Erythroderma (Generalized Exfoliative Dermatitis) Clinical Presentation

Updated: Oct 15, 2020
  • Author: Sanusi H Umar, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

History is the most important aid in diagnosing exfoliative dermatitis (ED). [43] Patients may have a history of the primary disease (eg, psoriasis, atopic dermatitis). Elicit a comprehensive drug history, including over-the-counter drugs.

Disease usually evolves rapidly when it results from drug allergens, lymphoma, leukemia, or staphylococcal scalded skin syndrome. Disease evolution is more gradual when it results from psoriasis, atopic dermatitis, or the spread of primary disease.

Pruritus is a prominent and frequent symptom. Malaise, fever, and chills may occur.

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Physical Examination

Patients often present with generalized erythema. Scaling appears 2-6 days after the onset of erythema, usually starting from flexural areas. Pruritus commonly results in excoriations. When exfoliative dermatitis (ED) persists for weeks, hair may shed; nails may become ridged and thickened and also may shed. Periorbital skin may be inflamed and edematous, resulting in ectropion (with consequent epiphora).

In chronic cases, pigmentary disturbances can occur (especially in darker-skinned races); patchy or widespread loss of pigment (resembling vitiligo) has been reported.

Diligent search for residual signs of underlying disease occasionally yields dividends. Residual signs may include the following:

  • Islands of sparing in pityriasis rubra pilaris
  • Few typical psoriatic plaques in psoriasis
  • Eyelid lesion may be a presenting symptom of mycosis fungoides, a cause of exfoliative dermatitis [44]
  • Papules or oral lesions of lichen planus
  • Superficial blisters of pemphigus foliaceus
  • Erythematous papular lesions of an early drug eruption

Dermatopathic lymphadenopathy can occur in exfoliative dermatitis not caused by lymphoma or leukemia. A lymph node biopsy is advised when lymph nodes exhibit lymphomatous characteristics (eg, large size, rubbery consistency) and the cause of exfoliative dermatitis is undetermined.

The general picture is modified according to the nature of the underlying disease and the patient's general physical condition.

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Complications

Complications in exfoliative dermatitis (ED) depend on underlying disease. Secondary infection, dehydration, electrolyte imbalance, temperature dysregulation, and high-output cardiac failure are potential complications in all cases.

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