EpistemisErythroderma
Specialty: Skin.
Why it occurs
- Exacerbation of previous dermatoses (psoriasis vulgaris, atopic dermatitis, seborrheic dermatitis)
- Serious adverse reactions to medications (pharmacodermias induced by allopurinol, anticonvulsants, sulfas or penicillins)
- Cutaneous T-cell lymphoma or Sézary syndrome (hematological neoplasm with cutaneous trophism)
- Idiopathic or erythroderma of unexplained cause ("red blanket" syndrome of the elderly)
- Systemic generalized infections or crusted scabies (Norwegian scabies).
Initial workup
Immediate hospitalization. Daily analytical monitoring: complete blood count, serum electrolytes, total proteins and albumin (protein loss due to massive desquamation), creatinine, urea nitrogen, skin cultures and blood cultures if sepsis is suspected. Multiple skin biopsies from different anatomical sites and peripheral blood smears to search for Sézary cells.
red flags
Severe hemodynamic instability (arterial hypotension and tachycardia secondary to massive vasodilation), uncontrolled hypothermia or hyperthermia, intense chills, signs of high-output congestive heart failure (dyspnea, pulmonary edema, engorged jugular veins), or oliguria evidence of prerenal acute renal failure due to loss of transcutaneous fluids.
Standard management
- Meticulous intravenous fluid and electrolyte replacement
- Inert emollients such as liquid Vaseline applied widely every 4 hours to reduce transepidermal loss
- Sedating H1 antihistamines such as diphenhydramine — dose of 25-50 mg IV or PO every 6 to 8 hours to control severe pruritus
- Ciclosporin (rapid-acting systemic immunosuppressant indicated if the cause is psoriasis or severe atopic dermatitis, doses of 3 to 5 mg/kg/day under close monitoring of blood pressure and renal function).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4