Erythroderma

Learning objectives
Clinical features
Investigations
Management
Activity

Learning objectives

• Identify the causes of erythroderma, its complications and management principles

Clinical features

Erythroderma is the term used to describe inflammatory skin disease affecting the entire skin surface. It may be acute or chronic. It often precedes or is associated with exfoliation when it may also be known as exfoliative dermatitis. Idiopathic erythroderma is sometimes called the red man syndrome.

Causes include:

• Adverse drug eruption (most often sulphonamides, penicillin, antimalarials, anticonvulsants and allopurinol)
• Dermatitis (any kind)
• Psoriasis
• Pityriasis rubra pilaris (PRP)
• Immunobullous disease
• Cutaneous T-cell lymphoma (Sézary syndrome)
• Underlying systemic malignancy
• Graft vs Host disease
• HIV infection

Erythroderma

Clinical features depend on the underlying cause. Generalised skin redness (erythema) may be accompanied by oedema (especially if due to eczema or drugs), serous exudate (eczema), scaling (eczema, psoriasis). Degree of itch varies from none (PRP) to intolerable (eczema, bullous diseases). Other features include:

• Hair loss
• Keratoderma of palms and soles
• Nail shedding or nail dystrophy
• Ectropion
• Hyper- or hypopigmentation
• Localised or generalised lymphadenopathy

Complications may include:

• Secondary infection
• Loss of temperature control
• High output heart failure
• Fluid and electrolyte imbalance
• Hypoalbuminaemia

Investigations

Investigations should be performed to identify underlying causes and complications. They may include:

• Skin swabs for bacterial culture
• Haematology and biochemistry
• Skin biopsy (results depend on underlying cause)

Management

The underlying cause of erythroderma should be established if possible. Most patients with acute erythroderma require hospitalisation to restore fluid and electrolyte balance, circulatory status and body temperature. However, erythroderma may also be relatively asymptomatic and managed as outpatient.

• Discontinue all unnecessary medications
• Apply emollients and mild topical steroids

Where relevant:

• Wet dressings
• Manage fluid balance and body temperature
• Oral or intravenous antibiotics
• Sedative antihistamines

Systemic treatment depends on the underlying cause and should be directed by a dermatologist.

Activity

Compare erythroderma arising in childhood with that occurring in the elderly.

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