrome
- Leukemia or Lymphoma
- Cutaneous T-Cell Lymphoma (esp. stage 4, Mycosis Fungoides)
- Other Causes
- Stevens-Johnson Syndrome (Erythema Multiforme Major)
- Toxic Epidermal Necrolysis
- Management
- Hospitalize all patients with suspected Erythroderma
- Treat underlying cause if identified (e.g. Toxic Shock Syndrome)
- Manage complications (similar to Burn Injury)
- Dehydration
- Electrolyte replacement
- Secondary infections
- Skin care - layered approach
- Layer 1: Low to moderate potency Corticosteroid (e.g. triamcinolone)
- Layer 2: Moist wrap or clothes
- Layer 3: Dry layer
- Complications
- Dehydration
- Metabolic abnormalities
- High output Heart Failure
- Secondary Skin Infections
- References
- Jhun, Grock and DeClerck in Herbert (2017) EM:Rap 17(3):18-9
- Fitzpatrick (1992) Color Atlas of Dermatology, p. 442-7