Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Barrier and thermoregulatory failure
Near-generalised inflamed scaling skin can lose heat, water and protein, increase metabolic and cardiac demand and permit sepsis; hypothermia, hypotension, oliguria, oedema, confusion or breathlessness signals physiological failure.
Action: Admit through an acute medical and dermatology pathway, nurse warm, assess ABCDE and temperature, obtain cultures and organ profiles, give carefully reassessed fluid and electrolyte support, start cause-directed treatment only after urgent diagnostic review, and escalate cardiac, renal, respiratory or septic deterioration.
Synopsis
Recognise erythroderma across skin tones, stabilise barrier, temperature and circulation, identify infection or organ failure, and investigate psoriasis, eczema, medicines, pityriasis rubra pilaris and cutaneous lymphoma without delaying supportive care.
Erythroderma means erythema and scale affecting more than 90% of body surface area; it is a dangerous clinical state, not a final aetiological diagnosis.
In brown or black skin, erythema may appear violaceous, grey, dusky or mainly as warmth, oedema and altered texture; examine palms, soles, nails, scalp and mucosae in good light.
Barrier loss causes evaporative fluid and heat loss, protein loss, increased metabolism, cutaneous vasodilation and infection risk; apparently hot skin can coexist with a cold patient.
Key red flags
Core hypothermia, tachycardia, hypotension, oliguria, rapid oedema or weight gain, breathlessness, chest pain, confusion, painful erosions, pustulation, mucosal disease, fever, focal infection, abrupt medicine withdrawal or frailty requires emergency hospital assessment.
Infection or skin loss
Fever, severe tenderness, honey crust, purulence, monomorphic erosions, pustules, blisters, mucosal lesions, focal necrosis or crepitus indicates a superimposed or alternative emergency.
Investigation priorities
01
Physiological severity assessmentFirst step
Detect thermoregulatory, circulatory, respiratory and renal failure immediately.
Management branches
First-line stabilisationTreat the skin as a failing organ
Erythroderma is suspected, especially with systemic symptoms or frailty.
Measure extent and full observations including core temperature, perfusion, weight and urine, then involve acute medicine and the on-call dermatologist.
Admit physiological compromise or high risk, use a warm humidified environment, gentle handling, non-adherent linen and regular bland ointment.
Key medicines
Bland paraffin-based emollient ointmentApply generously to all dry intact skin every 2 to 4 hours and immediately after gentle washing, with quantities adjusted to surface area and exudation.
Hydrocortisone 1% ointmentApply a thin measured layer once or twice daily for 5 to 7 days to selected face or flexural inflammation, then reassess with dermatology.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.