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
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...
, 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 comple ...
,
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,
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
Cutaneous T-cell lymphoma (CTCL) is a class of non-Hodgkin lymphoma, which is a type of cancer of the immune system. Unlike most non-Hodgkin lymphomas (which are generally B-cell-related), CTCL is caused by a mutation of T cells. The cancero ...
, 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 spontaneous origin. From Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approximately "a disease of its own kin ...
- 30%
*
Drug allergy
A drug allergy is an allergy to a drug, most commonly a medication, and is a form of adverse drug reaction. Medical attention should be sought immediately if an allergic reaction is suspected.
An allergic reaction will not occur on the first ex ...
- 28%
*
Seborrheic dermatitis - 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
Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin ( dermatitis). It results in itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thickens over tim ...
- 10%
* Lymphoma and leukemia - 14%
* Psoriasis - 8%
Treatment
The treatment for erythroderma depends on the primary cause.
Topical steroids 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
The retinoids are a class of chemical compounds that are vitamers of vitamin A or are chemically related to it. Retinoids have found use in medicine where they regulate epithelial cell growth.
Retinoids have many important functions throughou ...
and
immunosuppressive drug
Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent activity of the immune system.
Classification
Immunosuppressive drugs can be classified int ...
s 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 provide ...
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