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ERYTHRODERMA (EXFOLIATIVE) DERMATITIS/ECZEMA

Erythroderma is an abnormal reddening, flaking and thickening of the skin affecting the entire or a wide area of the body. More common after the age of fifty, it affects men 3 times more often than women. It may result from a pre-existing skin disease such as eczema or psoriasis or may even be caused by a reaction to drugs or a systemic (lymph) infection.

It is an acute and life-threatening skin disease, particularly, in the elderly and very young. The increased skin perfusion (leaking of fluid through tissue/cell walls) can cause hypothermia. In extreme cases the rapid and increased blood flow away from the heart to the skin can result in “high-output” cardiac failure. Death can sometimes result if treatment is not prompt and vigorous.

The disease has a sudden onset and its lesions either present as:-

Exfoliative Dermatitis – manifests as generalised diffuse reddening of the skin accompanied by swelling and fluid loss, especially prominent in skin folds and joint flexures. It is usually complicated by mucosal lesions such as conjunctivitis, sever inflammation of the eyelids, swollen, cracked and bright red lips, inflammation of the mucous lining of the mouth, stomatitis and severe swelling and weeping of the vulva, urethra and anus. Scaling and exfoliation of the skin is usually severe and continuous.

Erythrodermic – manifests as diffuse reddening and “blood” infiltration (filling) of skin cells. The skin is mildly scaly but there is severe pruritus (itching). It is common for bloody scratch marks, bloody crusts and “strips” to be present, caused by constant and vigorous scratching. Secondary infections are common. Heat and transdermal loss of fluid and protein is possible and if this occurs the situation is extremely serious.

IN BOTH CONDITIONS THERE MAY BE:

• Varying degrees of enlargement of the lymph nodes.  
• As many as one third to two thirds of patients also experience enlargement of the liver and/or spleen, especially in cases of allergic drug reactions.
• Some degree of hair loss is likely (both scalp and body)
• Long term atrophy (shrinkage), opaqueness (discolouration), pitting, ridging & deformity of the nails may occur.
• Cardiac failure, hypothermia and respiratory infections are serious complications that could occur.

The condition requires immediate hospitalization.

The inflammation of the skin should be treated in the first instance and the underlying trigger identified and eliminated or treated. If the trigger was not initially apparent (e.g. Hair dye application or drug induced allergic reaction it is possible that the condition may have been caused by a systemic infection.

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