|Other names||Exfoliative dermatitis, Dermatitis exfoliativa|
|Red skin syndrome|
In ICD-10, a distinction is made between "exfoliative dermatitis" at L26, and "erythroderma" at L53.9.
Erythroderma is generalized exfoliative dermatitis, which involves 90% or more of the patient's skin. The most common cause of erythroderma is exacerbation of an underlying skin disease, such as psoriasis, contact dermatitis, seborrheic dermatitis, lichen planus, pityriasis rubra pilaris or a drug reaction, such as the use of topical steroids. Primary erythroderma is less frequent and is usually seen in cases of cutaneous T-cell lymphoma, in particular in Sézary's disease.
The most common causes of exfoliative dermatitis are best remembered by the mnemonic device ID-SCALP. The causes and their frequencies are as follows:
- Idiopathic - 30%
- Drug allergy - 28%
- Seborrheic dermatitis - 2%
- Contact dermatitis - 3%
- Atopic dermatitis - 10%
- Lymphoma and leukemia - 14%
- Psoriasis - 8%
The primary cause has to be treated, or the exacerbation may persist and relapse. Topical steroids are the primary category of medications used to treat exfoliative dermatitis. A sedative antihistamine may be a useful adjunct for pruritic patients, since it helps patients to sleep at night, thus limiting nocturnal scratching and excoriations. Antimicrobial agents often are used if an infection is suspected to be precipitating or complicating exfoliative dermatitis. Other drugs specifically indicated for management of underlying cause of exfoliative dermatitis may be necessary.
The incidence of erythroderma is estimated to be 1-2 in 100,000. While erythroderma can occur at any age, it is most common in older, male adults.
The classification of exfoliative dermatitis into Wilson-Brocq (chronic relapsing), Hebra or pityriasis rubra (progressive), and Savill (self-limited) types may have had historical value, but it currently lacks pathophysiologic or clinical utility.
- Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. p. 436. ISBN 0-07-138076-0.
- James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. p. 125. ISBN 0-7216-2921-0.
- Erythroderma (Generalized Exfoliative Dermatitis) at eMedicine
- Fukaya, Mototsugu (2000). Withdrawal from corticosteroids in patients with atopic dermatitis. www.tclinic.jp. Archived from the original on December 23, 2014.CS1 maint: unfit url (link)
- Sigurdsson, V (November 2001). "The incidence of erythroderma: a survey among all dermatologists in The Netherlands". Journal of the American Academy of Dermatology. 45 (5): 675–678. doi:10.1067/mjd.2001.116224. PMID 11606915.