CURRENT Essentials of Critical Care.pdf

Chapter 18 Dermatology 263■■■Exfoliative ErythrodermaEssentials of Diagnosis• Generalized diffuse erythema with scaling, induration, variabledesquamation; mucous membranes usually spared• Pruritus, malaise, fever, chills and weight loss may be present;thermoregulatory dysfunction may lead to relative hypothermiaand chills; excoriations, peripheral edema, lymphadenopathycommon• Leukocytosis and anemia; eosinophilia suggestive of underlyingdrug reaction• Caused by multiple underlying conditions including eczematousconditions, psoriasis, scabies, medications, lymphoma• Skin biopsy results often nonspecific; may reveal cutaneous Tcell lymphoma, leukemia, Norwegian crusted scabiesDifferential Diagnosis• Morbilliform drug eruptions• Viral exanthems• Early phase of toxic epidermal necrolysis• Toxic shock syndrome• Graft-versus-host diseaseTreatment• Symptomatic relief; specific therapy once etiology known• Optimize nutrition• Discontinue possible offending agents• Avoid systemic steroids unless indicated as specific therapy forunderlying disease• Daily whirlpool treatments to remove scale; apply medium potencytopical steroid cream■ PearlSerologic testing for HIV is recommended in all patients with erythrodermicpsoriasis.ReferenceRothe MJ et al: Erythroderma. Dermatol Clin 2000;18:405. [PMID: 10943536]