Eczema Complications series – Erythroderma

This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Erythroderma and its Causes

Erythroderma refers to generalized redness of skin due to skin inflammation. It is a complication associated with severe eczema, psoriasis and other skin inflammatory diseases. It can also be caused by drug reaction or even without a known cause (idiopathic erythroderma). Other possible causes are:

• Other forms of dermatitis, apart from eczema, such as contact dermatitis, stasis dermatitis (skin inflammation from blood pooling in leg veins, common for women above 50) and seborrheic dermatitis
• Staphylococcal scalded skin syndrome, with fever, skin tenderness and irritability (staph bacteria infection causing blisters, aka scalded skin appearance, affecting kids below age 5)
• Pityriasis rubra pilaris, appears as reddish-orange scaling patches, more common in adults
• Pemphigus vulgaris and bullous pemphigiod, which refers to autoimmune blistering skin disease
• Lymphoma of the cutaneous T-cells, also known as Sezary syndrome
• Leukemia
• Malignant rectum, lung, colon and fallopian tubes
• Graft vs Host disease
• HIV infection and other immune-deficiency conditions

The common drugs causing erythroderma in children are sulfonamides, antimalarials, penicillins, isoniazid, thioacetazone, streptomycin, nonsteroidal anti-inflammatory drugs (NSAIDS), topical tar, homeopathic and ayurvedic medicines. For general population, drugs such as allopurinol, arsenicals, aspirin, carbamazepine, captopril, gold, hydantoins, mercurials, penicillin, phenothiazines, phenylbutazone, quinacrine, sulfonamides, homeopathic and ayurvedic medication as well.

Symptoms of Erythroderma

The onset of erythroderma can be sudden and spread quickly. Apart from skin redness, it is often seen with:

1. Skin exfoliation, also known as exfoliative dermatitis where about 90% of skin peel off in scales or layers
2. Swelling (oedema)
3. Oozing skin
4. Itch
5. Thickening of palms or soles or nails (even shedding nails)
6. Erythroderma of the scalp may result in hair loss
7. Erythoroderma of the eyelid may result in ectropian, which is rolling outwards of the inner eyelid (may also have conjunctivitis)
8. Measle-like eruptions if due to drug reaction

Treatment of Erythroderma

The underlying cause has to be treated, with the following general treatment steps:

• Wet wrap for skin moisture retention, with moisturizer and mild steroids
• Maintain hydration, fluid and electrolyte balance
• Antihistamines for itch
• Stop unnecessary medication, in case erythroderma is drug-induced

Bacterial skin infection commonly accompanies erythroderma, and therefore antibiotics may be prescribed. Where fluids have to be given intravenously, hospitalization is required.

Complications of Erythroderma

Most important to watch out in erythroderma is compensating for the loss of skin’s ability to temperature control and maintain fluids. Complications include:

• Pigment changes in skin to brown and white patch
• Secondary infection with the oozing and crust
• Swollen lymph nodes
• Dehydration, from fluid loss through skin from higher metabolism
• Heart failure from increased heart rate (usually in elderly)
• Hypothermia, from abnormal temperature regulation, thus hydration and temperature control are important
• Malnutrition, from protein loss and higher metabolism (to compensate for heat loss)

As I researched on erythroderma, I felt really sad for those suffering with it. As to why some people with inflammatory skin condition have an onset of erythroderma, it is not clear. I do hope though that keeping the underlying skin condition under control will forever keep erythroderma at bay. Anyone has experience with this?

Other parts of this series:

Eye and Eyelid Complications

Folliculitis

Molluscum Contagiosm