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Erythroderma

This is an intense, widespread reddening of the skin due to an inflammatory skin disease. It often precedes, or is associated with skin peeling (then known as exfoliative dermatitis).


Risk factors:

  • Male

  • Pre-exisiting skin disease

  • Systemic condition known to be associated with erythroderma


Causes

  • Drug eruption Dermatitis, especially atopic dermatitis

  • Psoriasis, especially after the withdrawal of systemic steroids or other treatment (Erythrodermic psoriasis)

  • Pityriasis rubra pilaris


Presentation

  • Generalised erythema - can occur acutely or over wks to months in the chronic type

  • Generalised oedema

  • Often preceded by a measles-like (morbilliform) rash, dermatitis, or plaque psoraisis

  • Pruritis

  • Scaling

  • Lympadenopathy

“Red (burning) skin syndrome: L-Top=pre-clobetasol topical steroid; L-Bottom=thinned skin from usage; C-Top=severe vascular impact at steroid withdrawal; C-Bottom=edema and Iatrogenic erythroderma (exfoliative dermatitis) aspect of topical steroid withdrawal; R-Top=persistent flare area without edema; R-Bottom=19 months from steroid withdrawal” © SalishSea2/Corinna Kennedy CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Investigations

  • Bloods - FBC, CRP, LFTs, IgE

  • Skin biopsy


Management

  • Stop all unneccessary medications

  • Monitor fluid balance and body temperature

  • Maintain skin moisture with emoillents and mild topical steroids

  • Abx for infection

  • Antihistamines for pruritis


Complications

The patient may have temperature dysregulation, therefore will lose a lot of fluid through the skin, which can lead to:

  • Hypothermia due to heat loss

  • Electrolyte abnormalities and dehydration due to fluid loss

  • Secondary skin infection e.g. cellulitis, impetigo

  • Hypoalbuminaemia due to protein loss

  • Pigmentory changes if chronic




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