Erythroderma is a medical term alluding to the clinical state whereby most or all of the skin is red or inflamed. It has been called exfoliative dermatitis in the past.
Causes
There are several potential causes of inflamed and reddened skin, some more prevalent than others.
Common causes of erythroderma include:
- Psoriasis
- Eczema (atopic)
- Eczema (seborrhoeic)
- Drugs - e.g. sulphonylureas, sulphonamides, penicillin
- Idiopathic
Rarer causes include:
- Sezary syndrome
- HIV infection
- Malignancy
- Toxic shock syndrome
Clinical Presentation
Patients' presenting complaints often include a feeling of tightness in the skin and itchiness. If erythroderma prevails for a long time, other complications may occur. These may include hair loss, eyelid inversion and nail shedding. There are also wider, non-specific symptoms, such as pyrexia and malaise.
Investigations
Clinical Examination - a patient should be fully inspected for pustules, nail changes and other symptoms indicative of psoriasis.
Skin biopsy - This may serve to elicit a specific diagnosis such as that of cutaneous lymphoma. T cell receptor gene rearrangement studies may be of some use.
Complications
As the skin is a large organ, its total inflammation causes metabolic and haemodynamic problems to arise elsewhere. Therefore, high-output cardiac failure may occur due to increased blood flow to the large area of skin. Other possible complications include, hypothermia from heat loss, fluid loss by transpiration, hypoalbuminaemia, increased basal metabolic rate and capillary leak syndrome. The latter is causes by inflammation causing vasoactive cytokines to be produced that causes leakage from vessels. This leads to oedema, particularly in pulmonary vasculature, leading to acute lung injury.
Treatment
Treatment often takes place in a hospital setting, with vital signs such as temperature and fluid balance monitored constantly. Mild topical steroids, or bland emollients may be used to assuage the inflammation. Other non-essential drugs must be ceased while the underlying cause of erythroderma is sought.
