Mr.

Yaman (Lontara 3 AB K5B1) / Erythroderma et causa Seborrheic

Dermatitis

First Condition 21/11/2014

A man 69 years old came to WahidinSudirohusodo Hospital with main complains
of

heartburn with scaly skin and redness accompanied by itching. Previous

patient had been treated in the hospital with a diagnosis Faizal erythroderma et
causa seborrheic dermatitis. During hospitalized Faizal, injuries to the whole body
of the patient appeared to be improving. After 2 weeks of home, lesions on the
skin appears

Dermatovenerology status:
Location

: Regio Generalize

Efflorescence

: Erythema, Squama

A : Erythroderma et causa Seborrheic Dermatitis

R/ IVFD RL 20 drops / min
R/ gentamicin injection of 80 mg / 12h / intravenous
R/ inerson oint 15 gr
lanolin 10%
Topical entire body morning and afternoon

Salicylic acid 3%
vaseline album 40 gr
R/ cetirizine 1 x 10 mg

by the whole body in the morning and afternoon

patients can move from one room

Last Condition 27-11-2014

6thdays of Treatmment
S : scaly and itchy skin (+)
O : Dermatovenerology status:
Location

: Regio Generalize

Efflorescence

: Erhytema, Squama

A:

Erythroderma et causa Seborrheic Dermatitis

Scabies
Tinea Corporis

P : IVFD RL 20 drops / min

gentamicin injection of 80 mg / 12 hours / IV (stop)
cetrizine 10 mg / 24 hours / oral
inerson lanolin ointment 15 g + 10% + salicylic acid + 3% + 40 grams of
vaseline album
ketoconazole 300 mg / 24 hours oral (third day)

DISCUSSION

Exfoliative Dermatitis ( Erytroderma)

Definition
Exfoliative dermatitis (ED) is defined as diffuse erythema and scaling of the skin
involving more than 90% of the total body skin surface area. Systemic and
potentially life-threatening complications include fluid and electrolyte imbalance,
thermoregulatory

disturbance,

fever,

tachycardia,

high-output

failure,

hypoalbuminemia, and septicemia. Common underlying etiologies are psoriasis,

atopic dermatitis, and other spongiotic dermatoses, drug hypersensitivity reaction,
and cuteaneus T-cell lymphoma (CTCL).
Epidemiology
Several large studies have reported a widely varied incidence of exfoliative
dermatitis (ED) ranging from 0.9 71.0 per 100.000 outpatients. A male
predominance has been described, with a male-to-female ratio of approximately
2:1 to 4:1.

Etiology
Psoriasis is the most common underlying skin disease to cause ED (23% of
cases), followed by spongiotic dermatitis (20%).

Clinical manifestasion
The classic prentation of ED is erythematous patches that inrease in size and
coalesce into generalized red erythema with a shiny appearence. By definition, ED
involves more than 90% of the patients skin surface. A few days after the onset
of erithema, fine white or yellow scaling begins, claasically arising in the flexuses.
Plate-like scaling may occur acutely and onthe palms and soles. The scaling
progresses further,giving the skin a dull red appearance. With chronicity, edema
and lichenification lead to skin induration. Ectropion and epiphora maydevelop
secondary to chronic periorital involvement. palmoplantar keratoderma has been
noted in up to 80% of patients with chronic ED.
Diagnosis
History Taking :A detailed history of a patient who presents with ED is an
important tool for diagnosing the underlying etiology. The patients may have a
history of dermatoses (psoriasis, atopic dermatitis) or a systemic medical contion.
A thorough medication history should be elicited, including naturopathic and over
the counter therapies. Patients with history of psoriasis and atopic dermatitis
should be queried aspecifically regarding use of topical and systemic
cortocosteroids, methotrexate, and other systemic medications, topical irritants,
systemic ilness, infection, phototherapy burns, pergnancy, and emotional stress.
ED patients commonly report thermoregulatory disturbances, malaise, fatigue, and
pruritus, these symptoms are not spesific to any Physical Examinationon The
classic presentation of ED is erythematous patches that increase in size and
coalesce into generalized red erythema with a shiny appearance. By definition, ED
involves more than 90% of the patients skin surface. The cutaneous lesions may
suggest the underlying etiology of ED. For example, in early psoriatic ED, classic
psoriatic plaques may be seen. Gottrons papules, heliotrope rash, and muscle
weakness may be present in ED caused by dermatomyositis. Papuloerythroderma
of Ofuji typically spares the abdominal skin ufolds (the deck chair sign).
Therapy

Complication
A variety of metabolic and physiological changes occur in ED, including fluid
and electrolyte imbalances, thermoregulatory disturbance, high-output cardiac
failure, cardiogenic shock, acute respiratory distress syndrome, decompensation of
chronic liver disease, and gynecomastia. Hypoalbuminemia is common since there
is an increas of protein loss via scaling (by 10%-15% in nonpsoriatic ED and up
to25%-30% in psoriatic ED) as well as increase in metabolism and decrease in
protein synthesis. These processess lead to a negative nitrogen balance, muscle
wasting, and edema.