Diagnosis and management of erythroderma; a systematic review

Abstract

Erythroderma, a condition characterized by diffuse erythema and scaling covering at least 90 percent of the skin\'s surface, poses a serious and potentially life-threatening threat. This systematic study aimed to establish diagnosis and management guidelines for erythroderma. Following PRISMA guidelines, a comprehensive review was conducted using PubMed/Medline, Scopus, and Embase databases focusing on English-language articles from 2010 to 2023. From 279 studies, seven articles were included, mainly comprising surveys and analyses of national databases. Erythroderma, as a clinical sign, can manifest as a consequence of various cutaneous and systemic diseases, drug hypersensitivity reactions, and rarely, Sezary syndrome. In pediatric patients, the clinical presentation encompasses a spectrum of acquired and inherited diseases, including infections, inflammatory skin conditions, ichthyoses, and congenital immunodeficiencies. Diagnosing erythroderma proves challenging due to its syndromatic nature, presenting with nonspecific clinical features. Dermatologists must diligently seek cause-oriented clues, employing multiple biopsies to enhance diagnostic accuracy. Initial management should include nutritional expert evaluation, assessment of fluid imbalance, skin barrier maintenance, sedative anti-histamines, and exclusion of secondary bacterial infection. Given its life-threatening potential, erythroderma might necessitate hospitalization. This study provides valuable insights into the complexities of erythroderma diagnosis and highlights essential considerations for effective management.