Erythroderma - Symptoms and Treatment

Erythroderma, is a skin disease characterized by intense, widespread reddening of the skin. 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). 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. The rate at which red blood cells settle out in a tube of blood under standardized conditions; a high rate usually indicates the presence of inflammation, also called erythrodermatitis. It may occur by excessive ultraviolet exposure or as a complication of topical therapy or systemical viral or bacterial disease. In psoriatic erythroderma, the skin is almost totally involved, with deep erythema, exfoliation, and associated abnormalities of temperature and cardiovascular regulation. It can be accompanied by severe itching and pain. It is often associated with the loss of hair and nails, hyperkeratosis of the palms and soles, and pruritus. It is often associated with exfoliation. So, it may also be known as exfoliative dermatitis (ED).

There may be associated scale, erosions, or pustules as well as shedding of the hair and nails. 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. Potential systemic manifestations include fever, chills, hypothermia, reactive lymphadenopathy, peripheral edema, hypoalbuminemia, and 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:

• Drug reactions play important role in the formation of erythroderma.
• A low calcium diet, may also induce erythroderma.
• Cutaneous T cell lymphoma.
• Most commonly from extension of pre-existing skin disorders like eczema, psoriasis, hodgkin's disease, leukemia.
• A positive family history in first degree relatives is seen in approximately 30 percent of patients with erythroderma.
• Stress, unexpressed anger and emotional disorders, including depression and anxiety are strongly associated with erythroderma.
• Psoriasis, may causes skin infection, which in turn causes erythroderma.

Symptoms of Erythroderma

Some common Symptoms of Erythroderma :

• Red skin patches.
• Skin thickening, peeling, flaking .
• Fever, and chills may occur.
• Hypothermia.
• Cardiac failure, high output.
• Skin is moist, red, and tender at birth.

Treatment of Erythroderma

• Emollients are very effective for the treatment of erythroderma.
• Antibiotics if secondary infection is present.
• Topical tar preparations and photo therapy should also be avoided in the early treatment of 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.
• Low-dose of methotrexate , ciclosporin or acitretin may also be beneficial for the treatment of erythroderma.
• Topical Steroids are the primary category of medications used to treat erythroderma.
• Bed rest is sometimes essential.
• A sedative antihistamine may be a useful for itchy patients.

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