Eryhtroderma Fixx

7/28/2019 Eryhtroderma Fixx

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Name : Tn. A

Age : 75 years old

Address : Sandana Village

Status : Married

Date of Admitted : 30 may 2013

Identify of Patient


3/27

Main Complain

Get peeled and redness skin whole body

Anamnesis:

Skin got peeled and redness at whole body sincethree weeks ago

At first, the patient felt itchy on lower part of the feetand then become wound and gradually the woundwas being redness and peeled widely.

The itchy (+), pain (-), warm (+) and sometimes chill

History Taking


4/27

History of medicine taking (+), salycilpowder and miconazole zalf.

History of allergic denied, History of usingantiseptic soap (+)

History of DM(+), HT(+), stroke (+)

History of the same disease in family (-)

Hypertrophy of prostate (+)

History Taking


5/27

Anemic (-), Icterus (-), Cyanosis (-)

Diffuse erythema with overlying scale covering

>90% the body surface area

cor/pulmonal : normal

Peristaltik : (+) normal

Physical examination


6/27

General status : compos mentis, adequate

nutrition

General Condition : Moderate Hygiene : Moderate

Vital Signs :

Blood Pressure : 130/80 mmHg

Pulse : 80x/minute RR : 24x/minute

Temperature : 36,7oC

Present Status


7/27

Location : regio Generalisata

Efflorescency : erythem, squamos, swollen,

Location : Regio pedis dextra et sinistra

Efflorescency : ulkus, swollen,madidans

Location : superior extremity

Efflorescency : swollen

Dermatovenerology

Status


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Laboratorium

Routine Blood

WBC : 21,76x 103 /ul

RBC : 3,95x 106

/ulHGB : 11,4 g/dl

HCT : 32,3%

PLT : 296 x 103 /ul

MCV : 95.8 fl

MCH : 28,9 pg

MCHC : 35.3 gr/dl

Kesan : Leukositosis

RDW-SD : 44.8 %

PDW : 11.0

MPV : 9,8 P-LCR: 23,1%

PCT : 0,29%

NEUT : 9,18x 103

LYM : 4.,85 x 103

EO : 5,31 x 103

BASO : 0,29 x 103

MONO :2,13 x 103


12/27

GDS : 274 mg/dl GDP : 140 mg/dl

GD2PP : 114 mg/dl Ureum : 79 Creatinin : 1.4 SGOT : 423 SGPT : 420

Kolest. Total : 145 HDL : 8 LDL : 83 Trigliserida : 275


13/27

Diagnosis

Eritroderma ec PerluasanPenyakit Sistemik


14/27

Differential Diagnosis

PsoriasisSebborhoic Dermatitis

Drug Eruption


15/27

Therapy

Inerson 30 gr + salycil acid 2% + Lanolin10%+ Vaselin Add 60 gr (upper body at

morning and lower body at afternoon)

Ceterizine 10 mg 0-0-1

Compress NaCl 0,9% for Ulcer atmorning and afternoon along 2 hours


16/27

DM Therapy

Diet DM 1700 kkal

Levemir 0-0-12

Novorapid 6-6-6

Ceftriaxon 1 gr/12 jam


17/27

Universal redness and scaling of the skin

affecting 90-100 % of the body

ERYTHRODERMA


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Idiopathic - 30%

Drug allergy 28%

Seborrheic dermatitis 20%

Contact dermatitis 3%

Atopic dermatitis 10 %

Lymphoma and leukimia

14% Psoriasis 8%

Etiology


19/27

The erythema extends rapidly and may be

universal in 12-48 hr. Scaling appears after 2-6 days, often first in the flexures.

The scales may be large, or fine and bran like.At this stage the skin is bright red,hot and

dry and palpably thickened.Pruritus is often cause by eczema.

Clinical Manifestation


20/27

When the erythroderma has been present for

some weeks, the scalp and body may be shed

and the nails become ridged andthickened,and may also be shed.

The periorbital skin is inflamed and

oedematous, resulting in ectropion,withconsequent epiphora.

Clinical Manifestation


21/27

The recognition of erythroderma is easy, but the

diagnosis of underlying cause may be very difficult.

The history is often helpful in identifying thehereditary disorders, drug reactions and psoriasis,but in some cases the erythroderma is of sudden

onset and the history may not be helpful, and theeczematous erythrodermas and those associatedwith lymphoma may not show any distinctivehistological features.

Diagnosis


22/27

Initial treatment of any etiology involves fluid andelectrolyte replacement.

Topical :- oatmel baths

- wet dressings

- emollients (lanolin 10%/urea cream 10%)

Systemic :- Antihistamines

- Corticosteroid

- systemic antibiotics if secondary infection

Treatment


23/27

- diuretics for peripheral edema

- corticosteroid for drug hypersensitivity

reactions,immunobullous disease,atopic dermatitis(1-2 mg/kg/day with taper )

- cyclosporine for psoriasis, atopic dermatitis (4-5mg/kg/day)

- methotrexate for psoriasis, atopic dermatitis,pityriasis rubra pilaris (5-25 mg qwk depend. onrenal func. and response to treatment)

continue


24/27

- acitretin (soriatane) for psoriasis, pityriasis rubra

pilaris (25-50 mg qd )

- mycophenolate mofetil for psoriasis, atopicdermatitis, immunobullous disease (1-3 g qd )

- infliximab for psoriasis (5-10 mg/kg)

continue


25/27

Most likely

Spongiotic dermatitis ( atopic,9% ; contact dermatitis,

6%; seborrheic dermatitis, 4%; chronic actinicdermatitis, 3%)

Psoriasis (23 %)

Drug hypersensitivity reaction (15%)

Cutaneous T-cell lymphoma (5%)

Idiopathic (approximately 20%)

Differential Diagnosis


26/27

Consider

Contact dermatitis

Immunobullous disease Infection (scabies,dermatophytosis)

Toxin mediated

Chronic actinic dermatitis

Pityriasis rubra pilaris Collagen vascular disease

Primary immunodeficiency

continue


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Eryhtroderma Fixx