Erythroderma is an inflammatory skin disease with
redness and scaling that affects nearly the entire cutaneous surface.
[Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. p. 436. .] This term applies when 90% or more of the skin is affected.
In
ICD-10, a distinction is made between "exfoliative dermatitis" at L26, and "erythroderma" at L53.9.
Causes
Erythroderma is generalized exfoliative dermatitis, which involves 90% or more of the patient's skin.
The most common cause of erythroderma is exacerbation of an underlying skin disease, such as
psoriasis
Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...
,
contact dermatitis
Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are ...
,
seborrheic dermatitis
Seborrhoeic dermatitis, sometimes inaccurately referred to as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the ...
,
lichen planus
Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, and is only named that because it looks like one. It is characterized by polygonal, fla ...
,
pityriasis rubra pilaris
Pityriasis rubra pilaris refers to a group of chronic disorders characterized by reddish orange, scaling plaques and keratotic follicular papules.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ...
or a drug reaction, such as the use of topical steroids. Primary erythroderma is less frequent and is usually seen in cases of
cutaneous T-cell lymphoma, in particular in
Sézary's disease.
The most common causes of exfoliative dermatitis are best remembered by the mnemonic device ID-SCALP.
The causes and their frequencies are as follows:
*
Idiopathic
An idiopathic disease is any disease with an unknown cause or mechanism of apparent wikt:spontaneous, spontaneous origin. From Ancient Greek, Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approxi ...
- 30%
*
Drug allergy - 28%
*
Seborrheic dermatitis
Seborrhoeic dermatitis, sometimes inaccurately referred to as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the ...
- 2%
*
Contact dermatitis
Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are ...
- 3%
*
Atopic dermatitis - 10%
* Lymphoma and leukemia - 14%
* Psoriasis - 8%
Treatment
The treatment for erythroderma depends on the primary cause.
Topical steroid Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have anti-inflammatory properties and are classifie ...
s and use of a
sauna suit
A sauna suit is a garment made from waterproof fabric designed to make the wearer sweat profusely. A sauna suit is sometimes called a "rubber suit" because the early types were made of rubber or rubberized cloth. Now, sauna suits are typically m ...
are often used to treat exfoliative dermatitis regardless of the cause.
Retinoids and
immunosuppressive drugs can be used when it is caused by psoriasis or pityriasis rubra pilaris.
A sedative
antihistamine
Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provid ...
may be a useful adjunct for pruritic patients, since it helps patients to sleep at night, thus limiting nocturnal scratching and excoriations.
Antimicrobial
An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals ar ...
agents often are used if an infection is suspected to be precipitating or complicating exfoliative dermatitis. Other drugs specifically indicated for management of underlying cause of exfoliative dermatitis may be necessary.
Epidemiology
The incidence of erythroderma is estimated to be 1–2 in 100,000.
While erythroderma can occur at any age, it is most common in older, male adults.
History
The classification of exfoliative dermatitis into Wilson-Brocq (chronic relapsing), Hebra or pityriasis rubra (progressive), and Savill (self-limited) types may have had historical value, but it currently lacks pathophysiologic or clinical utility.
References
External links
{{Papulosquamous disorders
Papulosquamous hyperkeratotic cutaneous conditions
Medical mnemonics