Erythroderma: a dermatologic emergency

Abstract

Erythroderma is a potentially fatal dermatologic emergency that is often mistaken for infection. Indeed, the fact that it is difficult to diagnosis is the main contributor to its significant mortality rate, as treatment is readily available. We present a case of a 36-year-old man who was incorrectly diagnosed and treated for 2 months. We review the etiologies, initial work-up and management of this disease. In our case, the patient was ill, had lost 11.3 kg and developed systemic inflammatory response syndrome. Without proper treatment he was at risk of developing full-blown sepsis. Although there are many causes of erythroderma, prompt initial treatment directed at the underlying etiology typically results in a rapid remission. RÉSUMÉL'érythrodermie constitue une urgence dermatologique potentiellement fatale qui peut souvent être confondue avec une infection. De fait, on attribue principalement l'important taux de mortalité associé à la maladie au fait qu'elle est difficile à diagnostiquer, alors qu'en soi, elle se traite facilement. Nous présentons ici le cas d'un homme de 36 ans qui a reçu un traitement inadéquat pendant deux mois pour un diagnostic erroné. Nous passons en revue les étiologies, les analyses et la prise en charge initiales de cette maladie. Dans ce cas-ci, le patient était mal en point, il avait perdu 11,3 kg et présentait un syndrome de réponse inflammatoire systémique. Faute de traitement approprié, il se trouvait exposé à un risque de sepsis avéré. Bien qu'il y ait de nombreuses causes de l'érythrodermie, un traitement initial instauré sans délai et selon l'étiologie sous-jacente procure généralement une rémission rapide.(e.g., cutaneous T-cell lymphoma and paraneoplastic phenomena), pre-existing dermatoses (e.g., atopic dermatitis, psoriasis, seborrheic dermatitis and pityriasis rubra pilaris), drug reactions, bullous disorders and allergic contact dermatitis. In up to 25% of cases, no underlying cause is found, and so it is termed idiopathic erythroderma. 1Erythroderma accounts for 1% of all dermatologic admissions to hospital and is more commonly seen in male patients. The importance of this disease is highlighted by the consequences of losing the cutaneous barrier: those affected are prone to lose heat, water, protein and electrolytes, and they are more susceptible to cutaneous infections.2 The disease can be mistaken as an infectious process and treated as such. The purpose of this case report is to highlight the pertinent clinical findings of erythroderma and its differentiation from infectious or malignant etiologies. CASE REPORTA 36-year-old man presented to our emergency department (ED). His chief complaint was a generalized pruritic rash ongoing for approximately 2 months. He also complained of concomitant fevers, night sweats and generalized malaise. Over the course of the previous 2 months he had seen his general practitioner and been to a walk-in clinic. Both times, he was given diphenhydramine hydrochloride and a topical corticosteroid without much relief. Ten days bef...

Breast Cancer Presenting as Paraneoplastic Erythroderma: An Extremely Rare Case

“…The patient's skin was bright red, dry, scaly, and warm to the touch, while she reported itching and skin tightness. Laboratory and histological findings, although nonspecific, were in line with those of erythroderma, such as mild anemia, leukocytosis with eosinophilia, high levels of CRP, and hypoalbuminemia [6, 18]. Skin biopsy findings were compatible with the usual histological ones of acute erythroderma (spongiosis parakeratosis, hyperkeratosis, acanthosis, and chronic perivascular inflammatory infiltrates).…”

Management of atopic dermatitis in the inpatient setting

“…It can cause shivering due to loss of temperature regulation, malaise, fatigue, and pruritus. Erythroderma can lead to multiple metabolic and physiologic complications including fluid and electrolyte imbalances, high-output cardiac failure, acute respiratory distress syndrome, and secondary infections, and should be considered a dermatological emergency [64,65]. Close temperature and vital sign monitoring is necessary along with hydration to maintain normal volume status.…”

“…Close temperature and vital sign monitoring is necessary along with hydration to maintain normal volume status. Laboratory monitoring of electrolytes should be performed, and electrolyte abnormalities corrected immediately [65].…”

Diagnosis dan Tata Laksana Eritroderma

“…Penanganan awal adalah dengan memperbaiki kondisi umum akibat ketidakseimbangan cairan, elektrolit, hipotermia, serta gangguan hemodinamik. 11,13 Tindakan perawatan kulit dapat dengan pelembap untuk mengurangi evaporasi akibat vasodilatasi dan pemberian steroid topikal potensi rendah (misalnya hydrocortisone 1%) untuk kenyamanan pasien. 13 Kulit eritroderma telah kehilangan fungsi proteksinya, sehingga pemberian antibiotik sistemik dapat dipertimbangkan jika terdapat infeksi sekunder atau sepsis.…”