From the Guidelines
Erythroderma is primarily caused by underlying conditions such as psoriasis, atopic dermatitis, contact dermatitis, seborrheic dermatitis, cutaneous T-cell lymphoma, and pityriasis rubra pilaris, as well as drug reactions and systemic diseases like HIV infection.
Causes of Erythroderma
The causes of erythroderma can be broadly categorized into several groups, including:
- Pre-existing skin disorders that suddenly worsen and spread, such as psoriasis, atopic dermatitis, contact dermatitis, and seborrheic dermatitis 1
- Drug reactions, particularly to antibiotics, anticonvulsants, allopurinol, and NSAIDs
- Cutaneous T-cell lymphomas, such as mycosis fungoides and Sézary syndrome
- Systemic diseases, including HIV infection, leukemia, lymphoma, and solid organ malignancies
- Immunodeficiency disorders and severe systemic infections
Diagnosis and Treatment
According to the guidelines of care for the management of psoriasis and psoriatic arthritis, the diagnosis of erythroderma is often made by the patient’s history and subtle clues in the clinical presentation, with skin biopsy specimens aiding in the diagnosis in selected cases 1. The treatment of erythrodermic psoriasis requires a distinct approach, with systemic treatments being inevitably necessary for the majority of patients, and oral cyclosporine being a logical choice due to its rapid and impressive onset of action 1.
Key Considerations
It is essential to note that the treatment of erythrodermic psoriasis should be based on short-term efficacy rather than long-term results or potential side effects, and that careful monitoring is necessary to avoid toxicity, particularly in patients at higher risk 1.
From the Research
Erythroderma Causes
Erythroderma is a condition characterized by widespread inflammation and scaling of the skin, affecting more than 90% of the body surface area. The causes of erythroderma can be diverse and include:
- Underlying dermatoses, such as psoriasis and eczema, which are the most common causes 2, 3, 4
- Drug reactions, including traditional medications and anti-tuberculous medications 5
- Malignancies, such as cutaneous T-cell lymphomas and solid-organ malignancies 5, 3
- Idiopathic disorders, where the cause is unknown 5, 3
- Infections 3
- Pityriasis rubra pilaris and pemphigus foliaceous 3
Common Causative Factors
The most common causative factors of erythroderma are:
- Underlying dermatoses (68.9%) 5
- Idiopathic causes (14.2%) 5
- Drug reactions (10.7%) 5
- Malignancies (4.0%) 5
Specific Causes
Specific causes of erythroderma include: