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

Differential Diagnosis

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

Complications

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