Erythroderma

Shri B. M. Patil Medical College and Research Centre, Vijayapura

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ERYTHRODERMA

Presenter – Dr. Deepak R. ChinagiGuide – Dr. L. S. Patil


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Introduction

• Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.

• Also known as exfoliative dermatitis• Idiopathic exfoliative dermatitis – also known

as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.


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Pathophysiology

1. Increased skin perfusion leads to– Temperature dysregulation >– Resulting in skin loss and hypothermia >– High output state >– Cardiac failure

2. BMR raises to compensate for heat loss3. Increased dehydration due to transpiration (similar

to burns)All lead to negative nitrogen balance and characterized

by edema, hypoalbuminemia, loss of muscle mass.


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• Normal skin loss per day is around 0.3 g/d• Skin exfoliation may reach upto 20 – 30 g/d• Excessive fluid loss through transpiration.• 18 – 20 % mortality is seen.• Male preponderance is seen .. Nearly 2-4

times..• Age ≥ 40 years


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CausesCauses Associated systemic conditionsAtopic dermatitis Acute / Chronic Leukemia

Contact dermatitis Reticulum cell carcinoma

Dermatophytosis Carcinoma of rectum

Hailey-Hailey Disease Carcinoma of fallopian tubes

Leiner disease GVHD

Lichen planus HIV

Lupus eryhthematosus Lymphoma

Mycosis Fungoides Multiple Myeloma

Pemphigoid Carcinoma Lung

Pitriyasis Rubra Pilaris Reiter Syndrome

Psoriasis , Seborrheic Dermatitis


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Mnemonic ID SCALP

Idiopathic (30%)

Drug Allergy (28%)

Seborrheic Dermatitis (2%)

Contact dermatitis (3%)

Atopic dermatitis (10%)

Lymphoma and Leukemia (14%)

Psoriasis (8%)


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Drugs that are commonly implicated in exfoliative dermatitis


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Clinical Features

• History of primary diease like psoriasis, atopic dermatitis may be present.

• Drug history has to elicited in detail, including OTC drugs

• Progression – Rapid – Drug induced , lymphoma, leukemia, SSSS.– Gradual – Psoriasis, Atopic Dermatitis.

• Pruritis is a predominant symptom• Fever and Chills may occur.


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Clinical Features

• It often begns with generalized erythema.• Scaling appears after 2-6 d.• Scaling usually starts from flexural areas.• Pruritis begins.• Skin excoriations occur due to scratching.• If it persists for weeks , hairs may shed, naiks may

become ridged.• Periorbital skin may be inflamed and edematous,

result in ectropion.


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Clinical Features

• In Chronic cases , loss of pigment may occur with patchy/widespread. Similar to vitiligo.

• Dermatopathic lymphadenopathy can occur,– Lymph node is enlarged and rubbery in

consistency.– Lymph node biopsy is advised.


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Diferential Diagnosis

Acanthosis Nigricans Atopic Dermatitis

Bullous Pemphigoid Allergic Contact Dermatitis

Irritan Contact Dermatitis Cutaneous T cell Lymphoma

Familial Benign Pemphigus (HH Disease) GVHD

Lichen Planus Pemphigus Foilaceous

Pitriyasis Rubra Pilaris Psoriasis – plaque

Reactive arthritis Sarcoidosis

Seborrheic Dermatitis

Stasis Dermatitis


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Investigations• CBC and LFT - ↑ESR, ↓Hb, ↓Sr.Albumin, ↑Sr. Globulin.• IgE ↑ - Atopic dermatitis.• Peripheral Blood Smears and bone marrow examinations. –

leukemia workup• Immunophentyping and flow cytometry – for lymphoma workup.• Skin scraping , may show hyphae or scabies mites• CD4 t cells are decreased in exfoliative dermatitis (in absence of

HIV), studied by Griffiths et al.• HIV test – PCR better than ELISA,• Chest X ray done.• Extensive work up for suspected cause.


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Investigations

• Patch test – for contact allergens and drugs that were used by patient prior to remission.

• Skin biopsy may show spongiotic dermatitis.– Subacute / Chronic Dermatitis


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Treatment • Strict Intake Output monitoring.• Monitor BP and temperature , risk of hypotension and

hypothermia.• Maintain skn moisture, Avoid scratching, Avoid precipitating

factors.• Topical steroids.• Treat underlying cause and complications.• For psoriasis , Phototherapy and systemic medications are given.• For idiopathic EF , prolonged glucocorticoids may be required ,

usually disease has multiple exacerbations .• Avoid the causative Drug.


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• Apply tap water gauze dressings. Change every 2-3 hrs. Topical steroids 0.025-0.5% triamcilone. Tepid bath once or twice /day

• As the condition improves , start on emolients.• Antihistamines to decrease pruritis and provide

sedation.• Systemic Steroids provide some relief (avoided in

psoriasis and SSSS)• Proper Nutrition, to treat Hypoalbuminemia.


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Thank You

Erythroderma

Health & Medicine

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