Erythroderma

Created 2008.

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.

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

Erythrodermic psoriasis

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.