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Debabrata Bandyopadhyay,  Associate Professor & Head,  Dept. of Dermatology,
 R G Kar Medical College, Calcutta, INDIA

Erythroderma or exfoliative dermatitis (ED) is a syndrome characterized by generalized inflammatory erythema with scaling. ED may result from a variety of causes, most commonly from extension of pre-existing skin disorders. It may also occur due to drug reactions or as a response to systemic diseases, notably internal malignancies. In a number of cases, the cause remains unknown. The clinical picture is same irrespective of the underlying cause and may be accompanied by a number of metabolic consequences.

ED may result from a variety of causes:

Skin Diseases Systemic Disorders Drugs




Atopic dermatitis

Hodgkin's lymphoma


Seborrhoeic dermatitis

Non-Hodgkin's lymphoma


Stasis dermatitis

Mycosis fungoides


Contact dermatitis

Sezary syndrome


Pityriasis rubra pilaris



Pemphigus foliaceus

Carcinoma of lung and colon


Norwegian scabies

HIV infection



Graft versus host disease


Lichen planus



Reiter's syndrome








Retinoids  and many other drugs

In a significant proportion of cases, no underlying cause can be found.
The primary pathophysiologic events resulting from these causes that subsequently lead to the clinical picture of generalized scaling and erythema remain undetermined. but it is probably a consequence of liberation of and interactions among the many cytokines and cellular adhesion molecules occurring in the skin. An increase in the rate of epidermal turnover occurs and the transit time of cells through the epidermis is shortened. This leads to  profuse scaling. The resultant loss of large amount  of proteins in the scales has adverse metabolic consequences.  

  • Erythroderma is more commonly found in older age groups. More males are affected than females.
  • The condition usually develops slowly, but may be of acute onset.
  • Erythema is usually the initial manifestation, followed by scaling, which becomes generalized. Scales may be fine or there may desquamation in large sheets.
  • 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.
  • There may be thick crusts on the scalp.
  • Palmoplantar thickening may develop.
  • Varying degrees of alopecia and nail dystrophy are common.
  • There is usually no clinical difference between the cases caused by underlying diseases and those which are idiopathic, but in some cases evidence of the underlying pathology like psoriasis may still be identified.
  • Lymphadenopathy occurs in majority of the cases, even in those cases without any evidence of lymphoid malignancy.

  • Hepatomegaly and splenomegaly in some cases

  • Raised body temperature due to abnormality in temperature control.

  • Tachycardia  

  • Hyperkinetic circulation, cardiac failure may occur.

  • Raised basal metabolic rate

  • Gynecomastia , its cause or significance is not known.

  • Anemia and eosinophilia  

  • Elevated IgE

  • Hypoalbuminemia and edema

  • Serum electrolyte abnormalities due to  dehydration resulting from  increased transepidermal water loss.
Biopsy is often non-contributory, showing non-specific features. Idiopathic and drug-induced cases commonly shows features of a subacute dermatitis with hyperkeratosis with parakeratosis, acanthosis and spongiosis. The primary pathologic processes like lymphoma or leukemia may be discernable, thus helping in the diagnosis. Repeated biopsies may be necessary to establish the underlying cause..
  • Depends on the underlying cause.
  • Withdrawal of drugs in drug-induced cases.
  • Specific treatments of underlying pathologies like like lymphoma or other malignancies.
  • Emollients
  • Maintenance of fluid balance.
  • Good, nutritious, protein-rich diet.
  • Antihistamines for pruritus
  • Judicious use of topical steroids.
  • PUVA therapy in cases caused by psoriasis or mycosis fungoides.
  • Methotrexate in psoriatic cases.
  • Systemic steroids when conservative therapy is ineffective ( not in cases caused by psoriasis) .
  • Prognosis of ED depends on the underlying disease process.
  • Drug-induced cases resolves after drug withdrawal and appropriate therapy.
  • Prognosis of cases resulting from underlying systemic disorders like lymphomas will depend on the success of treatment of those conditions.
  • ED caused by dermatoses will eventually clear with treatment, but may recur.
  • Idiopathic cases are unpredictable.They may persist for a long time often with waxing and waning of the condition.
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