What is Erythroderma?
A condition that accompanies or follows erythroderma is exfoliative dermatitis (ED) where the skin peels off in scales or layers.
What are the Causes of Erythroderma?The causes of Erythroderma include:
- Skin conditions like, atopic dermatitis, psoriasis, allergic contact dermatitis and in babies, seborrheic dermatitis
- Idiopathic conditions (ones that have no cause)
- Drugs including allopurinol, anti-epileptics, antibiotics, calcium channel blockers, dapsone, and cimetidine
- Malignant conditions like lymphoma, leukemia, mycosis fungoides and carcinoma of the rectum, lung, fallopian tubes, or colon, and HIV infection
What are the Symptoms and Signs of Erythroderma?The symptoms of Erythroderma can occur slowly or within a short duration. The common symptoms include:
- Skin feels warm to touch
- The patient experiences chills
- There is itching and rubbing which turns intolerable
- Hair loss or alopecia is experienced by some people due to thick scaling of the scalp
- Nail abnormalities which include dull, rigid and thickened nails
- Generalized swelling, and swelling of lymph nodes called lymphadenopathy
- There is thickening of the skin of palms and soles called keratoderma
What are the Complications of Erythroderma?The complications that occur in Erythroderma include:
- Secondary infections like (Impetigo, Cellulitis) that can further result in sepsis
- Heat loss that can lead to hypothermia
- Fluid loss can lead to electrolyte abnormalities and dehydration
- Pigmentations in the skin either dark or light patches can occur due to longstanding erythroderma
- High cardiac output failure
How do you Diagnose Erythroderma?The diagnosis of erythroderma requires identifying the underlying cause of the condition; this requires a medical workup with investigation that includes:
- Complete blood count that may show anemia, and low white blood cell count
- Peripheral blood film may show sezary cells in the blood film which is diagnostic of a rare and aggressive lymphoma of Sezary syndrome
- Biopsy of the skin is done when in doubt of the underlying condition
- Immunofluorescence studies are done to identify autoimmune conditions or connective tissue disorders
How do you Treat Erythroderma?This is a life threatening condition which requires hospitalisation if the patient is elderly, has poor health, has a high risk condition or has systematic involvement of organs. Otherwise the patient may be seen on out-patient basis.
The treatment modalities include:
- All unnecessary medications should be avoided.
- Emollients, steroids, skin barrier ointments and wet wraps are prescribed to protect the skin
- Maintain fluid balance
- For secondary bacterial infections, antibiotics are prescribed
- For severe itching, antihistamines are prescribed