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Erythroderma

Exfoliative dermatitis; Dermatitis exfoliativa; Pruritus - exfoliative dermatitis; Pityriasis rubra; Red man syndrome; Exfoliative erythroderma

Erythroderma is widespread redness of the skin. It is accompanied by scaling, peeling, and flaking of the skin, and may include itching and hair loss.

Causes

Erythroderma may occur due to:

  • Complication of other skin conditions, such as eczema and psoriasis
  • Reaction to medicines or some chemicals, such as phenytoin and allopurinol
  • Some types of cancer, such as lymphoma

Sometimes the cause is unknown. It is more common in males.

Symptoms

Symptoms may include any of the following:

  • Redness over 80% to 90% of the body
  • Scaly skin patches
  • Thickened skin
  • Skin is itchy or painful with an odor
  • Swelling of the arms or legs
  • Fast heart beat
  • Loss of fluids, leading to dehydration
  • Loss of temperature regulation by the body

There may be secondary infections of the skin.

Exams and Tests

Your health care provider will ask about your symptoms and take your medical history. The provider will do a skin examination with a dermatoscope. Most of the time, the cause can be identified after the exam.

If needed, the following tests may be ordered:

  • Biopsy of the skin
  • Allergy testing
  • Other tests to find the cause of erythroderma

Treatment

Since erythroderma can quickly lead to serious complications, the provider will start treatment right away. This usually involves strong doses of cortisone medicines to reduce inflammation.

Other treatments may include:

  • Medicines to treat the underlying cause of erythroderma
  • Antibiotics for any infection
  • Dressings applied to the skin
  • Ultraviolet light
  • Correction of fluid and electrolyte balance

Outlook (Prognosis)

In serious cases, the person needs to be treated in the hospital.

Possible Complications

Complications may include:

  • Secondary infections that can lead to sepsis (bodywide inflammatory response)
  • Fluid loss that can result in dehydration and an imbalance of minerals (electrolytes) in the body
  • Heart failure

When to Contact a Medical Professional

Contact your provider right away if:

  • Symptoms get worse or do not get better, even with treatment.
  • You develop new lesions.

Prevention

Risk for erythroderma may be reduced by following the provider's instructions on skin care.

References

Calonje E, Brenn T, Lazar AJ, Billings SD. Spongiotic, psoriasiform and pustular dermatoses. In: Calonje E, Brenn T, Lazar AJ, Billings SD, eds. McKee's Pathology of the Skin. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 6.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Pityriasis rosea, pityriasis rubra pilaris, and other papulosquamous and hyperkeratotic diseases. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 11.

Whittaker S. Erythroderma. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 10.

  • Eczema, atopic - close-up

    Eczema, atopic - close-up - illustration

    This view shows the red, scaly patches called plaques that are characteristic of atopic dermatitis.

    Eczema, atopic - close-up

    illustration

  • Psoriasis - magnified x4

    Psoriasis - magnified x4 - illustration

    This picture shows a 400% magnification of psoriasis. The whitish scales give the silvery appearance to the typical psoriasis lesion.

    Psoriasis - magnified x4

    illustration

  • Atopic dermatitis

    Atopic dermatitis - illustration

    The term dermatitis describes an inflammatory response of the skin, caused by contact with allergens or irritants, exposure to sunlight, or by poor circulation, even stress. An example of atopic dermatitis is eczema, an itchy rash that produces redness, blisters and scaling. AVOID SCRATCHING. Scratching the rash may spread the inflammation, lead to infection and even leave scars.

    Atopic dermatitis

    illustration

  • Exfoliation following erythroderma

    Exfoliation following erythroderma - illustration

    This picture shows diffuse redness (erythema) and scaling on the arm.

    Exfoliation following erythroderma

    illustration

    • Eczema, atopic - close-up

      Eczema, atopic - close-up - illustration

      This view shows the red, scaly patches called plaques that are characteristic of atopic dermatitis.

      Eczema, atopic - close-up

      illustration

    • Psoriasis - magnified x4

      Psoriasis - magnified x4 - illustration

      This picture shows a 400% magnification of psoriasis. The whitish scales give the silvery appearance to the typical psoriasis lesion.

      Psoriasis - magnified x4

      illustration

    • Atopic dermatitis

      Atopic dermatitis - illustration

      The term dermatitis describes an inflammatory response of the skin, caused by contact with allergens or irritants, exposure to sunlight, or by poor circulation, even stress. An example of atopic dermatitis is eczema, an itchy rash that produces redness, blisters and scaling. AVOID SCRATCHING. Scratching the rash may spread the inflammation, lead to infection and even leave scars.

      Atopic dermatitis

      illustration

    • Exfoliation following erythroderma

      Exfoliation following erythroderma - illustration

      This picture shows diffuse redness (erythema) and scaling on the arm.

      Exfoliation following erythroderma

      illustration


     

    Review Date: 2/18/2022

    Reviewed By: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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