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Drug Eruptions and Erythroderma

  • Yuri T. Jadotte
  • Robert A. Schwartz
  • Chante Karimkhani
  • Lindsay N. Boyers
  • Shivani S. Patel

Abstract

Erythroderma, also known as generalized exfoliative dermatitis, manifests as widespread scaling and erythema of most of the body’s cutaneous surface. Other than an apparent predilection for males, the disease occurs no more or less commonly in any other specific subsets of the population. Its etiology is highly variable, although the most common cause is a drug eruption, flare of a pre-existing dermatologic condition or lymphoma or other cancer. It may occur secondary to systemic use or topical application of the medication. Other causes may include infections, particularly in immunocompromised patients, excessive exposure to solar radiation while taking photosensitive drugs, and malignancy. Erythroderma is potentially life threatening, due to the severe associated hemodynamic and metabolic complications. The diagnosis of this disease is made clinically. Histological findings tend to be non-specific. Treatment of hemodynamic instability should be given precedence to reduce mortality, followed by rapid identification of the underlying cause of disease, as this relates directly to the prognosis of the condition as well as the likelihood of resolution from cessation of the offending agent or treatment of the underlying disease.

Keywords

Erythroderma Exfoliative dermatitis Generalized erythroderma Drug eruptions Erythema Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome 

Suggested Reading

  1. Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythroderma: a clinical study of 97 cases. BMC Dermatol. 2005;5(1):5.PubMedCentralCrossRefPubMedGoogle Scholar
  2. Botella-Estrada R, Sanmartin O, Oliver V, Febrer I, Aliaga A. Erythroderma: a clinicopathological study of 56 cases. Arch Dermatol. 1994;130(12):1503–7.CrossRefPubMedGoogle Scholar
  3. Grant-Kels JM, Bernstein M, Rothe MJ. Exfoliative dermatitis. In: Wolff K, Goldsmith S, Gilchrest B, Paller A, Leffell D, editors. Fitzpatricks dermatology in general medicine. New York: McGraw Hill; 2008. p. 1068–87.Google Scholar
  4. Hasan T, Jansén CT. Erythroderma: a follow-up of fifty cases. J Am Acad Dermatol. 1983;8(6):836–40.CrossRefPubMedGoogle Scholar
  5. Hengee UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54:1–16.Google Scholar
  6. Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part I. Clinical perspectives. J Am Acad Dermatol. 2013;68:693–705.Google Scholar
  7. Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part II. Management and therapeutics. J Am Acad Dermatol. 68:709–717.Google Scholar
  8. Janniger CK, Gascón P, Schwartz RA, Hennessey PN, Lambert WC. Erythroderma as the initial presentation of the acquired immunodeficiency syndrome. Dermatologica (Basel) 1991;183:143–5.Google Scholar
  9. King Jr LE, Dufresne Jr RG, Lovett GL, Rosin MA. Erythroderma: review of 82 cases. South Med J. 1986;79(10):1210–5.CrossRefPubMedGoogle Scholar
  10. Krasowska D, Szymanek M, Schwartz RA, Myśliński W. Cutaneous effects of the most commonly used antidepressant medication, the selective serotonin reuptake inhibitors. J Am Acad Dermatol. 2007;65(6):848–53.CrossRefGoogle Scholar
  11. Okoduwa C, Lambert W, Schwartz R, Kubeyinje E, Eitokpah A, Sinha S, et al. Erythroderma: review of a potentially life-threatening dermatosis. Indian J Dermatol. 2009;54(1):1–6.PubMedCentralCrossRefPubMedGoogle Scholar
  12. Pal S, Haroon TS. Erythroderma: a clinico‐etiologic study of 90 cases. Int J Dermatol. 1998;37(2):104–7.CrossRefPubMedGoogle Scholar
  13. Rothe MJ, Bialy TL, Grant-Kels JM. Erythroderma. Dermatol Clin. 2000;18(3):405–15.CrossRefPubMedGoogle Scholar
  14. Rubins A, Hartmane I, Lielbriedis Y, Schwartz R. Therapeutic options for erythroderma. Cutis. 1992;49(6):424–6.PubMedGoogle Scholar
  15. Rym BM, Mourad M, Bechir Z, Dalenda E, Faika C, Iadh AM, et al. Erythroderma in adults: a report of 80 cases. Int J Dermatol. 2005;44(9):731–5.CrossRefPubMedGoogle Scholar
  16. Schwartz RA, Leevy CM, Cohen PJ, Lambert WC. Erythroderma and fulminant hepatitis: a possible association. Cutis 1986;37:56–8.Google Scholar
  17. Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: part I. Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. J Am Acad Dermatol. 2013;69:173–84.Google Scholar
  18. Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: part II. Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. J Am Acad Dermatol. 201369: 187-202;69:187–202.Google Scholar
  19. Sehgal V, Srivastava G. Exfoliative dermatitis: a prospective study of 80 patients. Dermatologica. 1986;173(6):278–84.CrossRefPubMedGoogle Scholar
  20. Sehgal VN, Srivastava G, Sardana K. Erythroderma/exfoliative dermatitis: a synopsis. Int J Dermatol. 2004;43(1):39–47.CrossRefPubMedGoogle Scholar
  21. Sigurdsson V, Steegmans PH, van Vloten WA. The incidence of erythroderma: a survey among all dermatologists in the Netherlands. J Am Acad Dermatol. 2001;45(5):675–8.CrossRefPubMedGoogle Scholar
  22. Sigurdsson V, Toonstra J, Hezemans-Boer M, van Vloten WA. Erythroderma: a clinical and follow-up study of 102 patients, with special emphasis on survival. J Am Acad Dermatol. 1996;35(1):53–7.CrossRefPubMedGoogle Scholar
  23. Sigurdsson V, Toonstra J, van Vloten W. Idiopathic erythroderma: a follow-up study of 28 patients. Dermatology. 1997;194(2):98–101.CrossRefPubMedGoogle Scholar
  24. Thestrup-Pedersen K, Halkier-Sørensen L, Søgaard H, Zachariae H. The red man syndrome: exfoliative dermatitis of unknown etiology: a description and follow-up of 38 patients. J Am Acad Dermatol. 1988;18(6):1307–12.CrossRefPubMedGoogle Scholar
  25. Wilson DC, Jester JD, King Jr LE. Erythroderma and exfoliative dermatitis. Clin Dermatol. 1993;11(1):67–72.CrossRefPubMedGoogle Scholar
  26. Wilson HT. Exfoliative dermatitis: its etiology and prognosis. AMA Arch Derm Syphilol. 1954;69(5):577–88.CrossRefPubMedGoogle Scholar
  27. Zip C, Murray S, Walsh NM. The specificity of histopathology in erythroderma. J Cutan Pathol. 1993;20(5):393–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Yuri T. Jadotte
    • 1
  • Robert A. Schwartz
    • 2
  • Chante Karimkhani
    • 3
  • Lindsay N. Boyers
    • 4
  • Shivani S. Patel
    • 5
  1. 1.Division of Nursing Science and Department of Quantitative Methods, Epidemiology and BiostatisticsRutgers University School of Nursing and Rutgers University School of Public HealthNewarkUSA
  2. 2.Dermatology, Pediatrics, Medicine, and Preventive Medicine and Community HealthRutgers University New Jersey Medical School and Rutgers University School of Public Affairs and AdministrationNewarkUSA
  3. 3.Columbia University College of Physicians and SurgeonsNew YorkUSA
  4. 4.Georgetown University School of MedicineWashington, DCUSA
  5. 5.Medical University of South CarolinaCharlestonUSA

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