Erythroderma (exfoliative dermatitis) part two: energy homeostasis and dietetic management strategies

Erythroderma (exfoliative dermatitis) associates with important metabolic changes that include an enhancement in energy expenditure. The key components to total energy expenditure (TEE) include basal metabolic rate (~68% of TEE), physical activity (~22% of TEE) and thermic effect of food (~10% of TEE). In the erythrodermic state, there are likely multiple contributors to the increase in basal metabolic rate such as 'caloric drain' resulting from increased evaporation of water from enhanced transepidermal water loss, increased activity of the cardiovascular system (including high-output cardiac failure), increased non-shivering thermogenesis and hormonal changes (such as hypercortisolaemia). A change to patient's level of physical activity and appetite as a result of ill health status may further impact on their total energy expenditure and energy consumption. In part two of this two part concise review, we explore the key constituents of energy homeostasis, the potential mechanisms impacting on energy homeostasis in erythroderma and suggest much needed dietetic management strategies for this important condition.