Exfoliative erythroderma

(Redirected from Erythroderma)


  • Also known as exfoliative dermatitis
  • Diffuse, widespread scaly dermatitis that covers most of body surface
  • Cutaneous reaction to a drug or chemical agent or underlying systemic or cutaneous disease
  • Males affected twice as often as females
  • Most patients >40 years old

Clinical Features

  • Generalized erythema, warmth, scaling
  • Can be pruritic and painful
  • Abrupt onset if related to drug, contact allergen, or malignancy; gradual onset if related to underlying cutaneous disorder
  • Generally starts on face and trunk with progression to other skin surfaces
  • Low-grade fever common
  • Tends to be a chronic condition, mean duration 5 years

Differential Diagnosis

Erythematous rash



  • CXR
  • Determine underlying cause, including evaluation for underlying malignancy and biopsy of skin


Table of Severe Drug Rashes

Charateristic DRESS SJS/TEN AGEP Erythroderma
Image PMC3894017 JFMPC-2-83-g001.png Stevens-johnson-syndrome.jpg Acute generalized exanthematous pustulosis.png Red (burning) Skin Syndrome - Feet Collage.jpg
Onset of eruption 2-6 weeks 1-3 weeks 48 hours 1-3 weeks
Duration of eruption (weeks) Several 1-3 <1 Several
Fever +++ +++ +++ +++
Mucocutaneous features Facial edema, morbilliform eruption, pustules, exfoliative dermattiis, tense bullae, possible target lesions Bullae, atypical target lesions, mucocutaneous erosions Facial edema, pustules, tense bullae, possible target lesions, possibl emucosal involvement Erythematous plaques and edema affecting >90% of total skin surface with or without diffuse exfoliation
Lymph node enlargement +++ - + +
Neutrophils Elevated Decreased Very elevated Elevated
Eosinophils Very elevated No change Elevated Elevated
Atypical lymphocytes + - - +
Hepatitis +++ ++ ++ -
Other organ involvement Interstitial nephritis, pneumonitis, myocarditis, and thydoiditis Tubular nephritis and tracheobronical necrosis Possible Possible
Histological pattern of skin Perivascular lymphocytcic infiltrate Epidermal necrosis Subcorneal pustules Nonspecific, unless reflecting Sezary syndrome or other lymphoma
Lymph node histology Lymphoid hyperplasia - - No, unless reflecting Sezary syndrome or other malignancy
Mortality (%) 10 5-35 5 5-15



  • Admit


See Also

External Links


  • Tintinalli's Emergency Medicine 7th Edition, pg 1614, 1617
  • Harwood-Nuss' Clinical Practice of Emergency Medicine 6th Edition, pg 821