✅ MSRA Deep Dive: Erythroderma (Exfoliative Dermatitis)
In this urgent episode, we unpack one of the most severe dermatological emergencies – erythroderma, also known as exfoliative dermatitis. Whether you're preparing for the MSRA or want to sharpen your clinical knowledge, this revision-focused discussion covers the must-know facts that could save lives.

🧠 Key Learning Points

📌 Definition
• Erythroderma is a severe, widespread inflammatory skin condition involving >90% of body surface area
• Marked by intense erythema, scaling, and systemic symptoms
• Often signals a deeper, underlying issue—it's not just "a skin rash"

📌 Causes
Erythroderma is a final common pathway for many conditions:
• Drug reactions (e.g. penicillins, sulfonamides, anticonvulsants, NSAIDs)
• Inflammatory dermatoses: psoriasis, eczema, contact dermatitis
• Infections: HIV, hepatitis, fungal infections
• Malignancy: cutaneous T-cell lymphoma, leukaemia
• Idiopathic (no clear cause in ~30%)

📌 Pathophysiology
• Involves skin barrier breakdown + widespread immune dysregulation
• Leads to massive fluid, protein, and heat loss, increased metabolic demand, and infection risk
• The body enters a vicious inflammatory cycle

🚩 High-Risk Groups
• Older adults
• Patients with chronic skin conditions (psoriasis, eczema)
• Immunocompromised individuals
• History of drug sensitivity or allergic reactions

🔍 Differential Diagnoses
Distinguish erythroderma from:
• Stevens-Johnson syndrome (SJS) / Toxic epidermal necrolysis (TEN) – mucosal involvement, blistering
• Pityriasis rubra pilaris (PRP)
• Severe seborrhoeic dermatitis
• Severe psoriasis

🩺 Clinical Features
• >90% body surface area red and inflamed
• Scaling, pruritus, warmth, tenderness
• Systemic symptoms: fever, chills, malaise
• Desquamation – sheets of skin may peel off
• Complications: dehydration, infection, hypothermia, electrolyte imbalance

🧪 Investigations
• History & Examination: medication changes, systemic signs, underlying dermatoses
• Skin biopsy: confirms diagnosis, rules out malignancy
• Blood tests: CBC, ESR, CRP, U&Es, LFTs
• Serology: HIV, hepatitis
• Cultures if infection suspected

🚨 Emergency Management
🧭 Hospitalisation
• For monitoring, fluid/electrolyte management, and rapid intervention
• Monitor vital signs, fluid balance, and risk of sepsis

💊 Treatment
• Stop offending drug immediately
• Supportive care: emollients, wet wraps, temperature regulation
• Topical steroids – often not enough alone
• Systemic corticosteroids – first-line in many cases
• Other immunosuppressants may be needed depending on cause
• Treat complications (infection, sepsis, organ failure) as they arise

📉 Prognosis
• Depends on underlying cause and speed of treatment
• Drug-induced cases with early withdrawal → better outcomes
• Malignancy-linked or severe cases → guarded prognosis
• Mortality rate 20–40% in severe presentations due to sepsis, fluid loss, organ failure

💥 Complications to Watch For
• Sepsis (from secondary skin infections)
• Electrolyte imbalance, dehydration, hypothermia
• ARDS (Acute Respiratory Distress Syndrome)
• Multi-organ failure
• Protein loss, nutritional deficiency

🎯 Key Exam Reminder
If >90% of the skin is red, itchy, scaling, and the patient is systemically unwell → think erythroderma and act fast. Investigate underlying cause, initiate supportive care, and hospitalise immediately.

📚 MSRA Dermatology Resources
📝 Revision Notes: https://www.passthemsra.com/topic/erythroderma-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/erythroderma-flashcards/
🧠 Q&A Notes: https://www.passthemsra.com/topic/erythroderma-accordion-qa-notes/
🎓 Full Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/

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