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M . IZAZI HP
Departemen Ilmu Kesehatan Kulit dan Kelamin Fakultas Kedokteran UNSRI/RSMH Palembang 2011
dr. M. Izazi HP SpKK 1
2009
4/8/2013
characterized diffuse erythema & scaling involving >90% total body skin surface Cause ED unknown, approximately 20% cases idiopathic ED
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Epidemiology
Incidence 0,9-71,0/100000 outpatient Male > female ratio 2,1 : 4,1 Average onset 41 61, rare children Many diseases associated ED exacerbation previously localized disease >1/2 psoriasis identified almost cases
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Etiology
Drug Calcium channel blocker Anti-epileptic antibiotics (penicillin family, sulfonamides vancomycin Allopurinol,gold,lithium Quinidine Cimetidine Dapsone
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ED atopic dermatitis
ED atopic dermatitis, psoriasis and CTCL Circulating intercellular adhesion molecule 1 (ICAM 1) Vascular cell adhesion molecule1 (VCAM1) E-selectin
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Discontinuation poten topical or oral CS, metotraxate, or biologic treatment (efalizumab) Medicationlithium,terbinafine,antimalaria Topical irritanTar Infection HIV infections Pregnancy Emotional stress Systemic illness
dr. M. Izazi HP SpKK 7
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Chronic Idiopathic ED
risk progression mycosis fungoides or sezary syndrome Theorieschronic T-cell stimulation in chronic ED (atopic ED)promote developed CTCL In elderly patients with chronic or relapsing ED monoclonal CD4+CD7CD26- lymphocytes monoclonal Tcell dyscrasia of undertermined significance
dr. M. Izazi HP SpKK 8
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Pathogenesis
Not well understood Theorized staphylococcus aereus colonization (83% in the nares& 17% skin &nares) or another antigen (shock syndrome toxin-1) Cytokine profileTh1 cytokine Different profilebenign ED mechanism Sezary syndrome Th2cytokine IgE
dr. M. Izazi HP SpKK 9
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ED in psoriasis
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SEZARY SYNDROME
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Thermoregulator disturbance hyperthermia/ hypothermia most patients complain of feeling chilly Tachycardiaincreased blood flow to the skin High-output cardiac failure Peripheral pedal or pretibial edema Generalized lymphadenopathy Hepatomegaly Splenomegaly
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Laboratoric finding
Non specific Anemia, leucocytosis, lymphocitosis eosinophilia, IgE, ERS abnormal Electrolyte & creatinine Sezary syndrome circulating cell sezary >20% Quantitative real-time PCR assay molecular diagnosis Sezary syndrome Predominance CD4+
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Complication
Systemic fluid & electrolyte imbalance Thermoregulatory disturbance Fever Hypoalbunemia Peripheral edema susceptibility bacterial colonization Sepsis CTCL & HIV (+) risk staphylococcus sepsis
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Treatment
fluid & electrolyte Replacement ED caused drug discontinous Enviroment warm & humid Preventing hypothermia Gentle local skin care Bland emollient
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Treatment
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Topical treatment
Started CS low potency CS high potency, immunomodulator (tacrolimus) avoided Systemic Topical irritants absorption (anthralin&tar) avoided
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Treatment systemic
Psoriasis EDSystemic CS avoided Psoriasis ED reponsive MTX, cyclosporine,acitretin, mycophenolate mofetil, th/ biologic
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Treatment symptomatic
Sedating antihistaminpruritus Diuretica & leg elevation leg edema refractory Systemic antibiotic
localized & systemic secondary infection Without evidence secondary infection as bacterial colonization
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Approach ED
CXR=chest X-ray
PCP=primary care physician
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