1. Chris Pearce
Dermatology Presentation

2. Aims
To cover:
1. Definition
2.Clinical Presentation
3. Pathology
4.Causative conditions
5.Complications
6.Management
7.Prognosis

3. Definition
Erythroderma , which is also
known as Generalised
Exfoliative Dermatitis:
“An inflammatory dermatosis
which involves 90% or more of
the skin surface.”
(Gawkrodger, 2004)

4. Clinical Presentation
Four key points:
1. Patchy erythema becomes universal over 24-48
hours, accompanied by malaise, shivering and
pyrexia.
2. Scaling appears 2-6 day later, when the skin is hot,
dry, red and thickened.
3. Skin feels tight and itchy, and patients feel cold.
4. Scalp and body hair is eventually lost, whilst nails
become thickened or shed.

5. Pathology
Acute changes – Dermal/epidermal oedema and
inflammatory infiltrate.
Chronic changes – Lengthened rete ridges and
thickened epidermis.
Cytokines implicated: IL-1, IL-2, IL-8, ICAM-1, TNFα
and IFN-γ (Wilson et al, 1993)
Typical changes of underlying lesion.

6. Causes

7. Eczema
All types of
ezcema can
become
erythrodermic,
but this is more
common in the
elderly
(Rothe et al, 2005)

8. Psoriasis
Steroid withdrawal can
precipitate erythrodermic
psoriasis.
Progression can lead to
generalised pustular psoriasis.
(Kassay et al, 2001)
(Gawkrodger, 2004)

9. Malignancy:
Sezary Syndrome
(Rothe et al, 2005)(Harrison & Duvic 2004)

10. Drug reaction
Drug reactions of the
toxic erythema or
mobillform type can
become
erythrodermic
Carbemazepine,
phenytoin, diltiazem,
cimetidine, gold,
allopurinol and
sulphonamides are
common causes.
(Gawkrodger, 2004)

11. Complications
Oedema
Lymphadenopathy
Minor
Major
Cardiac failure
Metabolic disturbance
Hypothermia
Cutaneous or respiratory infection

12. Management

13. Prognosis
Sigurdsson et al (1996) found a mortality rate of 43%
in 102 patients with erythroderma , although only 18%
of these deaths occurred as a direct result of the
patient’s erythroderma.
Drug induced disease carries a much better
prognosis than that caused by malignancy. Chronic
conditions like eczema and psoriasis could lead to a
relapsing remitting course.

14. Conclusion
A secondary process occurring as a result of ezcema,
psoriasis and lymphoma.
Of sudden onset, exfoliative, erythematous and
oedematous.
Serious complications can arise, which can be life
threatening.
Management involves close inpatient monitoring and
initially topical steroids.

15. References
Gawkrodger, D.J. (2004) Dermatology – An illustrated colour text. 3rd
Ed. Churchill Livingstone
Harrison, A.L. & Duvic, M. (2004) Diagnosis and Treatment of Sézary
Syndrome: The Internet Journal of Dermatology, (5)2.
Kassay, E., Saringer, A., Torok, E. & Szalai, Z. (2001) Infantile
Psoriasis: A short clinical study. Acta Dermatovenerologica 10(2).
Rothe, M.J., Bernstein, M.L. & Grant-Kels, J.M. (2005) Life
Threatening Erythroderma: Diagnosing and treating the “red man.”
Clinics in Dermatology 23, 206-217.
Sigurdsson, V., Toonstra, J., Hezemans-Boer, M. & van Vloten,
W.A. (1996) Erythroderma. A clinical and follow-up study of 102
patients, with special emphasis on survival. Journal of the American
Academy of Dermatology 35(1), 53-7.