Definition

Erythroderma is the term used to describe intense and usually widespread reddening of the skin (>90%) due to inflammatory skin disease. It often precedes or is associated with exfoliation(skin peeling off in scales or layers), also known as exfoliative dermatitis. When the primary cause cannot be identified, it is called idiopathic erythroderma.

What causes Erythroderma?

Erythroderma may occur due to various causes, most of the times as the result of a pre-existing skin disease. Erythroderma may be also due to the adverse events of certain medicines. Nevertheless, the underlying cause cannot be identified in 30% of cases. This is called idiopathic erythroderma.

The most common pre-existing skin conditions to cause erythroderma include:

  • Dermatitis, especiallyatopic dermatitis, contact dermatitis (allergic orirritant) severe eczema in infants, seborrhoeic dermatitis
  • Psoriasis
  • Seborrhoeic dermatitis
  • Blistering diseases including pemphigus and bullous pemphigoid
  • Sezary syndrome (the erythrodermic form of cutaneous T-cell lymphoma)

Erythroderma may also be a symptom or sign of a systemic disease, such as:

  • Internal malignancies, e.g. carcinoma of rectum, lung, fallopian tubes, colon
  • Haematological malignancies, such as lymphoma and leukaemia
  • HIV infection

What are the clinical features of erythroderma?

Erythrodermathat is not due to eczema usually presents in persons above the age of 40. It is slightly more common in men than in women. It may develop quite fast. The signs and symptoms of erythroderma include:

  • Generalised skin redness (erythema)and swelling (oedema) that affects 90% or more of the skin surface
  • Serous ooze, resulting in clothes and dressings sticking to the skin and an unpleasant smell
  • Scaling approximately 2-6 days after the onset of erythema, as fine flakes or large sheets
  • Itch with varying degrees, sometimes intolerable
  • Scalingmay develop on scalp with varying degrees ofhairloss including complete alopecia (baldness)
  • Thickening of the skin of the palms (keratoderma)
  • Eyelid swelling may result inectropion (inner eyelid surface exposed)
  • Nails become ridged and thickened, and may even shed
  • Longstanding erythrodermamay result in pigmentary changes (brown and/or white skin patches)
  • Secondary skin infection may occur with pustules and then dryness
  • Swollen lymph nodes (lymphadenopathy)
  • Temperature dysregulation resulting in fever and chills or hypothermia
  • Increased heart rate that can lead to heart insufficiency, especially in the elderly
  • Electrolyte imbalances and dehydration due to loss of fluids from the skin
  • Hypoalbuminaemia from protein loss and increased metabolic rate

How is erythroderma managed?

The primary cause of erythroderma should be diagnosed if possible. Sometimes biopsy may help. Erythrodermais a serious condition, and most patients require hospitalisation to restore fluid and electrolyte balance, circulatory status and body temperature.

The following general measures apply:

  • Discontinuation of all unnecessary medications
  • Monitoring fluid balance and body temperature
  • Maintaining skin moisture with wet dressings, emollients and mild topical steroids
  • Prescription of antibiotics in case of infection
  • Antihistamines in cases of severe itch

If the cause can be identified then specific treatment should be administered, e.g. topical steroids for atopic dermatitis, acitretin, or methotrexate for psoriasis.