Erythroderma is defined as erythema that covers more than 70% of the body surface area. It represents the maximum severity of various skin disorders. Diagnosis is by history and examination. Treatment includes supportive measures and topical care.
A variety of skin disorders can result in erythroderma, including the following:
Different types of dermatitis (eg, atopic dermatitis, allergic contact dermatitis, seborrheic dermatitis)
Cutaneous T-cell lymphoma (particularly Sézary syndrome)
Erythroderma can develop in patients known to have skin disorders such as those above, but erythroderma can also develop spontaneously in patients without a history of prior skin problems.
An older, now only rarely used term for erythroderma is exfoliative dermatitis. However, exfoliative dermatitis is not a dermatitis. Although erythroderma can result from dermatitis, it can also result from many other (nondermatitis) skin conditions.
(See also Definition of Dermatitis.)
Симптоми та ознаки
Symptoms of erythroderma include malaise and chills due to the extensive inflammation and heat loss through large areas of hyperperfused skin. Patients with erythroderma have diffuse erythema and desquamation of the skin.
Pruritus is often present.
This photo shows erythroderma with diffuse erythema and desquamation of the skin.
Діагностика
Clinical evaluation
Diagnosis of erythroderma is by history and examination. Determining the cause may require extensive testing.
Blood tests (electrolytes, complete blood count, C-reactive protein, blood sedimentation rate) may reveal electrolyte imbalances and an increase in inflammatory markers; however, these findings are not diagnostic of erythroderma. If T-cell lymphoma is under consideration, T-cell receptor rearrangement studies to search for monoclonal T-cell expansions in the skin and/or in the peripheral blood and characterization of skin-infiltrating and peripheral T-cell subsets can be done.
Results of skin biopsy are often nonspecific, especially in patients without a history of prior skin problems, and repeat biopsies may be needed. When erythroderma develops in patients without a history of prior skin problems, immediate biopsy may not reveal the cause.
Лікування
Treatment of the underlying disorder
Supportive care (eg, rehydration, correction of electrolyte abnormalities)
Topical care (eg, emollients)
Sometimes topical or systemic corticosteroids
Stopping or changing any medication that may be the cause
Comprehensive skin care is indicated. Any known cause is treated.
Supportive care consists of correction of dehydration, correction of electrolyte abnormalities and nutritional deficiencies, and comprehensive wound care and dressings to prevent bacterial superinfection.
Skin care is with emollients and colloidal oatmeal baths.
Weak topical corticosteroids (eg, 1 to 2.5% hydrocortisone ointment) are often used. Systemic corticosteroids are often used for severe disease and can relieve symptoms. However, topical or systemic corticosteroids should be used cautiously because they can exacerbate certain disorders that could be the cause of erythroderma.
Because a medication reaction often cannot be ruled out by history alone, it may be necessary to stop all medications or the most suspect ones.
Прогноз
Prognosis depends on the cause.
Erythroderma may be life threatening; hospitalization is often necessary.
Ключові моменти
Erythroderma represents the maximum severity of widely heterogeneous skin conditions.
Often the underlying cause is not immediately apparent.
Symptoms include widespread erythema (> 70% of the body surface area) and often pruritus.
Diagnosis is clinical, but determining the underlying cause often requires extensive testing, including skin biopsies.
Hospitalization is often necessary, because the disease may be life threatening.
Treatment consists of supportive care, comprehensive skin care, and treatment of the cause.
