Carcinoma of the Rectum Presenting with Exfoliative Erythrodermia

Local and systemic steroid therapy has revolutionised the treatment of erythrodermia by suppressing the exfoliative process and the intense irritation which accompanies it and thus minimising the danger of death from overwhelming infection, severe protein loss and inanition. The ultimate prognosis, however, depends on the aetiology; in adults it may occur as a phase in the history of a primary skin disorder such as psoriasis, seborrhoeic dermatitis, pityriasis rubra pilaris, pemphigus foliaceus and occasionally contact eczema and lichen planus. Drugs are a well known cause, among the most celebrated being arsenic, gold and mercury, but penicillin, sulphonamides, barbiturates, quinidine, diphenylhydantoin, isoniazid and iodine have been incriminated. It may accompany or precede leukaemia, Hodgkin's disease and mycosis fungoides. Unfortunately the cause is nearly always difficult and frequently impossible to determine, as Abrahams, McCarthy and Sanders (1963) found in reviewing 101 cases of exfoliative dermatitis admitted to a New York hospital in the years 1930-1960. These they classified by aetiology as follows: