Erythroderma: Inpatient Management When Initial Supportive Therapy Has Not Relieved Pruritus
When initial supportive management of erythroderma fails to achieve its primary goal — relief of pruritus — the clinical picture may reflect uncontrolled systemic involvement requiring a more intensive, inpatient approach. This protocol describes the next step.
The preceding line, initial supportive management of erythroderma, did not achieve the target goal of relief of pruritus. This failure signals the need for escalation to structured inpatient care.
This protocol focuses on inpatient management of severe erythroderma, addressing the patient's volume and electrolyte status through IV fluid strategies, alongside structured nutritional support. The approach is individualised according to haemodynamic status. The complete decision algorithm, monitoring criteria, and intervention thresholds are available in the full protocol.
References
DOI: 10.1016/j.adengl.2018.05.033- If patient is hypovolemic initiate IV fluid resuscitation with crystalloids that contain sodium in the range 130-154 mmol/L, with a bolus of 500 ml over less than 15 minutes and consider referral to an intensive care unit.
- If patient euvolemic but can't meet fluid/electrolyte needs orally or enterally consider individualized maintenance IV fluids.
- Continue monitorization with urine output, creatinine and urea.