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Erythroderma — SCE Acute Medicine MCQ

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HardAcute Rheumatological and Dermatological EmergenciesErythrodermaSCE Acute Medicine

A 67-year-old man with psoriasis has confluent erythema and scaling over 95% of his body surface, temperature 35.2°C, albumin 21 g/L and peripheral oedema. He is haemodynamically stable. Which initial care package is best?

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Reveal the answer and explanation

Correct answer: D — Admit for warming, fluid-electrolyte care, infection assessment and dermatology input

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

E is correct. Erythroderma causes barrier failure, high insensible losses, hypothermia, hypoalbuminaemia, infection risk and potentially high-output cardiac failure. Admit, restore temperature and fluid-electrolyte balance cautiously, monitor cardiac and infective complications, use bland emollients and involve dermatology urgently to identify the cause and select disease-specific treatment. Abrupt systemic corticosteroid use in psoriasis can provoke rebound, and immediate systemic immunosuppression before excluding infection may be hazardous. Topical treatment alone and chemotherapy do not address acute physiological risk.

Reference: https://cdn.bad.org.uk/uploads/2024/04/15113327/Derm_Handbook_3rd-Edition-_Nov_2020.pdf