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Erythroderma

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Erythroderma, Exfoliative Erythroderma Syndrome, Exfoliative Dermatitis

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