What are general skin care recommendations for erythroderma?
Erythroderma is a medical term used to describe a skin condition when you have a red, scaly rash involving most of your skin. Usually at least 90% of the skin is involved. You may have severe itching and feel very cold when you have this rash. There can be several types of skin disease that cause this condition including cutaneous T-cell lymphoma and Sezary syndrome, but there are also diseases that are not related to lymphoma that cause this rash.
It is important to work with your doctor and they may prescribe oral and topical medications to help with this condition. You need to maintain your hydration and nutrition with this rash. A warm humid environment will usually also help. Your doctor may want you to use a "Sauna Suit" which is similar to a nylon jogging suit to create a warm humid environment for your skin. You may require oral antihistamines (like Benadryl/diphenhydramine ) to help with the itch. Oatmeal baths sometimes also decrease the itch. Use a bland moisturizer like petroleum jelly or a petrolatum based ointment several times a day to help maintain your skin barrier function. Your doctor may want you to use topical steroid ointments as well.
Doctors may also want you to use "wet wraps" to help your rash. Watch for infection. If you get open sores or areas with weeping or yellow crusting, let your doctor know. Your doctor may want you to do dilute bleach baths to decrease the amount of bacteria on your skin. Eye care also is important. Your doctor may make recommendations to help protect your eyes and may refer you to an eye doctor. Erythroderma is a significant skin condition that greatly impacts your health and daily life.
Answer provided by:
Kimberly Bohjanen MD,
Department of Dermatology
University of Minnesota
Erythroderma is a term used to describe when most (>80%) or all of the skin becomes diffusely red and scaly. It can result from a number of skin conditions including cutaneous T-cell lymphoma (CTCL), in particular, Sézary syndrome and advanced cases of mycosis fungoides. Having erythroderma can be uncomfortable and patients can feel itching and burning of the skin and often shiver and feel cold. The skin feels dry and leathery, the nails often become brittle and thickened, and patients can lose their hair. Erythroderma can also cause irritation and excessive tearing of the eyes.
Skin care recommendations for erythroderma
Your dermatologist and/or oncologist will put you on systemic therapy for your erythroderma dependent on how advanced your disease is, what medications you have tried before, and what other medical conditions you have. In addition, there are many things you can do to your skin at home that can make you feel more comfortable and actually improve the erythroderma.
- It is important to be gentle on your red, sore and irritated skin. I recommend washing with lukewarm water, avoid using drying soaps to wash and instead use a gentle soap substitute like Cetaphil Body Wash or Cerave Cleanser. Taking bleach baths is very helpful. Not only does it soothe the skin, but it also helps to improve erythroderma by reducing bacteria in the skin. Use one half cup of regular strength bleach to a full tub of water every day or every other day. If the face and scalp are affected, you can submerge your head with your eyes closed under the water for a few seconds at a time.
- Erythroderma makes the skin dry and scaly so it is important to moisturize while the skin is damp after bathing and then several times a day. I recommend either regular petroleum jelly Vaseline or if this is too greasy, then a bland cream like Vanicream.
- Your doctor will often prescribe a mid-potency steroid ointment which can be applied all over your skin and will reduce the redness and itching. It is always best to rub ointments and creams into the skin in a downward motion and not against the hair to prevent folliculitis.
- If the skin feels very dry and itchy, wet pajamas can soothe the skin when applied on ointments overnight. This is done by wetting old close-fitting pajamas in lukewarm water and then, wringing them till damp and putting them on. Then put on dry pajamas over this before going to bed.
- For the hair, using coconut oil can help with dryness and scaling, and can be massaged into the scalp in addition to a topical steroid prescribed by your doctor. It works best if left on overnight with the scalp wrapped in a headscarf, then washed off in the morning with a gentle shampoo.
- Brittle, thickened nails should be trimmed as short as possible and Vaseline applied on them overnight to prevent chipping and breaking.
- Artificial tears can often be helpful for dry gritty eyes in erythroderma in conjunction with seeing your ophthalmologist.
- Finally, make sure to take plenty of rest (as your skin is working overtime during erythroderma) and keep well hydrated with plenty of fluids (your skin loses water when it is red all over). Stay comfortable by wearing comfortable loose fitting cotton clothing.
Answer provided by:
Debjani Sahni, MD
Assistant Professor in Dermatology
Director, Cutaneous Oncology Program
Boston University School of Medicine
Boston Medical Center
When eighty percent (80%) or more of a person’s skin is affected by generalized redness, inflammation and scaling, dermatologists describe this as erythroderma. Erythroderma is defined as abnormal redness of the skin over widespread areas of the body. Although there are multiple possible causes of erythroderma, including drug reactions or severe psoriasis, the presence of erythroderma is particularly important to recognize in mycosis fungoides (MF) and Sézary syndrome (SS). Patients who are erythrodermic secondary to MF/SS often suffer from severe itching all over their bodies, which can interfere with sleep or otherwise impact their daily lives. Their skin may also feel tight or painful, and they often feel very sensitive to cold temperatures. The presence of erythroderma is associated with more advanced disease, and erythrodermic MF patients have a higher risk of lymphoma involvement outside of the skin compared to those patients with less extensive skin involvement.
For patients suffering from erythroderma secondary to MF/SS, it is most important to be closely followed by an experienced dermatologist or oncologist. In addition to the medications that might be prescribed to treat their condition, patients may benefit from steps at home to care for their skin. Good nutrition and hydration are important because erythroderma causes a person’s body to lose water and expend a lot of energy. Generous applications of petroleum jelly or other bland moisturizer, as well as topical steroids if prescribed by the person’s doctor, can help provide comfort and support the barrier function of the skin. Because skin infections can be a big problem for these patients, measures to reduce bacteria on the skin (such as dilute bleach baths, antibiotics, or antibacterial soaps) might also be recommended.
Edith V. Bowers MD, PhD
Assistant Professor of Dermatology
University of North Carolina at Chapel Hill