Erythroderma

Erythroderma = >90% body surface inflamed — the skin fails as an organ. Causes: psoriasis (esp. abrupt therapy withdrawal), eczema, drug reactions (DRESS), cutaneous lymphoma. Kills via hypothermia, high-output cardiac failure, fluid/protein loss…

Skin Failure Pathway

The pathway

1 · Recognise skin failure

>90% redness ± scale
Systemically unwell: shivering, tachycardia
Treat as organ failure

2 · Warm & fill

Warm room, no fans
IV fluids by balance + urine output
Monitor temp — hypothermia kills

3 · Bland skin care

Liberal 50:50 emollient frequently
Avoid potent steroids until cause known
Minimal handling

4 · Hunt the cause

Drug timeline (DRESS: eosinophils + LFTs)
Psoriasis/eczema history, nails
Lymphadenopathy → Sézary
Biopsy if unclear

5 · Watch for decompensation

Hypothermia + hypotension = escalate
High-output cardiac failure
Secondary staph sepsis — culture, treat proven infection

6 · Dermatology-led definitive care

Restart/start systemic therapy for psoriasis
Stop culprit drugs
Specialist follow-up

Drugs

Drug	Dose	Route	Notes
50:50 WSP emollient	Liberal, frequent	TOP	The core treatment while cause unknown.
Balanced crystalloid	Guided by balance	IV	Losses are large; albumin often falls — don't chase oedema with diuretics.
Flucloxacillin	2g QDS	IV	If staphylococcal sepsis suspected — culture first.

When to escalate

Hypothermia, hypotension or rising lactate — HDU,Sheets of pustules (GPP), mucositis (TEN), eosinophilia (DRESS) — specific urgent pathways,Suspected Sézary — dermatology + haematology,Any erythroderma — same-day dermatology discussion

Reference: BAD guidance / Rook's — dermatological emergencies

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