Exfoliative erythroderma

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 congestive 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

References

• Tintinalli's Emergency Medicine 7th Edition, pg 1614, 1617
• Harwood-Nuss' Clinical Practice of Emergency Medicine 6th Edition, pg 821