Erythroderma

Erythroderma

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  Chris Pearce Dermatology Presentation
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  Aims To cover: 1. Definition 2.ClinicalPresentation 3. Pathology 4.Causative conditions 5.Complications 6.Management 7.Prognosis
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  Definition Erythroderma , whichis also known as Generalised Exfoliative Dermatitis: “An inflammatory dermatosis which involves 90% or more of the skin surface.” (Gawkrodger, 2004)
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  Clinical Presentation Four keypoints: 1. Patchy erythema becomes universal over 24-48 hours, accompanied by malaise, shivering and pyrexia. 2. Scaling appears 2-6 day later, when the skin is hot, dry, red and thickened. 3. Skin feels tight and itchy, and patients feel cold. 4. Scalp and body hair is eventually lost, whilst nails become thickened or shed.
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  Pathology Acute changes –Dermal/epidermal oedema and inflammatory infiltrate. Chronic changes – Lengthened rete ridges and thickened epidermis. Cytokines implicated: IL-1, IL-2, IL-8, ICAM-1, TNFα and IFN-γ (Wilson et al, 1993) Typical changes of underlying lesion.
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  Causes
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  Eczema All types of ezcemacan become erythrodermic, but this is more common in the elderly (Rothe et al, 2005)
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  Psoriasis Steroid withdrawal can precipitateerythrodermic psoriasis. Progression can lead to generalised pustular psoriasis. (Kassay et al, 2001) (Gawkrodger, 2004)
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  Malignancy: Sezary Syndrome (Rothe etal, 2005)(Harrison & Duvic 2004)
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  Drug reaction Drug reactionsof the toxic erythema or mobillform type can become erythrodermic Carbemazepine, phenytoin, diltiazem, cimetidine, gold, allopurinol and sulphonamides are common causes. (Gawkrodger, 2004)
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  Complications Oedema Lymphadenopathy Minor Major Cardiac failure Metabolic disturbance Hypothermia Cutaneousor respiratory infection
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  Management
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  Prognosis Sigurdsson et al(1996) found a mortality rate of 43% in 102 patients with erythroderma , although only 18% of these deaths occurred as a direct result of the patient’s erythroderma. Drug induced disease carries a much better prognosis than that caused by malignancy. Chronic conditions like eczema and psoriasis could lead to a relapsing remitting course.
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  Conclusion A secondary processoccurring as a result of ezcema, psoriasis and lymphoma. Of sudden onset, exfoliative, erythematous and oedematous. Serious complications can arise, which can be life threatening. Management involves close inpatient monitoring and initially topical steroids.
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  References Gawkrodger, D.J. (2004)Dermatology – An illustrated colour text. 3rd Ed. Churchill Livingstone Harrison, A.L. & Duvic, M. (2004) Diagnosis and Treatment of Sézary Syndrome: The Internet Journal of Dermatology, (5)2. Kassay, E., Saringer, A., Torok, E. & Szalai, Z. (2001) Infantile Psoriasis: A short clinical study. Acta Dermatovenerologica 10(2). Rothe, M.J., Bernstein, M.L. & Grant-Kels, J.M. (2005) Life Threatening Erythroderma: Diagnosing and treating the “red man.” Clinics in Dermatology 23, 206-217. Sigurdsson, V., Toonstra, J., Hezemans-Boer, M. & van Vloten, W.A. (1996) Erythroderma. A clinical and follow-up study of 102 patients, with special emphasis on survival. Journal of the American Academy of Dermatology 35(1), 53-7.