Erythroderma - Symptoms & Treatment

Erythroderma is the term used to describe intense and usually widespread reddening of the skin due to inflammatory skin disease. It is characterized by erythema and scaling involving the skin's surface and often obscures the primary lesions that are important clues to understanding the evolution of the disease. 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 (ED). It is sometimes called the 'red man syndrome' when no primary cause can be found (idiopathic erythroderma). It is not a specific disease and can be seen in both benign and malignant diseases. Idiopathic (unknown cause) cases may persist longer than other types. Erythroderma is produced by several skin diseases, such as psoriasis, contact dermatitis, drug reactions, and mycosis fungoides (a cutaneous lymphoma).

Long-standing erythroderma is often associated with hair loss, ectropion of the eyelids and even nail shedding. The term red man syndrome is reserved for idiopathic ED in which no primary cause can be found, despite serial examinations and tests. Many drugs can also cause erythroderma. An increased skin blood perfusion occurs in ED that results in temperature dysregulation (resulting in heat loss and hypothermia) and possible high-output cardiac failure. 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. In psoriatic erythroderma, the skin is almost totally involved, with deep erythema, exfoliation, and associated abnormalities of temperature and cardiovascular regulation. ED onset usually occurs in persons older than 40 years, except when the condition results from atopic dermatitis, seborrheic dermatitis, staphylococcal-scalded skin syndrome, or a hereditary ichthyosis.

Causes of Erythroderma

The common causes and risk factor's of Erythroderma include the following:

• An extension of a pre-existing skin disorder.
• An adverse drug reaction.
• Pityriasis rubra pilaris.
• The various skin disorders like eczema, hodgkin's disease, leukemia etc. may also lead to erythroderma.
• Mycosis fungoides (a cutaneous lymphoma).
• Cutaneous T cell lymphoma.
• A low calcium diet, may also induce erythroderma.

Symptoms of Erythroderma

Some sign and symptoms related to Erythroderma are as follows:

• Thick scaling may develop on scalp with varying degrees of hair loss including complete baldness
• Fever, and chills may occur.
• A feeling of chilliness as well as varying degrees of itching which may be intolerable.
• Secondary infection may occur with pustules and crusting.
• Palmoplantar thickening may develop.
• Swollen lymph nodes (lymphadenopathy).
• Nails become ridged and thickened or may shed.
• Dehydration, is a common symptom of erythroderma.

Treatment of Erythroderma

Here is list of the methods for treating Erythroderma:

• Dithranol is very effective in 85-90 % of cases. It is applied to the skin for 24 hours and used in combination with UVB.
• Antibiotics if secondary infection is present.
• Low-dose of methotrexate , ciclosporin or acitretin may also be beneficial for the treatment of erythroderma.
• Systemic steroids may be helpful in some cases but should be avoided in suspected cases of psoriasis and staphylococcal-scalded skin syndrome.
• Emollients are very effective for the treatment of erythroderma.

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