Erythroderma, also known as exfoliative dermatitis, is inflammation of the skin in which scaling and erythema occurs in a more or less generalized distribution.

In more than 60% of cases, a pre-existing dermatosis has been found to be the cause of the condition. The secondary types of exfoliative dermatitis cannot be distinguished from the idiopathic skin disease. Some of the cutaneous diseases associated with this disorder include: psoriasis (see Diagnostic Code: 7816 Psoriasis), contact dermatitis, seborrheic dermatitis, and pityriasis rubra pilaris. Some of the systemic diseases associated with the condition include: cutaneous T-cell lymphoma, multiple myeloma, carcinoma of the lung, and graft versus host disease. In addition, exposure to a number of drugs may bring on an exfoliative dermatitis condition.

Individuals will differ from a textbook picture. However, some generalities in the idiopathic disease include: redness that begins in the genital area, trunk or head and, within days, has spread to involve the entire cutaneous surface. This is called the "redman syndrome". Scaling follows the erythema and, in approximately 25% of cases, there is loss of hair and nails. Hypopigmentation and hyperpigmentation areas may occur. Other organ systems may be involved, and lymphadenopathy, hepatomegaly, and splenomegaly occur in over 25% of cases. Anemia, lowered serum albumin levels, and eosinophilia are also seen. Serum electrolyte abnormalities may occur, and are attributed to the dehydration and extrarenal water loss (400 ml./day) from the skin.

In order to make a diagnosis, repeated skin biopsies are needed. Lymph node biopsy may be used as well as T-cell receptor gene studies.

The first step in therapy is to establish the cause of the disorder. When a drug reaction is the cause, removal of the drug and treatment locally or systemically bring about rapid skin clearing. When a cutaneous systemic disease is the offending agent, the skin will resist therapy until the underlying cause is treated. The course for patients with leukemia, or carcinoma will depend on the response of that process to therapy. Idiopathic exfoliative dermatitis is unpredictable and is associated with multiple outbreaks. There is a need for prolonged glucocorticoid therapy.

Prolonged use of steroid therapy has severe consequences and must be gradually withdrawn. Many patients recover from idiopathic exfoliative dermatitis within a year.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% and/or other requirements/qualifications under 38 CFR 3.350 [Special monthly compensation ratings]. Also reference 38 CFR 3.155(d)(2).   

• Treatment failure is defined as either disease progression, or less than a 25 percent reduction in the extent and severity of disease after four weeks of prescribed therapy, as documented by medical records 

• 38 CFR 4.118 (a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.   

• 38 CFR 4.118 (b) Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.