Erythroderma

Etiologies

• Inflammatory dermatoses
  • Psoriasis (60%), particularly after withdrawal of systemic medications
  • Atopic dermatitis (5%)
  • Pityriasis rubra pilaris (<5%)
  • Polymorphic light eruption (<5%)
  • Dermatitis other than atopic
  • Lichen planus
  • Chronic actinic dermatitis
  • Papuloerythroderma of Ofuji
  • Sarcoidosis
• Adverse drug reaction (15-20%)
  • ACE inhibitor, particularly enalapril and lisinopril
  • Allopurinol
  • Bevacizumab
  • Carbamazepine
  • Chlorpromazine
  • Dapsone
  • Erythropoietin
  • Gold salts
  • Hydroxychloroquine
  • Imatinib
  • Isoniazid
  • Penicillin
  • Phenobarbital
  • Phenytoin
  • Piroxicam
  • Proton pump inhibitor
  • Retinoids, including acitretin and isotretinoin
  • Streptomycin
  • Sulfasalazine
  • Terbinafine
  • Thalidomide
  • Co-trimoxazole
  • Vancomycin
• Malignancy
  • Hematologic
    • Cutaneous T-cell lymphoma, including Sézary syndrome and mycosis fungoides (10-15%)
    • Other lymphoma
    • Leukemia
  • Solid organ
    • Renal cell carcinoma
    • Hepatocellular carcinoma
    • Lung cancer
    • Colon cancer
• Immunobullous disease
  • Bullous pemphigoid (<5%)
  • Pemphigus foliaceus
  • Pemphigus vulgaris
  • Paraneoplastic pemphigus
• Connective tissue diseases
  • Dermatomyositis
  • Subactue lupus erythematosus
• Infections
  • Scabies
  • Dermatophytosis
  • Congenital cutaneous candidiasis
  • Staphylococcus scalded skin syndrome
  • Streptococcal erythroderma syndrome
• Blood disorders
  • Hypereosinophilic syndrome
  • Mastocytosis
  • Graft-versus-host disease
• Idiopathic

Clinical Manifestations

• Onset can be rapid after drug exposures, or more gradual when secondary to skin disorders
  • May be associated with withdrawal of medications in psoriasis
• Generalized erythema (affecting at least 90% of body surface area) and pruritus (almost universal, can be severe)
  • Occasionally there are islands of normal skin
• May be painful as well
• Can have scaling a few days after onset
• May be associated with fever (in half), malaise, fatigue, pitting edema, lymphadenopathy