Dermatological Emergencies: Erythroderma

Erythroderma is a term that refers to inflammatory skin disease which affects the entire surface of the skin. It can be either acute or chronic. Erythroderma can proceed or be associated with exfoliation. In dermatology, it is termed exfoliative dermatitis. The idiopathic form of erythroderma is also known as red man syndrome.

The possible causes of erythroderma include adverse drug eruption (such as anticonvulsants, penicillin, and sulphonamides), any kind of dermatitis, psoriasis, cutaneous T-cell lymphoma, HIV infection, immunobullous disease, and underlying systemic malignancy.

The clinical features of erythroderma vary and depend on each case. Generalised skin redness (erythema) is often accompanied by oedema if caused by drug eruption or eczema; scaling if caused by psoriasis or eczema; and serous exudate if caused by eczema. The degree of itch varies from none (in cases of pityriasis rubra pilaris) to intolerable (in cases of bullous disease and eczema). Other features include keratoderma of the palms and soles, nail shedding or nail dystrophy, ectropion, hair loss, hyperpigmentation, and hypopigmentation.

Complications associated with erythroderma include loss of temperature control, secondary infection, hypoalbuminemia, fluid and electrolyte imbalance, and high output heart failure.

Investigations of underlying causes of erythroderma are conducted to identify additional causes and complications associated with this condition. These procedures include skin swabs for bacterial culture, skin biopsy, haematology, and biochemistry.

Each underlying cause of erythroderma should be established where possible. Most patients who have acute erythroderma require hospitalisation in order to restore fluid and electrolyte balance, body temperature, and circulatory status. In some cases, erythroderma can be asymptomatic and managed on an outpatient basis. In such circumstances, unnecessary medications are to be discontinued and emollients along with mild topical steroids are recommended. If needed, oral or intravenous antibiotics may be prescribed. Wet dressings can be applied and sedative antihistamines may also be indicated.

The type of systemic treatment depends on the underlying cause of erythroderma and should be carefully directed by a dermatologist.