Exfoliative erythroderma

Background

Also known as exfoliative dermatitis
Diffuse, widespread scaly dermatitis that covers most of body surface
Cutaneous reaction to a drug or chemical agent or underlying systemic or cutaneous disease
Males affected twice as often as females
Most patients >40 years old

Erythroderma

Generalized erythema, warmth, scaling
Can be pruritic and painful
Abrupt onset if related to drug, contact allergen, or malignancy; gradual onset if related to underlying cutaneous disorder
Generally starts on face and trunk with progression to other skin surfaces
Low-grade fever common
Tends to be a chronic condition, mean duration 5 years

CBC, CMP, ESR
CXR
Determine underlying cause, including evaluation for underlying malignancy and biopsy of skin

Charateristic	DRESS	SJS/TEN	AGEP	Erythroderma
Image
Onset of eruption	2-6 weeks	1-3 weeks	48 hours	1-3 weeks
Duration of eruption (weeks)	Several	1-3	<1	Several
Fever	+++	+++	+++	+++
Mucocutaneous features	Facial edema, morbilliform eruption, pustules, exfoliative dermattiis, tense bullae, possible target lesions	Bullae, atypical target lesions, mucocutaneous erosions	Facial edema, pustules, tense bullae, possible target lesions, possibl emucosal involvement	Erythematous plaques and edema affecting >90% of total skin surface with or without diffuse exfoliation
Lymph node enlargement	+++	-	+	+
Neutrophils	Elevated	Decreased	Very elevated	Elevated
Eosinophils	Very elevated	No change	Elevated	Elevated
Atypical lymphocytes	+	-	-	+
Hepatitis	+++	++	++	-
Other organ involvement	Interstitial nephritis, pneumonitis, myocarditis, and thydoiditis	Tubular nephritis and tracheobronical necrosis	Possible	Possible
Histological pattern of skin	Perivascular lymphocytcic infiltrate	Epidermal necrosis	Subcorneal pustules	Nonspecific, unless reflecting Sezary syndrome or other lymphoma
Lymph node histology	Lymphoid hyperplasia	-	-	No, unless reflecting Sezary syndrome or other malignancy
Mortality (%)	10	5-35	5	5-15

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