QuestionSBA
QuestionChoice
Around 30% of cases of erythroderma are idiopathic. Most cases of erythroderma are associated with a pre-existing skin condition
32319
b
Idiopathic
QuestionChoice
The rash is highly suggestive of erythroderma. Erythroderma is a dermatological emergency where there is widespread erythema affecting >90% of the skin surface. The increased urea level suggests dehydration, an important complication of erythroderma, and highlights the importance of the skin's function in fluid balance.

The most common cause of erythroderma is a pre-existing skin condition such as eczema or psoriasis
32318
a
Pre-existing skin condition
QuestionChoice
Sezary syndrome is a type of cutaneous T-cell lymphoma and is a rare cause of erythroderma
32321
d
Sezary syndrome
QuestionChoice
Haematological malignancies can cause erythroderma; however, the lack of systemic symptoms, largely normal blood tests and absence of lymphadenopathy would go against this
32322
e
Haematological malignancy
QuestionChoice
Drug reactions can cause erythroderma; however, this is less likely than a pre-existing skin condition preceding erythroderma.
32320
c
Drug-reaction
QuestionComment
nah
6386
User
subscriber
Amnesia Haemophilus
QuestionComment
dean's list student question lmao
8613
User
subscriber
Yellow Zebras
QuestionComment
Could just say she has a history of eczema. How are you supposed to deduce anything from such a short stem?
9946
User
subscriber
Myotonia Bladder
QuestionComment
there's literally nothing in the stem to suggest pre-existing skin condition but apparently that's the reason why drug-reaction is wrong
25829
QuestionComment
I dont think that's the reason. I think it's simply much more commonly caused by pre-existing skin conditions. Since there was nothing to point you towards any particular cause, the most likely one is the most common one
43009
User
subscriber
Ale
User
subscriber
Kinase Power
Concept
Chapter
# Summary

Erythroderma, a serious dermatological emergency, is characterised by widespread erythema affecting over 90% of the skin surface. Its primary signs and symptoms include significant skin redness and potential systemic symptoms due to heat and fluid loss. A broad range of conditions, such as dermatitis and psoriasis, or external triggers like drug allergies, can provoke erythroderma. Investigations mainly involve skin biopsy and blood tests. Management primarily focuses on supportive care, including fluid replacement and emollients, alongside treatment of the underlying cause, usually under the guidance of a dermatology specialist.

# Definition

Erythroderma, also referred to as exfoliative dermatitis, is a severe and potentially life-threatening dermatological condition where there is widespread erythema covering more than 90% of the body's skin surface. This condition can lead to significant heat and fluid loss, which can further induce systemic symptoms, including hypothermia.

# Aetiology

The most common cause of erythroderma is the exacerbation of a pre-existing skin condition. These include:

- Dermatitis: Atopic dermatitis, seborrhoeic dermatitis, contact dermatitis
- Psoriasis
- Pityriasis rubra pilaris

Other causative factors include:

- Drug allergies
- Idiopathic triggers
- Sezary syndrome, a type of cutaneous T-cell lymphoma, which leads to erythroderma, lymphadenopathy, and hepatosplenomegaly. It is defined by the presence of Sezary cells, which are atypical T cells, in the peripheral blood circulation.

# Signs and Symptoms

[lightgallery]

The main sign of erythroderma is extensive redness (erythema) affecting over 90% of the skin surface. Other associated symptoms can include:

- Skin scaling or shedding
- Pruritus (itching)
- Fever and chills due to systemic involvement
- Swelling of the limbs (edema)
- Increase in heart rate (tachycardia)

# Differential Diagnosis

When assessing a patient with suspected erythroderma, other conditions that could cause similar symptoms need to be considered:

- Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: Symptoms include skin rash, fever, lymphadenopathy, and involvement of internal organs.
- Toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS): Key signs are extensive skin detachment, mucosal involvement, and systemic symptoms.
- Staphylococcal scalded skin syndrome (SSSS): Characterised by extensive skin blistering and sloughing, often accompanied by systemic symptoms.

# Investigations

Although the mainstay of diagnosis is clinical observation, further investigations may include:

- Full blood count (FBC), C-Reactive Protein (CRP) and other blood tests to assess systemic involvement and rule out infection.
- Skin biopsy to confirm diagnosis and identify underlying cause.
- Other tests depending on the suspected underlying cause, such as allergy testing or immunophenotyping for Sezary syndrome.

# Management

* The management of erythroderma should involve supportive care, including referral/admission under dermatology, fluid replacement to prevent dehydration and the use of emollients to soothe the skin
* Additionally, the underlying disease causing the erythroderma should be identified and treated, for instance, by administering steroids for an exacerbation of atopic dermatitis
* Hospitalisation may be necessary for severe cases due to the risk of life-threatening complications

# References
[Erythroderma - DermNet NZ](https://dermnetnz.org/topics/erythroderma)

857
Picture
An example of erythroderma seen in a female patient.
912
Erythroderma.jpeg
images/ae10zr0s1665036171716.jpg
images/ae10zr0s1665036171716_256.jpg
images/ae10zr0s1665036171716_512.jpg
HTgGDYTp03rvVWhMh2eZehkHgSJA
904
Erythroderma
Topic
4
Dermatology
Video
Concept
904
Erythroderma
39
hs5ThRX
images/videos/dermatology.png
Atopic dermatitis 1
Video
Concept
904
Erythroderma
311
m1dDZby
images/videos/dermatology.png
Quesmed Tutorial: Dermatology
6464
A pre-existing skin condition, such as psoriasis, atopic dermatitis, or seborrheic dermatitis, is a risk factor for erythroderma
A 32-year-old woman presents with a three-day history of a worsening rash across her body.

On examination, there is an erythematous rash covering the majority of the patient's skin, both anteriorly and posteriorly. The skin is hot to touch, and there is associated scaling. Systemic examination is otherwise normal.

Blood tests reveal increased urea to creatinine ratio but no other significant findings.

Which of the following is the most likely cause of the rash described?
a