You are on page 1of 21

Warning: The NCBI web site requires JavaScript to function. more...

NCBI
kip to main content

kip to navigation
Resources
How To
bout NCBI Accesskeys
Sign in to NCBI

PMC
US National Library of Medicine
National Institutes of Health

Search database
Search term

PMC

Search

Limits
Advanced
Journal list
Help

Journal List
Indian J Dermatol
v.54(1); Jan-Mar 2009
PMC2800861

Indian J Dermatol. 2009 Jan-Mar; 54(1): 16.


doi: 10.4103/0019-5154.48976
PMCID: PMC2800861

ERYTHRODERMA: REVIEW OF A POTENTIALLY LIFETHREATENING DERMATOSIS


Cynthia Okoduwa, W C Lambert, R A Schwartz, E Kubeyinje, A Eitokpah, Smeeta Sinha,
and W Chen
Author information Article notes Copyright and License information
This article has been cited by other articles in PMC.
Go to:

Abstract

Erythroderma, or generalized exfoliative dermatitis, is a disease characterized by erythema


and scaling of greater than 90% of the body's surface. The resultant dysmetabolism is
potentially life threatening. A detailed history is to identify and treat the underlying cause of
this dermatitis. We present two cases of erythroderma in African patients and review this
important disease.
Keywords: Erythroderma, causes, African patients
Go to:

Introduction
Erythroderma is an intense generalized redness of the skin; it was first described by Von
Hebra in 1868. It is an inflammatory disorder characterized by an extreme state of skin
dysmetabolism that gives rise to extensive erythema and scaling all over the body. This
condition classically involves greater than 90% of the body surface. The erythrodermic state
is of great concern because it poses significant risk of morbidity and mortality, in addition to
the risks inherent to the underlying disease and its therapy.
Erythroderma can be fatal, even when properly managed, primarily because of its metabolic
burden and complications. Hence it is mandatory to establish its etiopathology in order to
facilitate precise management. This disorder may be the morphologic presentation of a
variety of cutaneous and systemic diseases, and a thorough workup is essential. A detailed
outline of the patient's history to elicit possible triggering events, including infections, drug
ingestion, topical application of medications, sun/ultraviolet exposure and other factors,
should be determined. Management of the skin disorder continues to be a challenge due to
its multiple etiologies. The prognosis of erythroderma is determined by its underlying cause.
There is a paucity of information on erythroderma in Africa. The growing increase in use of
herbal medicines,[1] the HIV epidemic,[2] hospital visits in advanced disease stages and
limited investigational resources in Third World environments all exacerbate the lifethreatening nature of this condition. With increasing use of herbal and nonherbal medicines,
more individuals are at risk of contracting erythroderma.
Go to:

Two Illustrative Cases


Case 1
A 14-year-old African girl was referred to our Benin City clinic in 2005 for generalized scaling
and erythema of 5 years duration. The pruritic patches were first noted on the face and trunk
and later involved the entire body. There was no preexisting dermatosis, nor prior medical
problems. There was no prior exposure to chemical precipitants of dermatitis. Family history
was negative for similar conditions or skin disorders. The exfoliation did not improve with
herbal medicines (Yoruba Agbo leaves). Physical examination showed extensive nonuniform erythematous scaly patches involving the scalp, face, trunk, arms, legs, palms and
soles [Figure 1]. Scalp lesions formed whitish yellow scales with hair loss. On the soles, the
exfoliative eruption led to severe sloughing of the epidermis [Figure 2]. Laboratory
investigations and biopsy results were nonspecific. The etiology could not be determined due
to limited resources in our clinic. She was treated with intravenous and topical steroids and
was lost to follow-up.

Figure 1
Fifteen-years-old girl with diffuse erythema and scaling of lower extremities

Figure 2
Sloughing of epidermis of the soles in the above patient

Case 2
A 64-year-old man presented to our Benin City clinic in 2005 with an acute eruption of
numerous erythematous plaques that had appeared 2 weeks following oral intake of an
unknown amount of Aloe vera leaves taken to enhance well-being. There was no history of
preexisting dermatologic or medical conditions. Physical examination revealed scaling
plaques with prominence on the scalp, trunk and extremities [Figure 3, Figure 4]. Laboratory
investigations were consistent with dehydration and inflammatory changes. Topical and oral
steroids achieved rapid improvement of the lesions.

Figure 3
Sixty-four-years-old man with papulosquamous plaques on the scalp, arms and trunk

Figure 4
Erythematous scaling plaques of the lower extremities
Go to:

Epidemiology

The true incidence of erythroderma is unknown. Gehgal and Srivastava[3] performed a large
prospective study in the Indian subcontinent, where they determined the incidence to be 35
per 100,000 dermatologic outpatients. Sigurdsson[4] recorded the annual incidence in the
Netherlands to be 0.9 per 100,000 inhabitants. In general, studies have shown a male
predominance, with the male-to-female ratio ranging from 2:1 to 4:1, and the mean age
between 40 and 60 years.[3] Rym et al. conducted a retrospective study of 80 erythrodermic
adults, looking at patients examined between 1981 and 2000.[5] Patient information included
clinical, laboratory, histopathological and therapeutic data. The incidence of erythroderma
from the study was 0.3%, the average age being 53.78 18 years; and the male-to-female
ratio, 2.2:1. These numbers may, however, underestimate the current statistics in Third
World environments such as those in Africa.
Go to:

Etiology
A major challenge lies in establishing the underlying cause of erythroderma. Most published
series reveal that the majority of patients are diagnosed with psoriasis, spongiotic dermatitis,
drug reactions or cutaneous T cell lymphoma (CTCL).[6,7]
A preexisting dermatosis is the single most common cause of adult erythroderma.[3,5,813]
A number of dermatoses can progress to erythroderma, but the most common include
psoriasis and eczema.[3,5,9,12] Rym et al. reported 41 of 80 erythrodermic patients had
psoriasis,[5] a finding not inconsistent with Spanish, Middle Eastern and Indian
studies.[3,9,12] Psoriatic erythroderma may occur in relation to withdrawal of systemic or
topical glucocorticoids, use of systemic medications such as lithium and antimalarials,
phototherapy burns, infection and systemic illnesses.[14]
The apparent increase in the incidence of exfoliative dermatitis may have a bearing on the
introduction of many new drugs. It is therefore important to consider all drug
exposures.[14,15] Patients presenting with morbilliform, lichenoid or urticarial drug eruptions
may develop generalized exfoliative dermatitis.[16] This association has been inferred from
descriptions of patients on antiepileptic medications, antihypertensive agents, antibiotics,
calcium channel blockers and a variety of topical preparations.[14,17] Severe exfoliative
erythrodermic dermatitis has been reported with use of proton pump inhibitors.[18] Morar[19]
identified adverse drug reactions to antituberculosis medication as the most common cause
of erythroderma in HIV-seropositive South African patients. Rym et al.[5] implicated
carbamazepine, phenobarbital, penicillin and paracetamol. The intake of herbal medicines,
being very popular, may also increase risk among Africans.
Erythroderma may be a cutaneous manifestation of malignancy. The incidence of internal
malignancy is approximately 1%.[20] Reticuloendothelial neoplasms, as well as internal
visceral/blood vessel malignancies, may manifest as erythroderma.[16,21] Laryngeal, thyroid,
lung, esophageal, gallbladder, gastric, colon, fallopian tube and prostate carcinomas and
lymphomas have all been implicated.[2229] Other associations include cutaneous T cell
lymphomas, which comprise mycosis fungoides and Szary syndrome.[20,3032] Mycosis
fungoides may progress from, accompany, or follow T cell lymphomas, and their presentation
may be similar to benign erythroderma.[16,30,33,34] The ability to distinguish malignant from
benign erythroderma may require an immunophenotypic study with the use of advanced
antibody panels.[35] Definitive diagnosis of erythroderma due to internal malignancy cannot
be made based on clinical presentation alone, but a concomitant history of insidious
development, progressive decompensation, refractoriness to standard therapeutics and
absence of prior skin pathology may be existent.[28]
Erythroderma is also associated with disorders that are not readily classified. It has been
reported in association with dermatophytosis, hepatitis, renal failure, acquired
immunodeficiency syndrome, congenital immunodeficiency syndrome (Omenn syndrome),
graft-versus-host disease, histoplasmosis, lupus, dermatomyositis, thyrotoxicosis and
sarcoidosis.[3647]

Go to:

Pathogenesis
Currently, the mechanism of erythroderma is unclear. Adhesion molecules and their ligands
play a significant role in endothelial-leukocyte interactions, which impact the binding,
transmigration and infiltration of lymphocytes and mononuclear cells during inflammation,
injury or immunological stimulation.[48] The rise in adhesion molecule expression (VCAM-1,
ICAM-1, E-selectin and P-selectin) seen in exfoliative dermatitis stimulates dermal
inflammation, which may lead to epidermal proliferation and increased production of
inflammatory mediators.[48] The complex interaction of cytokines and cellular adhesion
molecules such as interleukin-1, -2 and -8; intercellular adhesion molecule-I (ICAM-I); and
tumor necrosis factor (TNF)[49] results in significantly elevated epidermal turnover rate,
leading to above-normal mitotic rate.[50] The amount of germinative cells increases and the
transit time of keratinocytes through the epidermis decreases, causing loss of more cellular
material from the surface.[14]
Sigurdsson et al. conducted an immunohistochemical study and observed that the dermal
infiltrate in patients with Szary syndrome mainly showed a T-helper 2 (Th2) cytokine profile,
in contrast to a T-helper 1 (Th1) cytokine profile in benign reactive erythroderma, which
suggests that a relatively uniform clinical picture in erythroderma does not imply similar
pathomechanisms for various etiologies.[48,51]
Go to:

Clinical Features
The pattern observed is erythematous patches, which increase in size and coalesce to form
extensive areas of erythema, and eventually spread to involve most of the skin
surface.[50,52] Some studies have shown sparing of the nose and paranasal areas, and this
has been described as the nose sign.[53,54]
The epidermis appears thin, giving a glossy appearance to the skin. Once erythema has
been established, white or yellow scales develop that progress to give the skin a dry
appearance with a dull scarlet and gray hue.[14] Induration and thickening of the skin from
edema and lichenification may provoke a sensation of severe skin tightness in the
patient.[14] The skin is bright red, dry, scaly and warm to touch.
Some patients may experience involvement of their palms and soles, with hair loss and nail
shedding.[55] Involved nails are thick, lusterless, dry, brittle, and show ridging of the nail
plate.[50] Subungual hyperkeratosis, distal onycholysis, splinter hemorrhages occur; and
sometimes, the nails may shed.[14] Shelley[56] described alternating bands of nail plate
discontinuity and leukonychia in drug-induced erythroderma.
Sometimes, the clinical presentation may be suggestive of the underlying cause. Typical
psoriasiform plaques may be apparent in early erythrodermic psoriasis. Pityriasis rubra pilaris
shows islands of sparing, orange-colored palmoplantar keratoderma and hyperkeratotic
follicular papules on juxta-articular extensor surfaces.[14] The violaceous papules and
reticulated buccal mucosal lesions of lichen planus may be evident. Joly et al.[57] described
three African patients presenting with lichenoid erythroderma different from the classic form
of lichen planus pemphigoides. The presence of heavy crusts on the palms and soles with
subungual hyperkeratosis raises the possibility of Norwegian scabies.[14] In patients with
pemphigus foliaceus, crusted patches and erosions may appear on the face and upper trunk.
A heliotrope rash, poikiloderma, Gottron's papules, periungual telangiectases and muscle
weakness may be seen in erythrodermic dermatomyositis.[26,42] Papuloerythroderma of
Ofuji presents in elderly men as flat-topped red papules that become generalized
erythrodermic plaques without the involvement of abdominal skin folds (deck chair
sign).[5860]

Postoperative erythroderma, a type of graft-versus-host disease following surgery along with


blood transfusion, is marked by erythroderma, fever, pancytopenia, hepatic insufficiency and
diarrhea and may be fatal.[50] Exfoliative dermatitis may also develop in HIV-infected
patients with florid manifestations.[38]
The presence of lymphadenopathy and hepatosplenomegaly, particularly in association with
liver dysfunction and fever, may suggest a drug hypersensitivity syndrome or malignancy.[14]
Gynecomastia has been reported in some patients, possibly reflecting a hyperestrogenic
state, although the significance of this finding is unclear.[13]
Go to:

Laboratory Findings
Laboratory findings in the erythrodermic patient are usually nonspecific.[16] Common
abnormalities are mild anemia, leukocytosis with eosinophillia, elevated sedimentation rate,
decreased serum albumin, increased uric acid, abnormal serum protein electrophoresis with
polyelevation in the gamma globulin region and elevated IgE levels.[49,61] Eosinophilia is
generally a nonspecific finding, although a highly elevated count raises the possibility of a
lymphoma.[52] Circulating Szary cells may be present; but whereas less than 10% is
considered nonspecific in the setting of erythroderma, the presence of 20% or more raises
the suspicion for Szary syndrome.[13,62]
Go to:

Histopathology
Biopsy specimens tend to have many nonspecific features.[16] Hyperkeratosis,
parakeratosis, acanthosis and a chronic perivascular inflammatory infiltrate, with or without
eosinophils, are examples.[6] The clinicopathologic correlation is difficult because nonspecific
features of erythroderma may mask the specific features of an underlying dermatosis. Direct
immunofluorescence studies may be of diagnostic utility in cases of erythroderma secondary
to pemphigus foliaceus, bullous pemphigoid, graft-versus-host disease and connective tissue
disorders.[52]
Go to:

Management
The initial management of erythroderma is the same regardless of etiology. This should
include replacement of nutritional, fluid and electrolyte losses.[6] Local skin-care measures
should be employed, such as oatmeal baths as well as wet dressings to weeping or crusted
sites followed by the application of bland emollients and low-potency corticosteroids.[63]
Known precipitants and irritants are to be avoided; and underlying cause, with its
complications, is to be treated.[6,16,50] Secondary infections are treated with antibiotics.
Edema in dependent areas, such as in periorbital and pedal areas, may require diuretics.[63]
Hemodynamic or metabolic instability should be addressed adequately. Serum protein,
electrolyte and blood urea levels should be monitored. This condition may resist therapy until
the underlying cause is treated; hence it is important to determine underlying etiology early in
its management.[63,64] In Africa and other Third World environments, however, this may not
be possible.
Go to:

Course

The disease course is greatly influenced by etiology. It is progressive when due to drug
allergy, lymphoma, leukemia, contact allergens or staphylococcal scalded skin
syndrome.[3,6,13,50] A slower course is observed if from a primary skin disease such as
psoriasis or atopic dermatitis.[3,6,13,50] Drug-induced erythroderma patients recover
completely with prompt diagnosis and treatment.[6,50] The outcome is unpredictable in
idiopathic erythroderma, and its course is marked by multiple exacerbations; prolonged
corticosteroid use is often required.[16,50,62]
Go to:

Prognosis
Conflicting reports have been published regarding the prognosis of patients with
erythroderma in developed nations. The most common causes of death in patients with
erythroderma are pneumonia, septicemia and heart failure.[16,63] Elderly patients who
develop complications such as infection, fluid/electrolyte imbalances and cardiac failure are
at higher risk of mortality.[16,50] Initial studies record death rate in the range of 4.6% to
64%,[5,9,16,49,50,61] but this has since been reduced due to advancement in diagnosis and
therapy.[50] In Third World countries, such as parts of Africa, the former prognosis may be
more accurate.
Go to:

Footnotes
Source of Support: Nil
Conflict of Interest: Nil.
Go to:

References
1. Busia K. Medical provision in Africa. Phyother Res. 2005;19:91923. [PubMed]
2. Ferrante P, Delbue S, Mancuso R. The manifestation of AIDS in Africa: An epidemiological
overview. J Neurovirol. 2005;11:507. [PubMed]
3. Sehgal VN, Srivastava G. Exfoliative dermatitis: A prospective study of 80 patients.
Dermatologica. 1986;173:27884. [PubMed]
4. Sigurdsson V, Steegmans PH, van Vloten WA. The incidence of erythroderma: A survey
among all dermatologists in The Netherlands. J Am Acad Dermatol. 2001;45:6758.
[PubMed]
5. 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;44:7315. [PubMed]
6. Rothe MJ, Bialy TL, Grant-Kels JM. Erythroderma. Dermatol Clin. 2000;18:40515.
[PubMed]
7. Balasubramaniam P, Berth-Jones J. Erythroderma:90% skin failure. Hosp Med.
2004;65:1002. [PubMed]
8. Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythroderma: A clinical study of 97
cases. BMC Dermatol. 2005;5:5. [PMC free article] [PubMed]
9. Botella-Estrada R, Sanmartin O, Oliver V, Febrer I, Aliaga A. Erythroderma: A
clinicopathological study of 56 cases. Arch Dermatol. 1994;130:15037. [PubMed]
10. Hasan T, Jansen CT. Erythroderma: A follow-up of fifty cases. J Am Acad Dermatol.
1983;8:83640. [PubMed]
11. Leenutaphong V, Kulthanan K, Pohboon C, Suthipinittharn P, Sivayathorn A,
Sunthonpalin P. Erythroderma in Thai patients. J Med Assoc Thailand. 1999;82:7438.
[PubMed]
12. Pal S, Haroon TS. Erythroderma: A clinico-etiologic study of 90 cases. Int J Dermatol.
1998;37:1047. [PubMed]

13. 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;35:537. [PubMed]
14. Rubins AY, Hartmane IV, Lielbriedis YM, Schwartz RA. Therapeutic options for
erythroderma. Cutis. 1992;49:4246. [PubMed]
15. Breathnach SM. Management of drug eruptions: Part II, Diagnosis and treatment.
Australas J Dermatol. 1995;36:18791. [PubMed]
16. Karakayli G, Beckham G, Orengo I, Rosen T. Exfoliative dermatitis. Am Fam Physician.
1999;59:62530. [PubMed]
17. Guin JD, Phillips D. Erythroderma from systemic contact dermatitis: A complication of
systemic gentamicin in a patient with contact allergy to neomycin. Cutis. 1989;43:5647.
[PubMed]
18. Cockayne S, Gawkrodger D, McDonagh A. Severe erythrodermic reactions to the proton
pump inhibitors omperazole and lansoprazole. Br J Dermatol. 1999;141:1734. [PubMed]
19. Morar N, Dlova N, Gupta AK, Naidoo DK, Aboobaker J, Ramdial PK. Erythroderma: A
comparison between HIV positive and negative patients. Int J Dermatol. 1999;38:895900.
[PubMed]
20. Chakraborty Lymphoma as a cause of exfoliative dermatitis. Indian J Dermatol.
1983;28:1213. [PubMed]
21. Nishijima S. Papuloerythroderma associated with hepatocellular carcinoma. Br J
Dermatol. 1998;139:11156. [PubMed]
22. Axelrod JH, Herbold DR, Freel JH, Palmer SM. Exfoliative dermatitis: Presenting sign of
fallopian tube carcinoma. Obstet Gynecol. 1988;71:10457. [PubMed]
23. Deffer TA, Overton-Keary PP, Goette DK. Erythroderma secondary to esophageal
carcinoma. J Am Acad Dermatol. 1985;13:3113. [PubMed]
24. Harper TG, Latuska RF, Sperling HV. An unusual association between erythroderma and
an occult gastric carcinoma. Am J Gastroenterol. 1984;79:9213. [PubMed]
25. Kameyama H, Shirai Y, Date K, Kuwabara A, Kurosaki R, Hatakeyama K. Gallbladder
carcinoma presenting as exfoliative dermatitis (erythroderma) Int J Gastrointest Cancer.
2005;35:1535. [PubMed]
26. Nousari HC, Kimyai-Asadi A, Spegman DJ. Paraneoplastic dermatomyositis presenting
as erythroderma. J Am Acad Dermatol. 1998;39:6534. [PubMed]
27. Patrizi A, Pileri S, Rivano MT, Di Lernia V. Malignant histiocytosis presenting as
erythroderma. Int J Dermatol. 1990;29:2146. [PubMed]
28. Rosen T, Chappell R, Drucker C. Exfoliative dermatitis: Presenting sign of internal
malignancy. Southern Med J. 1979;72:6523. [PubMed]
29. Bittencourt AL, Barbosa H, Brites C, Ferraz N. Clinicopathological aspects of HTLV-1
positive and negative T-cell lymphoma. Eur J Dermatol. 1997;7:2839.
30. vonderheid EC, Bernengo MG, Burg G. Update on erythroderma cutaneous T-cell
lymphoma-Report of International Society for Cutaneous Lymphoma. J Am Acad Dermatol.
2002;46:95106. [PubMed]
31. Burns MK, Cooper KD. Cutaneous T-cell lymphoma associated with HIV infection. J Am
Acad Dermatol. 1993;29:3949. [PubMed]
32. Higgins EM, du Vivier AW. Cutaneous manifestations of malignant disease. Br J Hosp
Med. 1992;48:5524. [PubMed]
33. Vonderheid EC. On the diagnosis of erythrodermic cutaneous T-cell lymphoma. J Cutan
Pathol. 2006;33:2742. [PubMed]
34. Vonderheid EC, Bernengo MG. The Sezary syndrome:hematologic criteria. Hematol
Oncol Clin North Am. 2003;17:136789. [PubMed]
35. Abel EA, Lindae ML, Hoppe RT, Wood GS. Benign and malignant forms of erythroderma:
Cutaneous immunophenotypic characteristics. J Am Acad Dermatol. 1988;19:108995.
[PubMed]
36. Fujiwara E, Tado O, Sasaki H, Hayashi Y. An autopsy case of postoperative
erythroderma after nephroureterectomy possibly induced by graft-versus-host reaction
following blood transfusion. Nippon Hinyokika Gakkai Zasshi - Jpn J Urol. 1992;83:34851.
[PubMed]
37. Gupta R, Khera V. Erythroderma due to dermatophyte. Acta Dermatol Venereol. 2000.
38. Janniger CK, Gascon P, Schwartz RA, Hennessey NP, Lambert WC. Erythroderma as
the initial presentation of the acquired immunodeficiency syndrome. Dermatologica.
1991;183:1435. [PubMed]

39. Mutasim DF. Severe subacute cutaneous lupus erythematosus presenting with
generalized erythroderma and bullae. J Am Acad Dermatol. 2003;48:9479. [PubMed]
40. Nazzari G, Crovato F, Nigro A. Papuloerythroderma (Ofuji): Two additional cases and
review of the literature. J Am Acad Dermatol. 1992;26:499501. [PubMed]
41. Otsuka S, Kunieda K, Hirose M, Takeuchi H, Mizutani Y, Nagaya M, et al. Fatal
erythroderma (suspected graft-versus-host disease) after cholecystectomy: Retrospective
analysis. Transfusion. 1989;29:5448. [PubMed]
42. Pierson JC, Taylor JS. Erythrodermic dermatomyositis. J Am Acad Dermatol.
1993;28:136. [PubMed]
43. Schwartz RA, Leevy CM, Cohen PJ, Lambert WC. Erythroderma with fulminant hepatitis:
A possible association. Cutis. 1986;37:568. [PubMed]
44. Takedai T, Yamamoto I, Tokeshi J. Acute generalized pustular psoriasis presenting with
erythroderma associated with shock and acute renal failure. Hawaii Med J. 2003;62:27881.
[PubMed]
45. Yungmann MP, Ford MJ. Histoplasmosis presenting as erythroderma in a patient with the
acquired immunodeficiency syndrome. Int J Dermatol. 2003;42:6369. [PubMed]
46. Zemtsov A, Elks M, Shehata B. Thyrotoxicosis presenting as generalized pruritic
exfoliative dermatitis and fever. Dermatology. 1992;184:157. [PubMed]
47. Yoon C, Lee C. Clinicopathological cases. Clin Exp Dermatol. 2003;28:5756. [PubMed]
48. Sigurdsson V, de Vries IJ, Toonstra J, Bihari IC, Thepen T, Bruijnzeel-Koomen CA, et al.
Expression of VCAM-1, ICAM-1, E-selectin, and P-selectin on endothelium in situ in patients
with erythroderma, mycosis fungoides and atopic dermatitis. J Cutan Pathol. 2000;27:436
40. [PubMed]
49. Wilson DC, Jester JD, King LE., Jr Erythroderma and exfoliative dermatitis. Clin
Dermatol. 1993;11:6772. [PubMed]
50. Sehgal VN, Srivastava G, Sardana K. Erythroderma/exfoliative dermatitis: A synopsis. Int
J Dermatol. 2004;43:3947. [PubMed]
51. Sigurdsson V, Toonstra J, Bihari IC. Interleukin-4 and interferon-gamma expression of
the dermal infiltrate in patients with erythroderm and mycosis fungoides- an
immunohistochemical study. J Cutan Pathol. 2000;27:43640. [PubMed]
52. Freedberg IM. Fitzpatrick's dermatology in general medicine. 6th ed. New York: McGraw
Hill; 2003. Exfoliative Dermatitis; pp. 117.
53. Kanwar AJ, Dhar S, Ghosh S. Nose sign in dermatology. Dermatology. 1993;187:278.
[PubMed]
54. Agarwal S, Khullar R, Kalla G, Malhotra YK. Nose sign of exfoliative dermatitis: A
possible mechanism. Arch Dermatol. 1992;128:704. [PubMed]
55. Jaffer AN, Brodell RT. Exfoliative dermatitis: Erythroderma can be a sign of a significant
underlying disorder. Postgrad Med. 2005;117:4951. [PubMed]
56. Shelley WB, Shelley ED. Shoreline nails: Sign of drug-induced erythroderma. Cutis.
1985;35:2202. [PubMed]
57. Joly P, Tanasescu S, Wolkenstein P, Bocquet H, Gilbert D. Lichenoid erythrodermic
bullous pemphigoid of the African patient. J Am Acad Dermatol. 1998;39:6917. [PubMed]
58. Harris DW, Spencer MJ, Tidman MJ. Papuloerythroderma-clinical and ultrastructural
features. Clin Exp Dermatol. 1990;15:1056. [PubMed]
59. Ofuji S. Papuloerythroderma. J Am Acad Dermatol. 1990;22:697. [PubMed]
60. Lacour JP, Perrin C, Ortonne JP. Ofuji papuloerythroderma: A new European case.
Dermatology. 1993;186:1902. [PubMed]
61. Nicolis GD, Helwig EB. Exfoliative dermatitis: A clinicopathologic study of 135 cases.
Arch Dermatol. 1973;108:78897. [PubMed]
62. Sigurdsson V, Toonstra J, van Vloten WA. Idiopathic erythroderma: A follow-up study of
28 patients. Dermatology. 1997;194:98101. [PubMed]
63. Rothe MJ, Bernstein ML, Grant-Kels JM. Life-threatening erythroderma: Diagnosing and
treating the red man Clin Dermatol. 2005;23:20617. [PubMed]
64. Mutluer S, Yerebakan O, Alpsoy E, Ciftcioglu MA, Yilmaz E. Treatment of
papuloerythroderma of Ofuji with Re-PUVA: A case report and review of the therapy. J Eur
Acad Dermatol Venereol. 2004;18:4803. [PubMed]

Articles from Indian Journal of Dermatology are provided here courtesy of Medknow
Publications

Formats:
Article

PubReader

ePub (beta)

Printer Friendly

Citation

Share

Facebook

Twitter

Google+

Save items
Add to FavoritesView more options

Create collection...
Manage collections...

loading

Similar articles in PubMed

Exfoliative erythroderma.[Acta Dermatovenerol Croat. 2007]

Life-threatening erythroderma: diagnosing and treating the "red man".[Clin Dermatol. 2005]

Neonatal and infantile erythrodermas: a retrospective study of 51 patients.[Arch Dermatol.


2000]

Erythroderma in children.[Indian J Dermatol Venereol Lep...]

Aetiopathological and clinical study of erythroderma.[J Indian Med Assoc. 2009]


See reviews...See all...

Cited by other articles in PMC

Breast Cancer Presenting as Paraneoplastic Erythroderma: An Extremely Rare Case[Case


Reports in Medicine. 2014]
See all...

Links

Compound

MedGen

PubMed

Substance

Recent Activity
ClearTurn OffTurn On

ERYTHRODERMA: REVIEW OF A POTENTIALLY LIFE-THREATENING DERMATOSIS


ERYTHRODERMA: REVIEW OF A POTENTIALLY LIFE-THREATENING DERMATOSIS
Indian Journal of Dermatology. Jan-Mar 2009; 54(1)1

Neonatal erythroderma: differential diagnosis and management of the "red baby"


Neonatal erythroderma: differential diagnosis and management of the "red baby"
Archives of Disease in Childhood. 1998 Aug; 79(2)186

Erythroderma in children. AND (Review[ptyp] AND free full text[sb... (9)


Erythroderma in children. AND (Review[ptyp] AND free full text[sb] AND Humans[Mesh])
Search

PubMed

Erythroderma/generalized exfoliative dermatitis in pediatric practice: an overvi...


Erythroderma/generalized exfoliative dermatitis in pediatric practice: an overview.
Int J Dermatol. 2006 Jul ;45(7):831-9.

PubMed

Neonatal erythroderma: differential diagnosis and management of the "red baby".


Neonatal erythroderma: differential diagnosis and management of the "red baby".

Arch Dis Child. 1998 Aug ;79(2):186-91.

PubMed
Your browsing activity is empty.
Activity recording is turned off.
Turn recording back on
See more...

Exfoliative dermatitis. A prospective study of 80 patients.[Dermatologica. 1986]


Sehgal VN, Srivastava G
Dermatologica. 1986; 173(6):278-84.

The incidence of erythroderma: a survey among all dermatologists in The


Netherlands.[J Am Acad Dermatol. 2001]
Sigurdsson V, Steegmans PH, van Vloten WA
J Am Acad Dermatol. 2001 Nov; 45(5):675-8.

Erythroderma in adults: a report of 80 cases.[Int J Dermatol. 2005]


Rym BM, Mourad M, Bechir Z, Dalenda E, Faika C, Iadh AM, Amel BO
Int J Dermatol. 2005 Sep; 44(9):731-5.

Review Erythroderma.[Dermatol Clin. 2000]


Rothe MJ, Bialy TL, Grant-Kels JM
Dermatol Clin. 2000 Jul; 18(3):405-15.

See more ...

Exfoliative dermatitis. A prospective study of 80 patients.[Dermatologica. 1986]


Sehgal VN, Srivastava G
Dermatologica. 1986; 173(6):278-84.

Erythroderma in adults: a report of 80 cases.[Int J Dermatol. 2005]


Rym BM, Mourad M, Bechir Z, Dalenda E, Faika C, Iadh AM, Amel BO
Int J Dermatol. 2005 Sep; 44(9):731-5.

Erythroderma: a clinical study of 97 cases.[BMC Dermatol. 2005]


Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H
BMC Dermatol. 2005 May 9; 5():5.

See more ...

Therapeutic options for erythroderma.[Cutis. 1992]


Rubins AY, Hartmane IV, Lielbriedis YM, Schwartz RA
Cutis. 1992 Jun; 49(6):424-6.

Review Management of drug eruptions: Part II. Diagnosis and treatment.[Australas J


Dermatol. 1995]
Breathnach SM
Australas J Dermatol. 1995 Nov; 36(4):187-91.

Review Exfoliative dermatitis.[Am Fam Physician. 1999]


Karakayli G, Beckham G, Orengo I, Rosen T
Am Fam Physician. 1999 Feb 1; 59(3):625-30.

Erythroderma from systemic contact dermatitis: a complication of systemic


gentamicin in a patient with contact allergy to neomycin.[Cutis. 1989]
Guin JD, Phillips D
Cutis. 1989 Jun; 43(6):564-7.

Severe erythrodermic reactions to the proton pump inhibitors omeprazole and


lansoprazole.[Br J Dermatol. 1999]
Cockayne SE, Glet RJ, Gawkrodger DJ, McDonagh AJ
Br J Dermatol. 1999 Jul; 141(1):173-5.

See more ...

Lymphoma as a cause of exfoliative dermatitis.[Indian J Dermatol. 1983]


Chakraborty
Indian J Dermatol. 1983 Jul; 28(3):121-3.

Review Exfoliative dermatitis.[Am Fam Physician. 1999]


Karakayli G, Beckham G, Orengo I, Rosen T
Am Fam Physician. 1999 Feb 1; 59(3):625-30.

Papuloerythroderma associated with hepatocellular carcinoma.[Br J Dermatol. 1998]


Nishijima S
Br J Dermatol. 1998 Dec; 139(6):1115-6.

Exfoliative dermatitis: presenting sign of fallopian tube carcinoma.[Obstet Gynecol.


1988]
Axelrod JH, Herbold DR, Freel JH, Palmer SM
Obstet Gynecol. 1988 Jun; 71(6 Pt 2):1045-7.

Review Update on erythrodermic cutaneous T-cell lymphoma: report of the


International Society for Cutaneous Lymphomas.[J Am Acad Dermatol. 2002]
Vonderheid EC, Bernengo MG, Burg G, Duvic M, Heald P, Laroche L, Olsen E,
Pittelkow M, Russell-Jones R, Takigawa M, Willemze R, ISCL
J Am Acad Dermatol. 2002 Jan; 46(1):95-106.

Review Cutaneous manifestations of malignant disease.[Br J Hosp Med. 1992]


Higgins EM, du Vivier AW
Br J Hosp Med. 1992 Nov 4-17; 48(9):552-4, 558-61.

See more ...

[An autopsy case of postoperative erythroderma after nephroureterectomy possibly


induced by graft-versus-host reaction following blood transfusion].[Nihon Hinyokika
Gakkai Zasshi. 1992]
Fujiwara E, Tado O, Sasaki H, Hayashi Y
Nihon Hinyokika Gakkai Zasshi. 1992 Mar; 83(3):348-51.

Case 6. Erythrodermic form of cutaneous sarcoidosis.[Clin Exp Dermatol. 2003]


Yoon CH, Lee CW
Clin Exp Dermatol. 2003 Sep; 28(5):575-6.

Expression of VCAM-1, ICAM-1, E-selectin, and P-selectin on endothelium in situ in


patients with erythroderma, mycosis fungoides and atopic dermatitis.[J Cutan Pathol.
2000]
Sigurdsson V, de Vries IJ, Toonstra J, Bihari IC, Thepen T, Bruijnzeel-Koomen CA,
van Vloten WA
J Cutan Pathol. 2000 Oct; 27(9):436-40.

Review Erythroderma and exfoliative dermatitis.[Clin Dermatol. 1993]


Wilson DC, Jester JD, King LE Jr
Clin Dermatol. 1993 Jan-Mar; 11(1):67-72.

Review Erythroderma/exfoliative dermatitis: a synopsis.[Int J Dermatol. 2004]


Sehgal VN, Srivastava G, Sardana K
Int J Dermatol. 2004 Jan; 43(1):39-47.

Therapeutic options for erythroderma.[Cutis. 1992]


Rubins AY, Hartmane IV, Lielbriedis YM, Schwartz RA
Cutis. 1992 Jun; 49(6):424-6.

Expression of VCAM-1, ICAM-1, E-selectin, and P-selectin on endothelium in situ in


patients with erythroderma, mycosis fungoides and atopic dermatitis.[J Cutan Pathol.
2000]

Sigurdsson V, de Vries IJ, Toonstra J, Bihari IC, Thepen T, Bruijnzeel-Koomen CA,


van Vloten WA
J Cutan Pathol. 2000 Oct; 27(9):436-40.

Interleukin 4 and interferon-gamma expression of the dermal infiltrate in patients with


erythroderma and mycosis fungoides. An immuno-histochemical study.[J Cutan
Pathol. 2000]
Sigurdsson V, Toonstra J, Bihari IC, Bruijnzeel-Koomen CA, van Vloten WA, Thepen
T
J Cutan Pathol. 2000 Oct; 27(9):429-35.

Review Erythroderma/exfoliative dermatitis: a synopsis.[Int J Dermatol. 2004]


Sehgal VN, Srivastava G, Sardana K
Int J Dermatol. 2004 Jan; 43(1):39-47.

See more ...

Therapeutic options for erythroderma.[Cutis. 1992]


Rubins AY, Hartmane IV, Lielbriedis YM, Schwartz RA
Cutis. 1992 Jun; 49(6):424-6.

Exfoliative dermatitis. Erythroderma can be a sign of a significant underlying


disorder.[Postgrad Med. 2005]
Jaffer AN, Brodell RT
Postgrad Med. 2005 Jan; 117(1):49-51.

Review Erythroderma/exfoliative dermatitis: a synopsis.[Int J Dermatol. 2004]


Sehgal VN, Srivastava G, Sardana K
Int J Dermatol. 2004 Jan; 43(1):39-47.

See more ...

Therapeutic options for erythroderma.[Cutis. 1992]


Rubins AY, Hartmane IV, Lielbriedis YM, Schwartz RA
Cutis. 1992 Jun; 49(6):424-6.

Lichenoid erythrodermic bullous pemphigoid of the African patient.[J Am Acad


Dermatol. 1998]
Joly P, Tanasescu S, Wolkenstein P, Bocquet H, Gilbert D, Thomine E, Wechsler J,
Roujeau JC, Revuz J, Tron F, Lauret P
J Am Acad Dermatol. 1998 Nov; 39(5 Pt 1):691-7.

Paraneoplastic dermatomyositis presenting as erythroderma.[J Am Acad Dermatol.


1998]
Nousari HC, Kimyai-Asadi A, Spegman DJ
J Am Acad Dermatol. 1998 Oct; 39(4 Pt 1):653-4.

Erythrodermic dermatomyositis.[J Am Acad Dermatol. 1993]


Pierson JC, Taylor JS
J Am Acad Dermatol. 1993 Jan; 28(1):136.

Papuloerythroderma--clinical and ultrastructural features.[Clin Exp Dermatol. 1990]


Harris DW, Spencer MJ, Tidman MJ
Clin Exp Dermatol. 1990 Mar; 15(2):105-6.

Review Ofuji papuloerythroderma: a new European case.[Dermatology. 1993]


Lacour JP, Perrin C, Ortonne JP
Dermatology. 1993; 186(3):190-2.

Review Erythroderma/exfoliative dermatitis: a synopsis.[Int J Dermatol. 2004]


Sehgal VN, Srivastava G, Sardana K
Int J Dermatol. 2004 Jan; 43(1):39-47.

Erythroderma as the initial presentation of the acquired immunodeficiency


syndrome.[Dermatologica. 1991]
Janniger CK, Gascon P, Schwartz RA, Hennessey NP, Lambert WC
Dermatologica. 1991; 183(2):143-5.

Therapeutic options for erythroderma.[Cutis. 1992]


Rubins AY, Hartmane IV, Lielbriedis YM, Schwartz RA
Cutis. 1992 Jun; 49(6):424-6.

Erythroderma. A clinical and follow-up study of 102 patients, with special emphasis
on survival.[J Am Acad Dermatol. 1996]
Sigurdsson V, Toonstra J, Hezemans-Boer M, van Vloten WA
J Am Acad Dermatol. 1996 Jul; 35(1):53-7.

Review Exfoliative dermatitis.[Am Fam Physician. 1999]


Karakayli G, Beckham G, Orengo I, Rosen T
Am Fam Physician. 1999 Feb 1; 59(3):625-30.

Review Erythroderma and exfoliative dermatitis.[Clin Dermatol. 1993]


Wilson DC, Jester JD, King LE Jr
Clin Dermatol. 1993 Jan-Mar; 11(1):67-72.

Exfoliative dermatitis. A clinicopathologic study of 135 cases.[Arch Dermatol. 1973]


Nicolis GD, Helwig EB
Arch Dermatol. 1973 Dec; 108(6):788-97.

See more ...

Review Exfoliative dermatitis.[Am Fam Physician. 1999]


Karakayli G, Beckham G, Orengo I, Rosen T

Am Fam Physician. 1999 Feb 1; 59(3):625-30.

Review Erythroderma.[Dermatol Clin. 2000]


Rothe MJ, Bialy TL, Grant-Kels JM
Dermatol Clin. 2000 Jul; 18(3):405-15.

Review Erythroderma.[Dermatol Clin. 2000]


Rothe MJ, Bialy TL, Grant-Kels JM
Dermatol Clin. 2000 Jul; 18(3):405-15.

Review Life-threatening erythroderma: diagnosing and treating the "red man".[Clin


Dermatol. 2005]
Rothe MJ, Bernstein ML, Grant-Kels JM
Clin Dermatol. 2005 Mar-Apr; 23(2):206-17.

Review Exfoliative dermatitis.[Am Fam Physician. 1999]


Karakayli G, Beckham G, Orengo I, Rosen T
Am Fam Physician. 1999 Feb 1; 59(3):625-30.

Review Erythroderma/exfoliative dermatitis: a synopsis.[Int J Dermatol. 2004]


Sehgal VN, Srivastava G, Sardana K
Int J Dermatol. 2004 Jan; 43(1):39-47.

Review Treatment of papuloerythroderma of Ofuji with Re-PUVA: a case report and


review of the therapy.[J Eur Acad Dermatol Venereol. 2004]
Mutluer S, Yerebakan O, Alpsoy E, Ciftcioglu MA, Yilmaz E
J Eur Acad Dermatol Venereol. 2004 Jul; 18(4):480-3.

Exfoliative dermatitis. A prospective study of 80 patients.[Dermatologica. 1986]


Sehgal VN, Srivastava G
Dermatologica. 1986; 173(6):278-84.

Review Erythroderma.[Dermatol Clin. 2000]


Rothe MJ, Bialy TL, Grant-Kels JM
Dermatol Clin. 2000 Jul; 18(3):405-15.

Erythroderma. A clinical and follow-up study of 102 patients, with special emphasis
on survival.[J Am Acad Dermatol. 1996]
Sigurdsson V, Toonstra J, Hezemans-Boer M, van Vloten WA
J Am Acad Dermatol. 1996 Jul; 35(1):53-7.

See more ...

Review Exfoliative dermatitis.[Am Fam Physician. 1999]


Karakayli G, Beckham G, Orengo I, Rosen T
Am Fam Physician. 1999 Feb 1; 59(3):625-30.

Review Life-threatening erythroderma: diagnosing and treating the "red man".[Clin


Dermatol. 2005]
Rothe MJ, Bernstein ML, Grant-Kels JM
Clin Dermatol. 2005 Mar-Apr; 23(2):206-17.

Review Erythroderma/exfoliative dermatitis: a synopsis.[Int J Dermatol. 2004]


Sehgal VN, Srivastava G, Sardana K
Int J Dermatol. 2004 Jan; 43(1):39-47.

See more ...

You are here: NCBI > Literature > PubMed Central (PMC)
Write to the Help Desk
xternal link. Please review our privacy policy.

NLM
NIH
DHHS

USA.gov
Copyright | Disclaimer | Privacy | Browsers | Accessibility | Contact
National Center for Biotechnology Information, U.S. National Library of Medicine 8600 Rockville Pike,
Bethesda MD, 20894 USA
Gambar y ang ditautk an tidak dapat
ditampilk an. File mungk in telah
dipindah, diganti nama, atau
dihapus. Pastik an bahwa tautan
y ang mengarah k e lok asi dan file
y ang benar.

We are experimenting with display styles that make it easier to read articles in
PMC. Our first effort uses eBook readers, which have several "ease of
reading" features already built in.
These PMC articles are best viewed in the iBooks reader. You may notice
problems with the display of certain parts of an article in other eReaders.
CancelDownload article