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Merck Manual

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Erythroderma

(Exfoliative Dermatitis)

By

Thomas M. Ruenger

, MD, PhD, Georg-August University of Göttingen, Germany

Last full review/revision Feb 2021| Content last modified Feb 2021
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Erythroderma is defined as erythema that covers more than 70% of the body surface area. It represents the maximum severity of various skin disorders. Diagnosis is by history and examination. Treatment includes supportive measures and topical care.

The various skin disorders that can result in erythroderma are the following:

Erythroderma can develop in patients known to have skin disorders such as those above, but erythroderma can also develop spontaneously in patients without a history of prior skin problems.

An older, now only rarely used, term for erythroderma is exfoliative dermatitis. However, exfoliative dermatitis is not a dermatitis. Although erythroderma can result from dermatitis, it can also result from many other (nondermatitis) skin conditions.

Symptoms and Signs

Symptoms of erythroderma include malaise and chills due to the extensive inflammation and heat loss through large areas of hyperperfused skin. Pruritus is often present.

Diagnosis

  • Clinical evaluation

Diagnosis of erythroderma is by history and examination. Determining the cause may require extensive testing.

Blood tests may reveal electrolyte imbalances and an increase in inflammatory markers; however, these findings are not diagnostic of erythroderma. T-cell receptor rearrangement studies to search for monoclonal T-cell expansions in the skin and/or in the peripheral blood and characterization of skin-infiltrating and peripheral T-cell subsets can be done to diagnose T-cell lymphoma when this disorder is under consideration.

Biopsy is often nonspecific, and sometimes repeat biopsies are needed. When erythroderma develops in patients without a history of prior skin problems, immediate biopsy may not reveal the cause.

Prognosis

Erythroderma may be life threatening; hospitalization is often necessary. Prognosis depends on the cause.

Treatment

  • Supportive care (eg, rehydration, treatment for electrolyte abnormalities)

  • Topical care (eg, emollients)

  • Treatment of the underlying disorder

  • Sometimes topical or systemic corticosteroids

  • Possibly stopping or changing any drug that may be the cause

Comprehensive skin care is indicated. Any known cause is treated. Supportive care consists of correction of dehydration, correction of electrolyte abnormalities and nutritional deficiencies, and comprehensive wound care and dressings to prevent bacterial superinfection. Skin care is with emollients and colloidal oatmeal baths.

Weak topical corticosteroids (eg, 1 to 2.5% hydrocortisone ointment) are often used. Systemic corticosteroids (eg, prednisone 40 to 60 mg orally once a day for 10 days, then tapered) are often used for severe disease. However, although topical or systemic corticosteroids can help relieve symptoms, they should be used cautiously because they can exacerbate certain disorders that could be the cause of erythroderma.

Because a drug reaction often cannot be ruled out by history alone, it may be necessary to stop all drugs or the most suspect ones.

Key Points

  • Erythroderma is the maximum severity of various widely heterogeneous skin conditions.

  • Often the underlying cause is not immediately apparent.

  • Symptoms include widespread erythema (> 70 % of the body surface area) and often pruritus.

  • Diagnosis is clinical, but determining the underlying cause often requires extensive testing, including skin biopsies.

  • Hospitalization is often necessary, because the disease may be life threatening.

  • Treatment consists of supportive care, comprehensive skin care, and treatment of the cause.

Drugs Mentioned In This Article

Drug Name Select Trade
CORTEF, SOLU-CORTEF
RAYOS
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