Erythroderma, also known as exfoliative dermatitis, involves extensive erythematous scaling affecting over 90% of the skin surface, often linked to various systemic conditions and characterized by high mortality rates. The document outlines pathophysiology, clinical features, differential diagnoses, investigations, and treatment options, emphasizing the importance of monitoring and addressing underlying causes. Key clinical symptoms include pruritis and generalized erythema, with treatment typically involving steroids, moisture maintenance, and addressing nutritional deficiencies.

1. ERYTHRODERMA
Presenter – Dr. Deepak R. Chinagi
Guide – Dr. L. S. Patil
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
1

2. Introduction
• Erythroderma is defined as the scaling
erythematous dermatitis involving 90% or
more of the cutaneous surface.
• Also known as exfoliative dermatitis
• Idiopathic exfoliative dermatitis – also known
as the “red man syndrome”, is characterized
by marked palmoplantar keratoderma,
dermatopathic lymphadenopathy,increased
IgE.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
2

3. Shri B. M. Patil Medical College and
Research Centre, Vijayapura
3

4. Pathophysiology
1. Increased skin perfusion leads to
– Temperature dysregulation >
– Resulting in skin loss and hypothermia >
– High output state >
– Cardiac failure
2. BMR raises to compensate for heat loss
3. Increased dehydration due to transpiration
(similar to burns)
All lead to negative nitrogen balance and
characterized by edema, hypoalbuminemia, loss
of muscle mass.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
4

5. • Normal skin loss per day is around 0.3 g/d
• Skin exfoliation may reach upto 20 – 30 g/d
• Excessive fluid loss through transpiration.
• 18 – 20 % mortality is seen.
• Male preponderance is seen .. Nearly 2-4
times..
• Age ≥ 40 years
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
5

6. Causes
Causes Associated systemic conditions
Atopic dermatitis Acute / Chronic Leukemia
Contact dermatitis Reticulum cell carcinoma
Dermatophytosis Carcinoma of rectum
Hailey-Hailey Disease Carcinoma of fallopian tubes
Leiner disease GVHD
Lichen planus HIV
Lupus eryhthematosus Lymphoma
Mycosis Fungoides Multiple Myeloma
Pemphigoid Carcinoma Lung
Pitriyasis Rubra Pilaris Reiter Syndrome
Psoriasis , Seborrheic Dermatitis
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
6

7. Mnemonic
ID SCALP
Idiopathic (30%)
Drug Allergy (28%)
Seborrheic Dermatitis (2%)
Contact dermatitis (3%)
Atopic dermatitis (10%)
Lymphoma and Leukemia (14%)
Psoriasis (8%)
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
7

8. Drugs that are commonly implicated in
exfoliative dermatitis
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
8

9. Clinical Features
• History of primary diease like psoriasis, atopic
dermatitis may be present.
• Drug history has to elicited in detail, including
OTC drugs
• Progression
– Rapid – Drug induced , lymphoma, leukemia, SSSS.
– Gradual – Psoriasis, Atopic Dermatitis.
• Pruritis is a predominant symptom
• Fever and Chills may occur.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
9

10. Clinical Features
• It often begns with generalized erythema.
• Scaling appears after 2-6 d.
• Scaling usually starts from flexural areas.
• Pruritis begins.
• Skin excoriations occur due to scratching.
• If it persists for weeks , hairs may shed, naiks may
become ridged.
• Periorbital skin may be inflamed and edematous,
result in ectropion.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
10

11. Clinical Features
• In Chronic cases , loss of pigment may occur
with patchy/widespread. Similar to vitiligo.
• Dermatopathic lymphadenopathy can occur,
– Lymph node is enlarged and rubbery in
consistency.
– Lymph node biopsy is advised.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
11

12. Diferential Diagnosis
Acanthosis Nigricans Atopic Dermatitis
Bullous Pemphigoid Allergic Contact Dermatitis
Irritan Contact Dermatitis Cutaneous T cell Lymphoma
Familial Benign Pemphigus (HH Disease) GVHD
Lichen Planus Pemphigus Foilaceous
Pitriyasis Rubra Pilaris Psoriasis – plaque
Reactive arthritis Sarcoidosis
Seborrheic Dermatitis
Stasis Dermatitis
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
12

13. Investigations
• CBC and LFT - ↑ESR, ↓Hb, ↓Sr.Albumin, ↑Sr. Globulin.
• IgE ↑ - Atopic dermatitis.
• Peripheral Blood Smears and bone marrow examinations. –
leukemia workup
• Immunophentyping and flow cytometry – for lymphoma
workup.
• Skin scraping , may show hyphae or scabies mites
• CD4 t cells are decreased in exfoliative dermatitis (in
absence of HIV), studied by Griffiths et al.
• HIV test – PCR better than ELISA,
• Chest X ray done.
• Extensive work up for suspected cause.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
13

14. Investigations
• Patch test – for contact allergens and drugs
that were used by patient prior to remission.
• Skin biopsy may show spongiotic dermatitis.
– Subacute / Chronic Dermatitis
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
14

15. Treatment
• Strict Intake Output monitoring.
• Monitor BP and temperature , risk of hypotension and
hypothermia.
• Maintain skn moisture, Avoid scratching, Avoid
precipitating factors.
• Topical steroids.
• Treat underlying cause and complications.
• For psoriasis , Phototherapy and systemic medications are
given.
• For idiopathic EF , prolonged glucocorticoids may be
required , usually disease has multiple exacerbations .
• Avoid the causative Drug.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
15

16. • Apply tap water gauze dressings. Change every 2-
3 hrs. Topical steroids 0.025-0.5% triamcilone.
Tepid bath once or twice /day
• As the condition improves , start on emolients.
• Antihistamines to decrease pruritis and provide
sedation.
• Systemic Steroids provide some relief (avoided in
psoriasis and SSSS)
• Proper Nutrition, to treat Hypoalbuminemia.
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
16

17. Thank You
Shri B. M. Patil Medical College and
Research Centre, Vijayapura
17