Dermatologic Emergencies

dermatology-emergencieskapak-1-0-25

Erythroderma (Exfoliative Dermatitis)

Merve UNUTMAZ
Ankara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye

Unutmaz M. Erythroderma (Exfoliative der- matitis). In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.41-8.

ABSTRACT

Definition: Erythroderma (exfoliative dermatitis) is a serious and potentially life-threatening condition characterized by widespread erythema and scaling involving more than 90% of the body surface area. Etiology: The most common causes of erythroderma include the exacerbation of pre-existing inflammatory dermatoses, hypersensitivity reactions to medications, and cutaneous T-cell lymphomas. In approximately one-third of cases, the cause of erythroderma remains unclear (idiopathic erythroderma). Clinical Presentation: Erythroderma can develop acutely within hours or days or gradually over weeks or months. Patients typically present with erythematous patches that enlarge and progress to generalized erythroderma. In individuals with darker skin, erythema may be less noticeable and appear brown or black. Patients often appear uncorfortable, experience chills, and complain of feeling cold. Scaling begins two to six days after the onset of erythema and may become prominent. Extracutaneous symptoms include fever or hypothermia, peripheral edema, and tachycardia. Diagnosis: The diagnosis of erythroderma is straightforward. However, determining the underlying cause often requires a thorough history, physical examination, skin biopsy, and labora- tory/imaging studies. In some cases, histology reveals the underlying etiology, though it is often nonspecific, requiring repeat skin biopsies. Initial Hospital Treatment: Patients with hemodynamic instability or severe symptoms may require hospitalization. Regardless of the specific etiology, initial treatment includes: – Evaluation, active management, and continuous monitoring of hemodynamic status – Fluid and electrolyte replacement – Skin assessment and management Evaluation and management of the oral mucosa, eyes, and genitourinary system – Monitoring body temperature – Nutritional support – Treatment of cutaneous superinfections – Symptomatic management of skin inflammation and pruritus Topical corticosteroids and oral antihistamines are recommended for symptomatic treatment of skin inflammation and itching. Management of Idiopathic Erythroderma: For idiopathic erythroderma patients who do not respond to topical therapy, systemic corticosteroids are recommended as first-line treatment over other immunosuppressive therapies. Prednisone is tapered gradually over several weeks to prevent rebound, while other immunosuppressive therapies, such as methotrexate or cyclosporine, are initiated.

Keywords: Dermatitis, exfoliative; drug hypersensitivity; psoriasis; Sezary syndrome; dermatitis, atopic, 1

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