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About Erythroderma - Exfoliative Dermatitis - Red man syndrome

Erythroderma or exfoliative dermatitis (ED) is a syndrome characterized by generalized inflammatory erythema (reddening of the skin due to inflammation) with scaling. It is a condition with thickening and flaking skin.

Erythroderma usually occurs in persons older than 40 years and more males are affected than females. It usually develops slowly, but may be serious. Patients often complain of their skin feeling 'tight' as well as itchy.

Causes of Erythroderma

ED may result from a variety of causes:

• most commonly from extension of pre-existing skin disorders like eczema, psoriasis, hodgkin's disease, leukemia.
• due to drug reactions or as a response to systemic diseases, notably internal malignancies.

Symptoms of Erythroderma

• Red skin patches
• Skin thickening, peeling, flaking
• Patients usually complains of a feeling of chilliness as well as varying degrees of itching which may be intolerable
• Oozing and secondary infection may develop

Long-standing erythroderma is often associated with hair loss, ectropion of the eyelids and even nail shedding.

Management & Treatment of Erythroderma

It depends on the underlying cause. As the patients of erythroderma require the monitoring of their total body functions (including intake and output), they often require admission.

The key is to maintain skin moisture, avoid scratching, avoid precipitating factors, apply topical steroids, and treat the underlying cause and complications.

All unessential drugs & medications should be stopped. Carefully monitor and control fluid intake and maintain proper fluid balance.

Systemic steroids may be helpful in some cases (not in the case of psoriasis).

Topical steroids are the primary category of medications used to treat erythroderma. A sedative antihistamine may be a useful adjunct for itchy patients, since it helps patients to sleep at night, thus limiting nocturnal scratching and excoriations. Antimicrobial agents often are used if an infection is suspected to be precipitating or complicating erythroderma. Other drugs specifically indicated for management of underlying etiology of erythroderma may be necessary.

Also, ensure adequate nutrition with emphasis on protein intake, since erythroderma patients lose a lot of protein through excessive desquamation and show a tendency toward hypoalbuminemia.