Erythroderma

Question 1

What is the diagnosis?

Answer 1

Erythroderma

Question 2

Define erythroderma.

Answer 2

Exfoliative dermatitis which is severe and potentially life-threatening, affecting >90% of TBSA with diffuse erythema and scaling

Question 3

What are the risk factors for erythroderma?

Answer 3

Most patients have a skin condition or systemic condition associated with erythroderma. Extensive causes shown below. 30% idiopathic.

• Atopic dermatitis
• Drug reaction
• Psoriasis
• Pityriasis rubra pilaris
• Pemphigus
• Sezary syndrome (cutaneous T cell lymphoma)

Question 4

What is the epidemiology of erythroderma?

Answer 4

Older adults 42-61yrs
3:1 M:F

Question 5

What are the clinical features of erythroderma?

Answer 5

• Erythematous scaly skin
• Scaling occurs over 2-6days after onset of erythema
• Ectropion/blepharitis
• Hair loss
• Nail - onycholysis and may shed (onychomadesis)
• Generalised dermatopathic lymphadenopathy
• Fever and malaise - occasional

Question 6

What investigations would you do for erythroderma?

Answer 6

Clinical diagnosis

If unclear/for monitoring:

• Skin biopsy
• FBC, electrolytes, glucose, serum albumin, LDH, LFTs, renal profile
• Peripheral blood smear: Sezary syndrome
• Blood cultures
• Wound swabs
• Skin scrapings - for scabies/tinea
• Imaging - malignancy

Question 7

What is the management of erythroderma?

Answer 7

Treat underlying cause e.g. topical and systemic steroids for atopic dermatitis; acitretin or methotrexate for psoriasis.

Treat skin failure:

• Side room with barrier nursing
• Temperature regulation
• Stop unnecessary medications
• Emollients
• Antibiotics - if secondary infection
• Strict monitoring - fluid balance
• Dietician input
• Antihistamine

Question 8

What are the complications of erythroderma?

Answer 8

Mortality rate between 4-64%

Question 9

How would you describe the initial underlying rash in erythroderma?

Answer 9

Morbiliform

Question 10

What is the prognosis with erythroderma?

Answer 10

Unpredictable course, may continue for extended periods with acute exacerbations

If erythroderma is the result of a generalised spread of a primary skin disorder such as psoriasis or dermatitis, it usually clears with appropriate treatment of the skin disease but may recur at any time.

Question 11

What is the diagnosis?

Answer 11

Acute generalised exanthematous pustulosis AKA toxic pustuloderma

90% is due to drug reactions but other causes include EBV, entero/adenoviruses, CMV, HBV, spider bites, herbal medications.
Associated with IL36RN gene mutation
5% mortality