Erythroderma in Atopic Dermatitis

Atopic dermatitis (eczema) can sometimes cause a widespread reddening of the skin, called erythroderma.

What is erythroderma?

While many people with atopic dermatitis experience localized redness of the skin, erythroderma is defined as redness involving more than 90% of the body’s surface area. A scaling (peeling) of the skin and itching usually accompany erythroderma, and it may also be called generalized exfoliative dermatitis.^1,2

What causes erythroderma?

Erythroderma is rare, but can occur at any age and in people of different races. It is slightly more common in men than in women. Erythroderma can be caused by a number of factors, including:

• Atopic dermatitis
• Seborrheic dermatitis
• Psoriasis
• Drug reaction^2,3

What does erythroderma look like?

Typically, erythroderma occurs gradually, except in cases where it is drug-induced where it tends to be sudden. In gradual cases, the red patches of skin begin to increase in size and meet to form extensive areas of redness, which eventually spreads to involve most of the skin’s surface. In patients with erythroderma, the skin appears thin and glossy. White or yellow scales develop and give the skin a dry appearance. The skin is bright red, dry, scaly, and warm to the touch.^3,4

What happens with erythroderma?

While the exact processes that cause erythroderma are not fully understood, doctors know erythroderma is the result of an increased amount of blood to the skin, which results in temperature dysregulation. With erythroderma, the skin loses more heat than normal, which may lead to hypothermia in some cases. There is also a risk of high-output heart failure, as the body’s metabolic rate rises to compensate for the heat loss. People with erythroderma experience an increased loss of fluid through the skin, which can lead to dehydration.^1,2

How is erythroderma treated?

The initial treatment for erythroderma is the same regardless of what caused it and includes replacement of nutritional, fluid, and electrolyte losses. Local skin care strategies that can help include oatmeal baths, wet dressings to weeping or crusted areas of skin, and the use of emollients. Topical corticosteroids can help treat skin inflamed by erythroderma, and an intensive application of topical corticosteroids using a “soak and smear” method can help. The soak and smear method involves a 20-minute soak in plan water followed by application of corticosteroids.^4,5

Medications

Additional treatments are targeted to the cause of erythroderma. In the case of atopic dermatitis, additional treatment may involve:

• Topical calcineurin inhibitors
• Topical phosphodiesterase-4 inhibitors
• Immunomodulators
• Dupilumab
• Antibiotics
• Antihistamines
• Phototherapy

Other symptoms of atopic dermatitis

In addition to erythroderma, atopic dermatitis can cause a rash, scaly patches, weepy sores, itching, blisters, and a change in skin color. Some people also experience eye symptoms or cracks behind the ears. Over time, the areas of skin affected by atopic dermatitis may become thickened.