Erythroderma

Erythroderma is characterised by generalised erythema, scaling and exfoliation of the skin affecting at least 90% of the body surface area (Figures 16.1 and 16.2). It has many different causes (Table 16.1). The cause may not be identified in 20–30% of cases (idiopathic).

Complications occur due to skin failure and loss of skin function:

Skin infections and septicaemia (loss of skin barrier function)
Hypothermia (loss of thermoregulation)
Peripheral oedema (loss of albumin)
Tachycardia and high-output cardiac failure
Renal failure (loss of fluid and electrolytes).

Management

Identify and treat or withdraw underlying cause (e.g. drugs)
Supportive care
Prevention of complications.

The patient should be managed in a warm environment to prevent hypothermia, with regular monitoring of core body temperature, blood pressure, pulse, fluid balance and for evidence of sepsis.

Treatment:

Fluid and electrolyte replacement, nutritional support
Sedating anti-histamines for itching
Frequent topical application of emollients
Systemic antibiotics if evidence of infection
Systemic steroids (oral prednisolone) may be considered if the underlying cause is likely to be drug induced.

Erythema Multiforme

See Chapter 41.

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

This is a disease spectrum, usually drug induced and characterised by potentially life-threatening muco-cutaneous exfoliation (Table 16.2; Figures 16.3–16.5). Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are defined by the affected body surface area (<10% = SJS, 10–30% = SJS–TEN overlap, >30% = TEN).

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