Erythroderma
D E F I N I T I ON
Non-specific intense widespread reddening of the skin often preceded by
exfoliation.
AET IOLOGY
Pre-existing skin conditions: Eczema, psoriasis.
Malignancy: Cutaneous T-cell lymphoma, lymphoma, leukaemia.
Adverse drug reaction.
Infection: HIV, toxic shock syndrome.
Idiopathic.
E P IDEMI OLOGY
Incidence: 1–2 in 100,000/year. 1 % of dermatological admissions.
Age usually > 40 years. < : ,¼2.5 : 1.
H ISTORY
The skin feels hot and tight. Pruritus, erythema, scaling and shedding, fever and
shivering. Symptoms of cardiac failure. The history should also be directed towards establishing
aetiology.
EXAMI N A T ION
The patient may be pyrexial or hypothermic.
Erythema and scaling of 90 % of the skin. Evidence of skin shedding.
The skin is hot and radiates warmth to the surroundings, can ! hypothermia.
Peripheral oedema, signs of volume depletion including # BP and tachycardia.
Signs of cardiac failure.
Signs of the underlying condition, e.g. psoriatic plaques.
PATHOLOGY/PATHOGENESIS
Interaction of cytokines and cellular adhesion molecules
! "epidermal turnover rate ! severe scaling and shedding ! loss of fluid, electrolytes and
albumin. There is increased blood flow through the skin, which may cause temperature
dysregulation and high-output cardiac failure.
I N V E S T IGATIONS
Skin biopsy: In order to make a definitive diagnosis lymph node biopsy if significant
lymphadenopathy.
Blood:
FBC: # Hb, " WBC if secondary infection, may reveal underlying haematological dyscrasia.
ESR, U&E: May have # Na
þ
, # K
þ
, " urea if lost through skin.
LFT: # Albumin loss through the skin leakage to extracellular space from leaky capillaries.
Immunoglobulins: Hypergammaglobulinaemia, " IgE.
Blood film: For Sezary cells typical of T-cell lymphomas.
ABGs: For renal failure (metabolic acidosis) and ARDS.
Imaging: ECG, CXR or echocardiogram may show signs of cardiac failure.
MANAGEMENT
This is a dermatological emergency.
1. Nurse the patient in a warm room.
2. Regularly monitor vital signs.
3. Catheterize and close fluid balance monitoring.
4. Treat the underlying cause if identified.
5. Continue only vital medications.
6. Swab the skin for secondary infection.
7. Ensure topical steroid and bandaging. Consider systemic steroid (controversial and never
used in cases of psoriatic erythroderma).
8. Use antihistamine for pruritus and sedative effect.
9. Managecomplications.
COMPL I C A T IONS
Cardiac failure, renal failure, hypothermia, secondary infection, ARDS.
PROGNOSIS
Mortality 20–40 %.
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