Erythroderma
Clinical presentation
General symptoms and signs
Some features are common to all patients with erythroderma, no matter what the cause. It is twice as common in men and mainly affects the middle-aged and elderly. The condition often develops suddenly, particularly when associated with leukaemia or an eczema. A patchy erythema may rapidly spread to be universal within 12–48 h and be accompanied by pyrexia, malaise and shivering. Scaling appears 2–6 days later and, at this stage, the skin is hot, red, dry and obviously thickened. The patient experiences irritation and tightness of the skin and feels cold. The exfoliation of scales may be copious and continuous. Scalp and body hair is lost when erythroderma has been present for some weeks. The nails become thickened and may be shed. Pigmentary changes occur and, in those with a dark skin, hypopigmentation is seen. The picture is influenced by the patient’s general condition and the underlying cause. The commonest causes of erythroderma are eczema, psoriasis and lymphoma (Table 1). Other dermatoses, including drug eruptions and pityriasis rubra pilaris, may also be implicated. Multiple skin biopsies may help in diagnosis.
Table 1 Causes of erythroderma and their relative frequencies
| Cause | Frequency (%) |
|---|---|
| Eczema (contact/atopic/seborrhoeic/unclassified) | 40 |
| Psoriasis | 25 |
| Lymphoma/leukaemia/Sézary syndrome | 15 |
| Drug eruption | 10 |
| Pityriasis rubra pilaris/ichthyosiform erythroderma | 1 |
| Other skin disease | 1 |
| Unknown | 8 |
