Erythroderma (generalised exfoliative dermatitis)
What it is and why it matters
Erythroderma is a rare, potentially life‑threatening inflammatory condition of the skin characterised by confluent erythema and scaling that involves most of the body surface area (classically ≥ 90%).
Loss of normal skin function produces major systemic consequences - fluid and protein loss, impaired thermoregulation, electrolyte disturbance and increased risk of secondary infection and sepsis. Most patients require hospital admission and early dermatology review (NICE CG153; RCEM curriculum).
Pathophysiology - mechanisms of harm
Widespread inflammation and exfoliation disrupt the skin’s roles in barrier protection, fluid/electrolyte conservation, thermoregulation and immunity. Consequences include:
- Large evaporative fluid and protein losses leading to hypovolaemia and hypoalbuminaemia.
- Thermoregulatory failure causing hypothermia and altered metabolic demand.
- Electrolyte and acid-base disturbances with increased arrhythmia risk.
- Loss of barrier function permitting secondary bacterial invasion and bloodstream infection.
- Increased cardiac workload from high‑output states or fluid shifts, which may precipitate heart failure.
Common causes to consider in the ED
Erythroderma is a final common pathway for many disorders. Key differentials and precipitants to prioritise are:
- Exacerbation of pre‑existing dermatoses: erythrodermic psoriasis (important and may follow withdrawal of topical or systemic therapy) and severe atopic dermatitis (NICE CG153).