Exfoliative erythroderma: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 7: | Line 7: | ||
==Clinical Features== | ==Clinical Features== | ||
*Generalized erythema, warmth, scaling | *Generalized [[rash|erythema, warmth, scaling]] | ||
*Can be pruritic and painful | *Can be [[pruritus|pruritic]] and painful | ||
*Abrupt onset if related to drug, contact allergen, or malignancy; gradual onset if related to underlying cutaneous disorder | *Abrupt onset if related to drug, contact allergen, or malignancy; gradual onset if related to underlying cutaneous disorder | ||
*Generally starts on face and trunk with progression to other skin surfaces | *Generally starts on face and trunk with progression to other skin surfaces | ||
*Low-grade [[fever]] common | *Low-grade [[fever]] common | ||
*Tends to be a chronic condition, mean duration 5 years | *Tends to be a chronic condition, mean duration 5 years | ||
==Complications== | |||
*[[Hypothermia]] | |||
*fluid/electrolyte/protein loss | |||
*Invasion of bacteria and opportunistic organisms through the skin | |||
*[[High-output heart failure]] due to vasodilatation | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 19: | Line 25: | ||
*[[Toxic shock syndrome]] | *[[Toxic shock syndrome]] | ||
*[[Staphylococcal scalded skin syndrome]] | *[[Staphylococcal scalded skin syndrome]] | ||
*Drug eruption | *[[Drug eruption]] | ||
*[[DRESS syndrome]] | *[[DRESS syndrome]] | ||
| Line 29: | Line 35: | ||
==Management== | ==Management== | ||
*Emergent dermatology consult | *Emergent dermatology consult | ||
*Fluid replacement for hypovolemia, monitor fluid intake | *[[Fluid replacement]] for [[hypovolemia]], monitor fluid intake | ||
*Warming measures for hypothermia | *Warming measures for [[hypothermia]] | ||
*Wound care | *Wound care | ||
*Discontinue all unnecessary medications | *Discontinue all unnecessary medications | ||
*Systemic corticosteroids after dermatology consult | *Systemic [[corticosteroids]] after dermatology consult | ||
*Antibiotics if evidence of secondary infection | *[[Antibiotics]] if evidence of secondary infection | ||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==See Also== | ==See Also== | ||
Revision as of 22:31, 27 September 2019
Background
- Also known as exfoliative dermatitis
- Diffuse, widespread scaly dermatitis that covers most of body surface
- Cutaneous reaction to a drug or chemical agent or underlying systemic or cutaneous disease
- Males affected twice as often as females
- Most patients >40 years old
Clinical Features
- Generalized erythema, warmth, scaling
- Can be pruritic and painful
- Abrupt onset if related to drug, contact allergen, or malignancy; gradual onset if related to underlying cutaneous disorder
- Generally starts on face and trunk with progression to other skin surfaces
- Low-grade fever common
- Tends to be a chronic condition, mean duration 5 years
Complications
- Hypothermia
- fluid/electrolyte/protein loss
- Invasion of bacteria and opportunistic organisms through the skin
- High-output heart failure due to vasodilatation
Differential Diagnosis
- Erythema multiforme
- Stevens-Johnson syndrome and toxic epidermal necrolysis
- Toxic shock syndrome
- Staphylococcal scalded skin syndrome
- Drug eruption
- DRESS syndrome
Evaluation
- CBC, CMP, ESR
- CXR
- Determine underlying cause, including evaluation for underlying malignancy and biopsy of skin
Management
- Emergent dermatology consult
- Fluid replacement for hypovolemia, monitor fluid intake
- Warming measures for hypothermia
- Wound care
- Discontinue all unnecessary medications
- Systemic corticosteroids after dermatology consult
- Antibiotics if evidence of secondary infection
Disposition
- Admit
See Also
External Links
References
- Tintinalli's Emergency Medicine 7th Edition, pg 1614, 1617
- Harwood-Nuss' Clinical Practice of Emergency Medicine 6th Edition, pg 821