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PCDS home Erythroderma (syn. exfoliative dermatitis)
About the PCDS

Dermatology: the basics
Diagnostic tables

Dermoscopy Introduction
Erythroderma is a term used to describe erythema affecting Related chapters
A-Z of clinical guidance more than 90% of the body surface. The term exfoliative
A-Z list dermatitis is also used, and describes the exfoliation (skin Eczema - atopic eczema
peeling) found in erythroderma. The extent of the skin Psoriasis: an overview and chronic
Image Library changes can obscure the primary lesion making it difficult to plaque psoriasis
diagnose the underlying cause.
Leg dressings and other bandaging Cutaneous lymphoma
This chapter is set out as follows: Drug rashes: severe
Other guidelines
Aetiology Pityriasis rubra pilaris
Patient information leaflets History
Quality of Life Measures Clinical findings
Self-examination of moles
Skin surgery and cryosurgery
GPwSI & service development

PCDS educational events

Other educational programmes Aetiology
The causes, in order of frequency, are:
Patient support groups
Eczema (including atopic, seborrhoeic and contact allergic)
Latest news and bulletins
Research and fundraising Lymphoma and leukaemia (cutaneous t-cell lymphoma followed by Hodgkin’s disease are the most common
malignant causes). The Sézary syndrome is one form of cutaneous t-cell lymphoma associated with
Affiliated societies erythroderma
Ethical dermatology Drugs - more than 60 drugs have been implicated. The most commonly associated drugs include the
sulphonamides, isoniazid, penicillin, antimalarials, phenytoin, captopril and cimetidine
Rare causes - these include pityriasis rubra pilaris, pemphigus foliaceus, dermatomyositis, and those usually
presenting at birth eg ichthyosiform erythroderma

Males are affected 2-3 times more commonly than females
Variable degrees of itch, which sometimes can be severe

Clinical findings
Clinical features

Erythema spreads quickly to affect more than 90% of the body surface
Scaling appears days 2-6 and the skin becomes thickened
Although the skin feels hot, patients often feel cold
Keratoderma develops ie thickened skin on the palms and soles
After several weeks, erythema and scaling of the scalp can lead to hair loss
The nails become thickened, ridged and may be lost
Lymphadenopathy is common
Secondary infection may arise
The patient may become systemically compromised

Defining the cause

Making a diagnosis of erythroderma is usually straightforward, however, determining the cause can be much more

the skin is often very infiltrated and lymphadenopathy can be considerable Pityriasis rubra pilaris . which often has an orange tinge. Notice and credit must be given to the PCDS and any other named contributor. including any homeopathic treatments Psoriasis may be scaly from the onset Adverse drug reactions often start with a morbilliform rash.the erythema.both prescribed and over-the-counter medication. and scaly papules are often found on the backs of the fingers as well as on the elbows and knees Papuloerythroderma of Ofuji This is a rare variant of erythroderma. and resolve within six weeks of the drug being discontinued Lymphoma and leukaemia . especially axillary and inguinal sites. predominantly affecting elderly male patients. The rash may evolve less quickly when it arises from eczema or psoriasis Past and/or family history of inflammatory dermatoses Medication .difficult. islands of normal skin persist within the erythrodermic skin.the rash usually evolves rapidly when it results from a drug reaction. Figure: 1 Erythroderma secondary to eczema Figure: 2 Same patient as above . Images must only be used for teaching purposes and are not for commercial use. The condition presents with brown-red flat-topped lesions that become confluent. starts at the head and spreads downwards. or choose to download. The following may provide clues to the diagnosis: Speed of onset . In some cases it may take several years before the diagnosis becomes apparent. and in others the cause remains undetermined (idiopathic). Images Please click on images to enlarge. and malignancies such as lymphoma or leukaemia. There is sparing of the face and flexures. Pruritus can be severe.

Figure: 3 As above Figure: 4 As above .hair loss Figure: 5 Erythrodermic psoriasis Figure: 6 Erythrodermic psoriasis .

Figure: 7 The Sézary syndrome Copied with kind permission from Dermatoweb Figure: 8 The Sézary syndrome Very infiltrated skin Copied with kind permission from Dermatoweb Figure: 9 The Sézary syndrome Copied with kind permission from Dermatoweb .

Figure: 10 Adverse cutaneous drug reaction evolving into erythroderma The initial rash was morbilliform Figure: 11 Erythroderma secondary to pityriasis rubra pilaris Arrows denote small islands of unaffected skin Copied with kind permission from Dermatoweb Figure: 12 Erythroderma secondary to pityriasis rubra pilaris Islands of unaffected skin Copied with kind permission from Dermatoweb .

Figure: 13 Erythroderma secondary to pityriasis rubra pilaris Copied with kind permission from Dermatoweb Figure: 14 Papuloerythroderma of Ofuji Initial presentation with brown-red flat-topped lesions that become confluent Figure: 15 Papuloerythroderma of Ofuji Later on the rash becomes erythrodermic with sparing of some flexural sites .

although one has to be mindful that the skin barrier function is very compromised and as a result much larger amounts of topical treatments will be absorbed The optimal management of erythroderma remains unclear.Nail disorders | 13. Web Design . Charity No.2016 2nd Floor. Hatfield. Titan Court.2016 Tel: 01707 226024 Email: pcds@pcds.11.Mode Ten Designs. eg elderly and living alone or is in poor general health.06. 1109376 PCDS Latest News & Bulletins Lead Author . PCDS Bulletin Winter 2016 | 30. AL10 9NA. Investigations Patients require a thorough work-up A FBC and peripheral blood film should be examined for abnormal cells.2017 The Primary Care Dermatology Society.Dr Tim it usually clears with appropriate treatment of the condition but may recur at any time PCDS Corporate Sponsors (View all sponsors) Contact Us Site Map Disclaimer Copyright © 1994 .05. mainly ointments. or the patient is high-risk. although partly depends on the cause The prognosis of erythroderma depends on the cause. All rights reserved. UK New clinical chapter . 3 Bishop Square. are required to improve the skin barrier function Topical steroids are . which if can be removed or corrected then the prognosis is generally very good.2016 PCDS Bulletin Summer 2016 | 13. Sézary cells (atypical lymphocytes with cerebriform nuclei) are often observed in erythroderma but when they constitute more than 20% of the circulating peripheral blood mononuclear cells they become diagnostic of a form of cutaneous t-cell lymphoma known as the Sézary syndrome Histology: multiple biopsies may aid in the diagnosis Management Erythroderma is a medical emergency and should be discussed with the on-call dermatologist If the patient is systemically compromised. the patient will need admitting Otherwise an urgent out-patient appointment will be needed Consider stopping all non-essential medications Large quantities of emollients. If erythroderma is the result of a primary skin condition such as psoriasis or eczema.