Dermatologic Emergencies

dermatology-emergencieskapak-1-0-25

Exfoliative Erythroderma

Ramiz YAZICI
University of Health Sciences Faculty of Medicine, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Department of Emergency Medicine, İstanbul, Türkiye

Yazıcı R. Exfoliative erythroderma. In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.31-5.

ABSTRACT

Exfoliative erythroderma, more commonly known as erythroderma, is a serious disease char- acterized by erythema and squamous erythema involving more than 90% of the total skin integrity as a result of different etiologies, which can cause life-threatening complications and is associated with increased mortality and morbidity. In adults, various systemic and cutaneous diseases, infections, malignancies and medi- cations are responsible, while in the pediatric population, congenital immunodeficiencies and hereditary diseases are added to these causes. Despite extensive research, the cause of up to 30% of cases cannot be de- termined and is classified as idypathic erythroderma. Underlying causes include cutaneous diseases such as seborrheic dermatitis and contact dermatitis, often psoriasis, drug reactions, malignancies such as cutaneous T-cell lymphoma, immunobullous diseases, connective tissue diseases and infections. The diagnosis is made clinically by the appearance of erythema and squamma covering more than 90% of the body. The basic ap- proach to treatment consists of discontinuation of all potentially risky medications, adequate hydration and nu- trition, replacement of essential electrolytes, wound care for compromised skin integrity and antibiotics for infection. Targeted therapy is important in cases where there is an underlying cause of erythroderma.

Keywords: Exfoliative dermatitis; erythroderma; erythema; squamous; dermatitis

Referanslar

  1. Harper-Kirksey K. Erythroderma. In: Rose E, eds. life-Threatening Rashes. Springer, Cham; 2018. p.265-77. [Crossref]  [PMC]
  2. Khaled A, Sellami A, Fazaa B, Kharfi M, Zeglaoui F, Kamoun MR. Acquired erythroderma in adults: a clinical and prognostic study. J Eur Acad Dermatol Venereol. 2010;24(7):781-8. [Crossref]  [PubMed]
  3. Usatine Rp, Smith MA, Chumley HS, Mayeaux EJ Jr. Chapter 156. Erythroderma. The Color Atlas of Family Medicine. 2nd ed. New York: McGraw-Hill; 2013. p.622-45 [Link]
  4. Sigurdsson V, Steegmans pH, van Vloten WA. The incidence of erythroderma: a survey among all dermatologists in The Netherlands. J Am Acad Dermatol 2001;45(5):675-8. [Crossref]  [PubMed]
  5. Sarkar R, Garg VK. Erythroderma in children. Indian J Dermatol Venereol leprol. 2010;76(4):341-7. [Crossref]  [PubMed]
  6. Sarkar R, Basu S, Sharma RC. Neonatal and infantile erythrodermas. Arch Dermatol. 2001;137(6):822-3. [Link]
  7. Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythroderma: a clinical study of 97 cases. BMC Dermatol. 2005;5(5). [Crossref]  [PubMed]  [PMC]
  8. Pal S, Haroon TS. Erythroderma: a clinico-etiologic study of 90 cases. Int J Dermatol. 1998;37(2):104-7. [Crossref]  [PubMed]
  9. Rym BM, Mourad M, Bechir Z, Dalenda E, Faika C, Iadh AM, et al. Erythroderma in adults: a report of 80 cases. Int J Dermatol. 2005;44(9):731-5. [Crossref]  [PubMed]
  10. Li J, Zheng HY. Erythroderma: a clinical and prognostic study. Dermatology. 2012;225(2):154-62. [Crossref]  [PubMed]
  11. Sigurdsson V, Toonstra J, Hezemans-Boer M, van Vloten WA. Erythroderma. A clinical and follow-up study of 102 patients, with special emphasis on survival. J Am Acad Dermatol. 1996;35(1):53-7. [Crossref]  [PubMed]
  12. Fraitag S, Bodemer C. Neonatal erythroderma. Curr Opin pediatr. 2010;22(4):438-44. [Crossref]  [PubMed]
  13. Rothe MJ, Bernstein Ml, Grant-Kels JM. life-threatening erythroderma: diagnosing and treating the "red man". Clin Dermatol. 2005;23(2):206-17. [Crossref]  [PubMed]
  14. Sheen YS, Chu CY, Wang SH, Tsai TF. Dapsone hypersensitivity syndrome in non-leprosy patients: a retrospective study of its incidence in a tertiary referral center in Taiwan. J Dermatolog Treat. 2009;20(6):340-3. [Crossref]  [PubMed]
  15. Thestrup-pedersen K, Halkier-Sørensen l, Søgaard H, Zachariae H. The red man syndrome. Exfoliative dermatitis of unknown etiology: a description and follow-up of 38 patients. J Am Acad Dermatol. 1988;18(6):1307-12. [Crossref]  [PubMed]
  16. Grant-Kels JM, Fedeles F, Rothe MJ. part 2 Chapter 23.Exfoliative dermatitis. In: Goldsmith lA, Katz SI, Gilchrest BA, paller AS, leffell DJ, Wolff K, eds. Fitzpatrick's dermatology in general medicine. 8th ed. New York: McGraw Hill Medical; 2012. [Link]
  17. Sigurdsson V, Toonstra J, van Vloten WA. Idiopathic erythroderma: a followup study of 28 patients. Dermatology. 1997;194(2):98-101. [Crossref]  [PubMed]
  18. Groen D, poole DS, Gooris GS, Bouwstra JA. Is an orthorhombic lateral packing and a proper lamellar organization important for the skin barrier function? Biochim Biophys Acta. 2011;1808(6):1529-37. [Crossref]  [PubMed]
  19. pilgram GS, Vissers DC, van der Meulen H, Koerten HK, pavel S, van der lavrijsen S, et al. Aberrant lipid organization in stratum corneum of patients with atopic dermatitis and lamellar ichthyosis. J Invest Dermatol. 2001;117(3):710-7. [Crossref]  [PubMed]
  20. Singh RK, lee KM, Ucmak D, Brodsky M, Atanelov Z, Farahnik B, et al. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. psoriasis (Auckl). 2016;6:93-104. [Crossref]  [PubMed]  [PMC]
  21. Gandhi NA, pirozzi G, Graham NMH. Commonality of the Il-4/Il-13 pathway in atopic diseases. Expert Rev Clin Immunol. 2017;13(5):425-37. [Crossref]  [PubMed]
  22. Sehgal VN, Srivastava G, Sardana K. Erythroderma/exfoliative dermatitis: a synopsis. Int J Dermatol. 2004;43(1):39-47. [Crossref]  [PubMed]
  23. Davis . Erythroderma in adults [Internet]. Uptodate; 2024 [Erişim tarihi: 30 August 2024]. Erişim adresi: [Link]
  24. Kim YH, Bishop K, Varghese A, Hoppe RT. prognostic factors in erythrodermic mycosis fungoides and the Sezary syndrome. Arch Dermatol. 1995;131(9):1003-8. [Crossref]  [PubMed]
  25. Sterry W, Steinhoff M. Erythroderma. In: Bolognia Jl, Jorizzo Jl, Schaffer JV, eds. Dermatology. 3rd ed. philadelphia: Elsevier Saunders; 2012. p.171-81. [Link]
  26. Bi MY, Curry Jl, Christiano AM, et al. The spectrum of hair loss in patients with mycosis fungoides and Sézary syndrome. J Am Acad Dermatol. 2011;64(1):53-63. [Crossref]  [PubMed]
  27. Klein A, landthaler M, Karrer S. pityriasis rubra pilaris: a review of diagnosis and treatment. Am J Clin Dermatol. 2010;11:157-70. [Crossref]  [PubMed]
  28. Mistry N, Gupta A, Alva A, Sibbald G. A Review of the Diagnosis and Management of Erythroderma (Generalized Red Skin). Advances in Skin & Wound Care. 2015;28(5):228-36. [Crossref]  [PubMed]
  29. Kanthraj GR, Srinivas CR, Devi pU, Ganasoundari A, Shenoi SD, Deshmukh Rp, et al. Quantitative estimation and recommendations for supplementation of protein lost through scaling in exfoliative dermatitis. Int J Dermatol. 1999;38(2):91-5. [Crossref]  [PubMed]
  30. Green MS, prystowsky JH, Cohen SR, Johen JI, lebwohl MG. Infectious complications of erythrodermic psoriasis. J Am Acad Dermatol. 1996;34(Issue 5 part 2):911-4. [Crossref]  [PubMed]
  31. Jaffe D, May lp, Sanchez M, Moy J. Staphylococcal sepsis in HIV antibody seropositive psoriasis patients. J Am Acad Dermatol. 1991;24(6 part 1):970-2. [Crossref]  [PubMed]
  32. Bruno TF, Grewal p. Erythroderma: a dermatologic emergency. CJEM. 2009;11(3):244-6. [Crossref]  [PubMed]
  33. Rosenbach M, Hsu S, Korman NJ, lebwohl MG, Young M, Bebo BF Jr, et al. Treatment of erythrodermic psoriasis: from the medical board of the National psoriasis Foundation. J Am Acad Dermatol. 2010;62(4):655-62. [Crossref]  [PubMed]
  34. Viguier M, pagès C, Aubin F, Delaporte E, Descamps V, lok C, et al. Efficacy and safety of biologics in erythrodermic psoriasis: a multicentre, retrospective study. Br J Dermatol. 2012;167(1):417-23. [Crossref]  [PubMed]
  35. Paller AS, Silverberg JI, Cork MJ, Guttman-Yassky E, lockshin B, Irvine AD, et al. Efficacy and Safety of Dupilumab in patients With Erythrodermic Atopic Dermatitis: A post Hoc Analysis of 6 Randomized Clinical Trials. JAMA Dermatol. 2023;159(3):255-66. [Crossref]  [PubMed]  [PMC]