VERIFIED CONTENTAuthor: lek. Łukasz Kujawa

Erythroderma, also known as exfoliative dermatitis (ED), is a common term used in dermatological conditions. It is not a separate disease entity. It is a symptom complex that can be a manifestation of various diseases. What does erythroderma look like and what causes it? Can it be treated? Is she dangerous?

Erythroderma , otherwiseexfoliative dermatitis( exfoliative dermatitis , ED), affects more often men than women (the ratio is approximately 3: 1). The age at which symptoms appear depends on the etiology, although it is assumed that in most cases it affects people over 40 (the exception is erythroderma, which occurs in the course of, among others, atopic dermatitis, seborrheic dermatitis and Ritter's disease, i.e. exfoliating skin of newborns).

Erythroderma: symptoms

Erythrodermais inflammatory. The most important feature is generalized skin redness covering more than 90 percent of its surface.

It is usually accompanied by intense exfoliation, which appears 2-6 days after the redness appears - initially in the flexion areas.

The skin is warm, and the changes may be accompanied by persistent itching, resulting in bouts.

Prolonged erythroderma can lead to disorders of the skin appendages. The nails lead to hair loss, streaking and thickening, and consequently to onycholysis or detachment of the nail plate from the placenta.

The skin is also swollen. The swelling of the eyelids is particularly characteristic, which causes the so-called ectropion, i.e. the lower eyelid curl outwards.

Chronic cases can lead to local or diffuse vitiligo-like pigmentation disorders, which is especially noticeable among the black race. One should also remember about the coexistence of lesions and eruptions characteristic of the diseases that underlie a given case of erythrodemia.

Erythroderma: causes

The etiology of exfoliative dermatitis varies widely. Undoubtedly, its background is constituted by complex immunological processes. It can be primary orappear secondary to other skin diseases.

Drugs are an important trigger of primary ED. The list of potential culprits is very long. Chemotherapeutic agents from various groups may be triggering factors, including

  • neuroleptics
  • antibiotics
  • anti-tuberculosis drugs
  • anti-cancer drugs

There is an equally long list of skin diseases in which the course of erythroderma may be secondary:

  • psoriasis - the usual cause of erythroderma in this case is the systemic use of steroids (other triggers may be antimalarial drugs, lithium preparations, burns during PUVA therapy)
  • pityriasis rubra pilaris
  • atopic dermatitis
  • contact eczema
  • seborrheic dermatitis
  • pemphigus
  • pemfigoid
  • erythema multiforme (especially its most severe forms, which may constitute drug reactions - Stevens-Johnson syndrome and Lyell's syndrome, i.e. toxic epidermal necrolysis)
  • Sezary's syndrome and mycosis fungoides - cutaneous T-cell lymphomas

Symptoms of erythroderma appearing without prior skin changes require careful diagnosis, as they can be a cutaneous manifestation of neoplastic diseases, in particular malignant hyperplasia of the hematopoietic system - lymphomas and leukemias. Other cancers that may be accompanied by :

  • lung cancer
  • rectal cancer
  • fallopian tube cancer

Erythrodermacan therefore be the so-called paraneoplastic syndrome.

It is worth noting that exfoliative dermatitis can also occur in the course of HIV infection and in GVHD ( graft versus host disease ), i.e. a graft versus host disease resulting from an undesirable response in the organism of the transplant recipient under the influence of introduced antigenically foreign lymphocytes.

Erythrodermais idiopathic in approximately 30% (for no proven reason). In the literature, this character is sometimes referred to as the "red man syndrome".

Is erythroderma dangerous?

Clinical pictureerythrodermicmay be variable and vary in severity and dynamics of the course depending on the cause.

Erythrodermais a potentially life-threatening condition. Delayed treatment can even lead to shock.

As a result of the expansion of small blood vessels in the skin, thermoregulation is impaired - heat loss increases drastically. The consequence is also a disturbed fluid balance inthe body. Dehydration and electrolyte disturbances are progressing.

Increased cutaneous blood flow leads to an increase in cardiac output (hyperkinetic circulation) which may eventually result in heart failure.

Inflammation developing on such a large surface as the skin causes a strong increase in metabolism, which is reflected in, among others, impaired production of proteins in the liver (albumin) and, as a result, edema. Immunodeficiency associated with erythrodemia carries further threats. There may be secondary infections in the skin lesions and pneumonia, which can be fatal complications.

Erythroderma: treatment

Patients presenting severe symptoms often require hospitalization. Pediatric patients deserve special attention. In this group, the clinical deterioration occurs much faster and more rapidly. In the most severe cases, monitoring of vital functions and intensive therapy may be necessary.

Initial treatment for generalized severe erythrodemia is the same regardless of etiology. The key is to replenish water and electrolyte losses.

Topical treatment mainly includes long-term skin moisturizing with moist dressings, application of emollients and topical steroid drugs.

In order to control the acute phase of symptoms and prevent another exacerbation, it may be necessary to use steroids also systemically.

The supply of antihistamines, which reduce the feeling of itching, also turns out to be helpful.

The factors of secondary infection are, in turn, a prerequisite for the implementation of antibiotic therapy.

Erythroderma: prognosis

The prognosis inerythrodermalargely depends on its background.

If the underlying cause (e.g., drug) is removed, symptoms resolve without sequelae and the prognosis is generally good.

Exfoliative dermatitis secondary to other conditions may recur and primarily requires optimization of treatment of the underlying disease and avoidance of factors that may trigger an exacerbation.

Category:

Dermatology