Erythroderma Flashcards
Erythroderma
generalized redness and scaliness of the skin - a clinical definition, not a disease entity. Due to preexisting dermatoses or can be idiopathic. Occasionally called “red man syndrome”
What is critical to do in managing a pt with Erythroderma
Identify the underlying process to alleviate the condition as erythroderma places high metabolic demands upon the pt and can lead to mortality.
Pathogenesis of Erythroderma
due to underlying disorders, like dermatitis, psoriasis, drug eruptions, CTCL. 33% are idiopathic
Dermatopathology
scales of nuclei acids and soluble proteins. Losing scales much faster than normal skin
Clinical Presentation - Skin symptoms
erythema and scale encompass 90% of the total body surface, pruritus, scratch-itch cycle, hypo/hyperpigment
Hair in Erythroderma
can have diffuse non-scarring alopecia
Nails in Erythroderma
initially look shiny, can become discolored, brittle with subungal hyperkeratosis, splinter hemorrhages, nail shedding
Skin becomes secondarily infected due to
intense scratching from pruritus
Other clinical symptoms of erythroderm
can have conjunctivitis, pretibial edema, tachycardia due to increased blood flow and fluid loss, high cardiac output failure with the elderly, Lymphadenopathy, Hepatomegaly
Idiopathic Erythroderm
in elderly men, chronic, pruritus, “red man syndrome”. lymphadenopathy, palmoplantar keratoderma
Most common drugs a/w Erythroderma
Allopurinol, Dapsone, Vanco, Ampicilin, Pheytoin, Phenobarbital, Sulfa
Psoriasis –> Erythroderma
D/t withdrawal of topical or oral corticosteroids or MTX. Check nails as nail changes may still be present
CTCL –> Erythroderma
If d/t Sezary, will have malignant T cells and Sezary cells with keratoderma and lymphadenopathy. If MF, no sezary cells.
Pityriasis Rubra Pilaris –> Erythroderma
Perifollicular keratotic plugs on the knees, elbows, hands with “nappes claires” islands of uninvolved skin
Paraneoplastic Erythroderma
Due to T Cell Lymphoma, will have a brown hue to the skin “melanoerythroderma”
Bullous Erythroderma
Involved with PF, blisters and erosions with a collorette scale and crust
3 types of Ichthyosis a/w Erythroderm: 1) Ichthyosis Non bullous ichthyosiform erythroderma
(colloidal baby) - erythroderma and a fine white scale.
2) Bullous congenital ichthyosisform erythroderma
bullae and generalized erythroderma that turn into hyperkeratotic spiny lesions in flexural areas
3) Netherton Syndrome
erythroderma a/w trichorrhexia invaginata
Staphylococcal Scalded Skin Syndrome
identified via blood studies and UA
Omenn’s Syndrome
fatal without a stem cell transplant. Exfoliative erythroderma with alopecia, will have leukocytosis and elevated IgE
Treatment of Erythroderma
Nutrition and fluid assessment is the primary focus, prevent hypOthermia, tx secondary skin infections, oral antihistamines, wet wrap to remove crust, emollients, low topical steroids, tx disease process
Severe case tx
systemic corticosteroids 1-3mg/kg/day with a slow taper of Cyclosporine at 1-3mg/kg/day
Treatment of Erythroderma
Nutrition and fluid assessment is the primary focus, prevent hypOthermia, tx secondary skin infections, oral antihistamines, wet wrap to remove crust, emollients, low topical steroids, tx disease process
Severe case tx
systemic corticosteroids 1-3mg/kg/day with a slow taper of Cyclosporine at 1-3mg/kg/day
