Erythroderma is the term used to describe intense and usually widespread reddening of the skin due to inflammatory skin disease. It is sometimes called the 'red man syndrome' when no primary cause can be found. Erythroderma is characterized by intense, widespread reddening of the skin. Erythroderma can arise from a variety of causes, most often as an extension of a pre-existing skin disorder. Erythroderma may also be due to an adverse drug reaction. It is also known as erythrodermatitis, generalized exfoliative dermatitis. Erythroderma is more commonly found in older age groups. More males are affected than females. The condition usually develops slowly, but may be of acute onset. It often precedes or is associated with exfoliation (skin peeling off in scales or layers) when it may also be known as exfoliative dermatitis. In psoriatic erythroderma, the skin is almost totally involved, with deep erythema, exfoliation, and associated abnormalities of temperature and cardiovascular regulation.
Erythroderma is produced by several skin diseases, such as psoriasis, contact dermatitis, drug reactions, and mycosis fungoides. An increased skin blood perfusion occurs in erythroderma that results in temperature dysregulation and possible high-output cardiac failure.It is not a specific disease and can be seen in both benign and malignant diseases. Many drugs can also cause erythroderma. Erythroderma of unknown cause and protracted course may be secondary to senile atopic dermatitis, intake of drugs overlooked by the patients, and patients who are in slow progression to cutaneous T-cell lymphoma. Prognosis of erythroderma depends on the underlying disease process. If the cause can be removed or corrected then prognosis is generally very good. If erythroderma is the result of a generalised spread of a primary skin disorder such as psoriasis or dermatitis, it usually clears with appropriate treatment of the skin disease but may recur at any time. Preexisting malnutrition may become more marked and require nutritional intervention in older patients.
Causes of Erythroderma
Erythroderma can arise from a variety of causes, most often as an extension of a pre-existing skin disorder. Erythroderma may also be due to an adverse drug reaction. However, in as many as 30% of all cases of erythroderma, no underlying cause can be found. A dermatologist must first diagnose the cause, usually with a skin biopsy, a blood smear examined by a pathologist and patch testing.
Common causes and risk factors of Erythroderma:
- A positive family history.
- Dermatitis especially atopic dermatitis.
- Bacterial or viral infection eg. streptococcal infections.
- Drug reactions.
- Emotional disorders.
Signs and Symptoms of Erythroderma
Erythroderma that is not due to eczema usually occurs in people older than 40 years. It is slightly more common in men than women. Patients usually complains of a feeling of chilliness as well as varying degrees of itching which may be intolerable. It can develop quite rapidly. Long-standing erythroderma is often associated with hair loss, ectropion of the eyelids and even nail shedding.
Sign and symptoms may include the following :
- Red skin patches.
- Ectropion of the eyelids.
- Skin thickening.
- Hair loss.
- Fluid filled blisters.
Treatment for Erythroderma
The best treatment is geting adequate nutrition with emphasis on protein intake, since erythroderma patients lose a lot of protein through excessive desquamation and show a tendency toward hypoalbuminemia. All unessential drugs & medications should be stopped. Carefully monitor and control fluid intake and maintain proper fluid balance. The blanket use of systemic steroid therapy for erythroderma remains controversial in view of possible side-effects.
Treatment may include:
- Emollients are very effective for the treatment of erythroderma.
- Topical Steroids are the primary category of medications used to treat erythroderma.
- Bed rest is sometimes essential.
- Low-dose of methotrexate, ciclosporin or acitretin may also be beneficial for the treatment of erythroderma.
- A sedative antihistamine may be a useful for itchy patients.