erythroderma (exfoliative dermatitis)
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Introduction
Intense widespread (> 80-90%) reddening of the skin from dilated blood vessels, often associated with exfoliation.
Etiology
- primary cutaneous disorders
- drug reactions
- type
- hypersensitivity
- acute generalized exanthamotous pustolosis
- toxic epidermal necrolysis
- drugs
- carbamazepine[6]
- penicillins
- barbiturates
- gold salts
- phenylbutazone
- quinine
- salicylates
- sulfonamides
- systemic glucocorticoids (prednisone)
- psoriasis can flare to erythroderma after systemic glucocorticoids[3]
- type
- infections/infestations
- autoimmune disease
- pemphigus foliaceus
- pemphigus vulgaris
- bullous pemphigoid
- linear IgA disease
- cutaneous lupus erythematosus
- dermatomyositis
- graph vs host disease (chronic)[3]
- psoriasis can flare to erythroderma after systemic glucocorticoids[3]
- malignancy
- other
Pathology
- skin biopsy may show slight acanthosis & parakeratosis with a granulocytic infiltrate (case report)[10]
Clinical manifestations
- widespread erythema from dilated blood vessels (> 80-90% of body surface)
- erosions from severe pruritus
- may be associated scales, pustules, exfoliation
- may be papular, spare skin folds & face
- alopecia, nail dystrophy, or thickening of the palms & soles are manifestations of a long-standing cause of erythroderma
- potential systemic manifestations
- fever/chills
- hypothermia
- reactive lymphadenopathy (50%)
- peripheral edema
- high-output cardiac failure
Laboratory
- complete blood count
- peripheral blood smear:
- serum chemistries
- abnormal liver function tests (hypersensitivity)
- renal function tests (hypersensitivity)
- serum IgE elelvations favors atopic dermatitis
- lymph node biopsy for suspected lymphoma
- skin biopsy all patients
Complications
- infection
- fluid & electrolyte imbalances
- thermoregulatory disturbance
- high output cardiac failure
- acute respiratory distress syndrome[4]
Management
- dermatologic urgency
- treatment depends on etiology
- discontinue offending medications
- treat infection, malignancy
- general measures
- nutritional support
- fluid & electrolyte replacement
- gentle local skin care
- oatmeal baths
- wet dressings to weeping or crusted sites
- followed with application of bland emollient & low-potency topical corticosteroid[4]
- antihistamine for pruritus[3]
- immunosuppression with systemic glucocorticoids & cyclosporine may suppress pruritus until tapered
More general terms
More specific terms
Additional terms
References
- ↑ Stedman's Medical Dictionary, 26th ed. Williams & Wilkins
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 291
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ 4.0 4.1 4.2 Rothe MJ, Bernstein ML, Grant-Kels JM. Life-threatening erythroderma: diagnosing and treating the "red man". Clin Dermatol. 2005 Mar-Apr;23(2):206-17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15802214
- ↑ Bruno TF, Grewal P. Erythroderma: a dermatologic emergency. CJEM. 2009 May;11(3):244-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19523275
- ↑ 6.0 6.1 Khaled A, Sellami A, Fazaa B et al Acquired erythroderma in adults: a clinical and prognostic study. J Eur Acad Dermatol Venereol. 2010 Jul;24(7):781-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20028449
- ↑ Okoduwa C, Lambert WC, Schwartz RA Erythroderma: review of a potentially life-threatening dermatosis. Indian J Dermatol. 2009;54(1):1-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20049259
- ↑ 8.0 8.1 DermNet NZ: Erythroderma (images) http://www.dermnetnz.org/reactions/erythroderma.html
- ↑ 9.0 9.1 Umar SH, Elston DM (images) Medscape: Erythroderma (Generalized Exfoliative Dermatitis) http://emedicine.medscape.com/article/1106906-overview
- ↑ 10.0 10.1 10.2 10.3 Ampollini L, Rusca M. Erythroderma and a Pulmonary Nodule. N Engl J Med 2018; 379:e41 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30575466 https://www.nejm.org/doi/full/10.1056/NEJMicm1802572
- ↑ Mistry N, Gupta A, Alavi A, Sibbald RG. A review of the diagnosis and management of erythroderma (generalized red skin). Adv Skin Wound Care. 2015 May;28(5):228-36; quiz 237-8. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/2588266
- ↑ 12.0 12.1 12.2 Li S, Yu X, Wang T Papuloerythroderma of Ofuji JAMA Dermatol. 2020;156(12):1365 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33052383 https://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2020.2973
- ↑ Inamadar AC, Ragunatha S. The rash that becomes an erythroderma. Clin Dermatol. 2019;37:88-98. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30981298