Erythroderma - Picture, Cause, Symptoms and Treatment of Erythroderma CTCL

Erythroderma is the term used when the majority of the skin surface is erythematous (red in color). There may be associated scale, erosions, or pustules as well as shedding of the hair and nails. Potential systemic manifestations include fever, chills, hypothermia, reactive lymphadenopathy, peripheral edema, hypoalbuminemia, and high-output cardiac failure.

The major causes of erythroderma are:

(1) cutaneous diseases such as psoriasis and dermatitis;

(2) drugs;

(3) systemic diseases, most commonly CTCL; and

(4) idiopathic.

In the first three groups, the location and description of the initial lesions, prior to the development of the erythroderma, aid in the diagnosis. For example, a history of red scaly plaques on the elbows and knees would point to psoriasis. It is also important to examine the skin carefully for a migration of the erythema and associated secondary changes such as pustules or erosions. Migratory waves of erythema studded with superficial pustules are seen in pustular psoriasis.

Diagnosis of Erythroderma

Drug-induced erythroderma (exfoliative dermatitis) may begin as a morbilliform eruption or may arise as diffuse erythema. Fever and peripheral eosinophilia often accompany the eruption, and occasionally there is an associated allergic interstitial nephritis. A number of drugs can produce an erythroderma, including penicillins, sulfonamides, carbamazepine, phenytoin, gold, allopurinol, and captopril. While reactions to anticonvulsants can lead to a pseudolymphoma syndrome, reactions to allopurinol may be accompanied by hepatitis, gastrointestinal bleeding, and nephropathy.

Treatment of Erythroderma

The most common malignancy that is associated with erythroderma is CTCL; in some series, up to 25% of the cases of erythroderma were due to CTCL. The patient may progress from isolated plaques and tumors, but more commonly the erythroderma is present throughout the course of the disease (Sezary syndrome). In the Sezary syndrome, there are circulating atypical T lymphocytes, pruritus, and lymphadenopathy. In cases of erythroderma where there is no apparent cause (idiopathic), longitudinal follow-up is mandatory to monitor for the possible development of CTCL. There have been isolated case reports of erythroderma secondary to some solid tumors¾lung, liver, prostate, thyroid, and colon¾but it is usually in a late stage of the disease.

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