Erythroderma is the name given to redness of the skin that occurs all over the body. It is a collective name for various skin diseases.
What is erythroderma?
Doctors speak of erythroderma when the skin is red all over the body. In this case, there is an inflammation of the skin, which is accompanied by the dilation of the vessels. As a result, there is a loss of protein, salts and fluid. In the worst case, secondary infections may even endanger life. Erythroderma is not an independent disease. Rather, it is a symptom that is triggered by various diseases. Thus, erythroderma is considered a collective term for several dermatoses (skin diseases). Another typical feature of erythroderma is scaling of the skin. If the symptoms appear only on certain parts of the body, it is called suberythroderma, which is classified as a special form. In women, erythroderma occurs twice as often as in the male sex. The average age of onset is between 50 and 60 years.
Causes
Erythroderma represents a manifestation of accelerated epidermal cell turnover. The cause has not yet been determined. Usually, erythroderma presents together with an underlying disease of the skin. This may be seborrheic dermatitis, contact dermatitis, atopic eczema, pityriasis rubra pilaris or psoriasis. However, the use of certain medications also sometimes causes erythroderma. These drugs include sulfonamides, penicillin, barbiturates, phenytoin or isoniazid. Other triggers include malinomas as in leukemia (blood cancer), adenocarcinomas or mycosis fungoides. However, about 25 percent of all patients do not suffer from an underlying disease. In medicine, erythroderma is divided into two forms: These are primary erythroderma and secondary erythroderma.
- The primary form presents without a previous disease and gives a response to an acute process. It occurs in Sézary syndrome, mycosis fungoides, drug exanthema, or senile erythroderma in men, among others.
- Secondary erythroderma forms from a skin disease that is previously known. It is more common than the primary form and occurs in psoriasis or atopic eczema. Psoriasis has a share of erythroderma of circa 25 percent.
Symptoms, complaints and signs
As a rule, the symptoms of erythroderma occur on the entire body of the affected person. In this case, there is a reddening of the skin on the whole body. Furthermore, the affected persons also suffer from chills and fever in the process. In addition, the affected persons suffer from itching as well as a general feeling of illness, so that the patients also appear tired and listless and thus do not participate in everyday life. The erythema is initially diffuse and appears in the form of patches. In the further course, the redness of the skin extends to almost the entire body. The redness also has a negative effect on the regulation of the body temperature, so that the affected persons often sweat or freeze. Patients often have to dress warmly. Likewise, erythroderma can lead to deficiency symptoms or to various nutrient losses if the redness persists. Because there is also extensive peeling of the epidermis, this has a negative effect on the regulation of body temperature. For this reason, patients show increased sensitivity to cold due to a loss of heat caused by the dilation of the blood vessels. Thus, affected individuals often dress warmly because they are cold. Other problems include a lack of nutrients caused by a marked loss of protein and an increase in metabolic rate with a hypercatabolic status. Transdermal loss of fluid also reveals hypovolemia, in which the amount of blood within the circulation is reduced. Due to extensive peripheral vasodilation, there is also a risk of heart failure. In extreme cases, life may be in danger. The symptoms of erythroderma can also have a negative effect on the psychological state of the affected person, so that some patients also suffer from depression or other psychological upsets.
Diagnosis
To diagnose erythroderma, the attending physician first looks at the patient’s medical history. He then performs a physical examination. If there is a recognizable skin disease in addition to the typical symptoms, a causal relationship can be established. If mycosis fungoides is suspected, a tissue sample (biopsy) is taken. A blood test often reveals hypocalcemia, iron deficiency, or hypoproteinemia. In some cases, erythroderma takes a life-threatening course. For this reason, the patient usually has to go to a hospital. Thus, there is a risk of significant complications.
When should one go to the doctor?
Redness of the skin is considered unusual no matter where it occurs on the body. A doctor should be consulted as soon as they appear spontaneously or continue to spread. If the skin changes occur repeatedly over several weeks or months, they should be presented to a doctor to have the cause clarified. If further complaints set in, there is reason for concern. Open wounds can lead to the penetration of germs, which trigger additional illnesses. Itching, swelling or dry skin layers should be investigated and treated medically. If the skin redness occurs after taking medication or eating certain foods, there may be an intolerance. A doctor should be consulted to obtain clarity on the cause through an allergy test. Scaling of the skin indicates dryness of the skin layers. Relief can be achieved with an appropriate remedy. If psychological problems or changes in mood occur as a result of the changes in the skin, the affected person should seek help. Behavioral changes, a social withdrawal or feelings such as shame reduce the general well-being. If the affected person notices signs of inflammation on the skin, he should consult a doctor. If there is the formation of pus, pain or an increased body temperature, he needs medical treatment. Equally unusual and to be clarified by a doctor are insensations of the skin.
Treatment and therapy
Treatment of erythroderma depends on its extent and triggers. Because the accompanying symptoms often cause a life-threatening condition, inpatient therapy must always be given in severe cases. This applies especially to acute and severe erythroderma, because the danger to life is particularly pronounced. But even in the case of an insidiously progressing form of the disease, treatment must take place in hospital from a certain degree of severity. There, the patient receives drugs such as cortisone and sufficient fluids. It is particularly important to counteract impending dehydration (dehydration) due to the considerable loss of fluids as part of the treatment. The same applies to the loss of proteins and heat, as well as in vasodilation of the peripheral blood vessels, which stresses the heart and circulation. Drug exanthema cannot always be ruled out in erythroderma. For this reason, all medications are discontinued or switched as part of the therapy. In addition, the patient should receive only those medications that are absolutely necessary. The patient is given emollients to care for the skin. If the erythroderma is severe, glucocorticoids such as prednisone are administered. In this case, the patient takes 40 to 60 milligrams systemically for ten days initially.
Outlook and prognosis
Erythroderma can be treated very well nowadays. If the condition is detected at an early stage, drug treatment is usually sufficient to relieve symptoms and discomfort. Once it has subsided, erythroderma usually does not cause any further symptoms. If the condition is detected too late or is not adequately treated, the redness can spread to other areas of the body. Drug treatment can alleviate the symptoms, but scars and pigmentary disorders may remain. Erythroderma generally has a good prognosis. Provided appropriate treatment is given, the pathological redness of the skin subsides within a few days to weeks. The dermatologist in charge can make an exact prognosis, taking into account the course of the disease and the patient’s state of health. To achieve a long-term improvement of the skin condition, the underlying disease must be treated.Otherwise, erythroderma may recur, causing progressive deterioration of the skin condition. Life expectancy is not reduced by erythroderma. Only if severe diseases such as ichthyosis are underlying, life expectancy may be reduced, as the disease then progresses progressively.
Prevention
Preventive measures against erythroderma are not known. If the condition is triggered by certain medications, it is important to discontinue them or replace them with other preparations.
Aftercare
The patient has very limited options for aftercare in the case of erythroderma. In this case, the patient is primarily dependent on medical treatment for permanent relief of symptoms and prevention of further complications. Since erythroderma cannot heal itself, early diagnosis and treatment of this disease is very important to limit the spread of the symptoms. In most cases, the symptoms are treated with the help of medications or ointments and creams. The affected person should pay attention to the regular use and application, whereby consultation with a physician should also be made. Since erythroderma can also lead to severe dehydration, it is recommended to make sure to always drink enough water. Only in this way can the symptoms be completely alleviated. Even after successful treatment of erythroderma, the patient is dependent on regular examinations by a physician. If the symptoms recur, further treatment is necessary. The life expectancy of the patient is not reduced by the disease. In some cases, contact with other patients with the disease may be useful in this regard.
