EpistemisExfoliative erythroderma
Specialty: Skin.
Why it occurs
- Severe exacerbation of previous psoriasis vulgaris due to abrupt suspension of systemic corticosteroids
- Severe late-type adverse drug reaction (pharmacodermia due to allopurinol, carbamazepine or vancomycin)
- Cutaneous T-cell lymphoma or Sézary syndrome
- Refractory and chronically infected adult atopic dermatitis
- Pityriasis rubra pilaris in its classic adult form (characterized by islands of spared healthy skin and orange keratoderma).
Initial workup
Requires mandatory hospitalization in an intermediate care or burn unit. Urgent blood analysis with complete blood count, serial electrolytes (monitoring hyperkalemia), albumin, total proteins, urea, serum creatinine, and peripheral blood smear. Multiple skin biopsies from different anatomical regions and cultures of skin secretions for MRSA screening.
red flags
Clinical evidence of severe hypothermia refractory to thermal blankets, severe oliguria or anuria indicating prerenal acute renal failure due to massive insensible losses, hemodynamic shock (hypotension with reflex tachycardia), or signs of secondary bacterial sepsis due to total disruption of the skin barrier (positive blood cultures).
Standard management
- Intravenous hydroelectrolyte fluid replacement guided by strict balance of inputs and outputs
- Unscented neutral emollient creams mixed with solid Vaseline applied liberally over the entire body every 3-4 hours
- Cyclosporine — rapid-acting systemic immunosuppressant indicated to control severe psoriatic or atopic forms of erythroderma, dose of 3 to 5 mg/kg/day intravenously or orally
- Intravenous cloxacillin or vancomycin (if there is confirmation of generalized bacterial superinfection or well-founded clinical suspicion of bacteremia).
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