From the Guidelines
Erythroderma is a severe skin condition characterized by widespread redness and scaling that affects more than 90% of the body's skin surface, often accompanied by systemic symptoms and potentially life-threatening complications.
Definition and Causes
Erythroderma can result from various underlying causes, including severe psoriasis, drug reactions, cutaneous T-cell lymphoma, atopic dermatitis, or contact dermatitis 1. The most severe form of psoriasis, erythrodermic psoriasis, may closely resemble other forms of erythroderma, both clinically and histologically 1.
Clinical Presentation
The condition typically develops rapidly over days to weeks and is often accompanied by symptoms like intense itching, pain, swelling, and a feeling of skin tightness. Patients may also experience systemic symptoms including fever, chills, fatigue, and lymph node enlargement.
Diagnosis
The diagnosis is 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. Screening for HIV and obtaining blood for flow cytometry and Sézary cell count can also be useful in diagnosing erythroderma 1.
Treatment
Treatment focuses on identifying and addressing the underlying cause while providing supportive care. Systemic treatments, such as oral cyclosporine in a dose of 3 to 5 mg/kg/d, are often necessary for the majority of patients presenting with erythrodermic psoriasis 1. Other systemic choices for erythrodermic psoriasis include acitretin, MTX, and the TNF-alfa inhibitors 1.
Management
Hospitalization is often necessary for severe cases to manage complications and provide comprehensive care. The condition requires prompt medical attention as it can lead to serious complications, including sepsis, heart failure, and pneumonia if left untreated. Some key points to consider in the management of erythroderma include:
- Identifying and addressing the underlying cause
- Providing supportive care, such as topical emollients and wet dressings
- Using systemic corticosteroids, such as prednisone 0.5-1 mg/kg/day, to reduce inflammation
- Managing systemic symptoms, such as fever and chills
- Preventing complications, such as infection and fluid loss.
From the Research
Definition of Erythroderma
- Erythroderma is an inflammatory skin syndrome characterized by desquamation and erythema of more than 90% of the body surface area 2, 3.
- It is a disease characterized by erythema and scaling of greater than 90% of the body's surface, with resultant dysmetabolism being potentially life-threatening 3.
- Erythroderma is associated with high morbidity and mortality, and determining the underlying cause of the condition frequently presents a diagnostic challenge 4.
Clinical Presentation
- Erythroderma presents with widespread erythema with variable degrees of exfoliation, pustulation, or vesiculobullous formation 4.
- The condition can arise acutely or follow a chronic course, and its clinical presentation can vary depending on the underlying etiology 5, 6.
Etiologies of Erythroderma
- The most frequent cause of erythroderma is psoriasis, followed by eczematous conditions, drug-induced reactions, pityriasis rubra pilaris, and cutaneous T-cell lymphomas 2.
- Erythrodermic psoriasis is a severe form of psoriasis that can arise acutely or follow a chronic course, and its pathogenesis is not well understood 6.
Diagnosis and Treatment
- Diagnostic approach must include a thorough history and clinical examination, and if the etiology of erythroderma is uncertain, multiple skin biopsies may enhance diagnostic accuracy 2.
- The initial management of erythroderma must include a nutrition expert evaluation, fluid imbalance assessment, maintaining skin barrier function, sedative antihistamines, and exclusion of secondary bacterial infection 2.
- Treatment options for erythrodermic psoriasis include cyclosporine, infliximab, acitretin, methotrexate, and biologic therapies such as ustekinumab and ixekizumab 5, 6.