Erythroderma (exfoliative dermatitis). Part 2: energy homeostasis and dietetic management strategies

Abstract

Erythroderma (exfoliative dermatitis) is associated with important metabolic changes that include an enhancement in energy expenditure. The key components to total energy expenditure (TEE) include basal metabolic rate (~68% of TEE), physical activity (~22% of TEE) and thermic effect of food (~10% of TEE). In the erythrodermic state, there are likely multiple contributors to the increase in basal metabolic rate, such as 'caloric drain' resulting from increased evaporation of water from enhanced transepidermal water loss, increased activity of the cardiovascular system (including high-output cardiac failure), increased nonshivering thermogenesis and hormonal changes such as hypercortisolaemia. A change in the patient's level of physical activity and appetite as a result of ill health status may further impact on their TEE and energy consumption. In Part 2 of this two-part concise review, we explore the key constituents of energy homeostasis and the potential mechanisms influencing energy homeostasis in erythroderma, and suggest much-needed dietetic management strategies for this important condition.

Ichthyosis with superimposed mycosis fungoides, a rare case of generalized erythema with malaise

“…[ 15 16 ] Above all, due to its systemic complications, including thermoregulatory disturbance, electrolyte imbalance, dehydration, high output heart failure, hypoalbuminemia, and septicemia, it is a potentially life-threatening situation . [ 17 18 19 ] Thus, we performed several surveys, including a skin biopsy to find out the culprit underlying cause , and finally, the diagnosis of ichthyosis with superimposed mycosis fungoides was established.…”

Actualización y perlas clínicas del abordaje diagnóstico y terapéutico de la eritrodermia en adultos

“…La tasa metabólica basal aumenta para compensar la pérdida de calor, y la pérdida de fluidos por transpiración se ve incrementada (3,6). La tasa mitótica aumentada y un periodo de tránsito disminuido de células epidérmicas a través de las capas de piel resultan en una descamación que puede alcanzar 20-30 g/día, con una pérdida significativa de proteínas, aminoácidos y ácidos nucleicos a través de la piel, siendo estas pérdidas superiores en la psoriasis eritrodérmica (6,9).…”

Clinical phenotypes of adult atopic dermatitis and related therapies

“…Lichenoid pattern is more frequent in black skin patients [5 & ]. Differential diagnoses include psoriasis, drug reaction, seborrheic dermatitis, Sezary syndrome, (ACD), pityriasis rubra pilaris, irritant contact dermatitis [25,26].…”

“…Erythroderma is defined as the presence of erythema affecting more than 90% of the body surface area [25,26]. It can be associated with impairment of hydro-electrolytic imbalance that can led to the exitus severely debilitated patients [25,26]. It is more frequent in persistent atopic dermatitis and in patients with preexisting generalized eczema [24].…”

“…It is more frequent in persistent atopic dermatitis and in patients with preexisting generalized eczema [24]. Atopic dermatitis is an uncommon cause of erythroderma, other causes being psoriasis, drug reaction, seborrheic dermatitis, cutaneous lymphoma, (ACD), or pityriasis rubra pilaris [25,26].…”