ERHYTRODERMA

Identify of Patient

Name
: Tn. M
Age
: 70 years old
Address
: Pokko village, Polmas
Status
: Married
Date of Admitted : 27 may 2013

History Taking

Main Complain
Itching at whole body
Anamnesis:
patient felt itching at whole body ,
this sensation has been felt since 2 weeks
ago.
The itching and redness first time appear at
hands and continuing to whole body.
Nowdays, the whole body becoming dry and
peeling.

History Taking

History of medicine taking (-)

History
of
hospitalization(+)
with
cystostomy 2 month ago,
History of allergic (-),
History of the same disease (-),
History of DM(-), HT(-),
History of the same disease in family (-)

Physical examination

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

Diffuse erythema with overlying scale
covering >90% the body surface area
cor/pulmonal : normal
Peristaltik : (+) normal

Present Status

General status
: compos mentis,
adequate
nutrition
General Condition : Moderate
Hygiene
: Moderate
Vital Signs :
Blood Pressure : 120/70 mmHg
Pulse
: 88x/minute
RR
: 18x/minute
Temperature : 36,8oC

Dermatovenerology
Status

Location

: regio Generalisata
Efflorescency : erythem, erosion, excoriation,
crusta
Location
: Regio abdomen
Efflorescency : erythem, excoriation

Laboratorium

Routine Blood
WBC : 15.71 x 103 /ul
RBC : 4.05 x 106/ul
HGB : 12.6 g/dl
HCT : 38.8 %
PLT : 346 x 103 /ul
MCV : 95.8 f
MCH : 31.1 pg
MCHC : 32.5 gr/dl
Kesan : Leukositosis

RDW-SD : 43.4 %
PDW : 9.0
MPV : 8.6
P-LCR: 14.6%
PCT : 0,30%
NEUT : 5.92 x 103
LYM : 4.08 x 103
EO : 4. 59 x 103
BASO : 0.04 x 103
MONO :1.08 x 103

GDS : 95 mg/dl
Ureum : 31
Creatinin : 1.1
SGOT : 25
SGPT : 21
Prot Tot : 3,5
Albumin : 2
Globulin : 0,2
Hipoalbuminemia

Diagnosis

Eritroderma

Differential Diagnosis

Psoriasis
Sebborhoic Dermatitis
Drug Eruption

Therapy

Bethametasone + Fuson Cream

(twice a day, whole body)
Cetirizine 1x1

ERYTHRODERMA

Universal redness and scaling of the

skin
affecting 90-100 % of the body

Etiology

Idiopathic - 30%
Drug allergy 28%
Seborrheic dermatitis 20%
Contact dermatitis 3%
Atopic dermatitis 10 %
Lymphoma and leukimia 14%
Psoriasis 8%

Clinical Manifestation

The erythema extends rapidly and may

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

When the erythroderma has been

present for some weeks, the scalp and
body may be shed and the nails
become ridged and thickened,and may
also be shed.
The periorbital skin is infamed and
oedematous, resulting in ectropion,with
consequent epiphora.

Diagnosis

The recognition of erythroderma is easy, but

the diagnosis of underlying cause may be
very difficult.
The history is often helpful in identifying the
hereditary disorders, drug reactions and
psoriasis, but in some cases the
erythroderma is of sudden onset and the
history may not be helpful, and the
eczematous erythrodermas and those
associated with lymphoma may not show any

Treatment

Initial treatment of any etiology involves fuid

and electrolyte replacement.
Topical :
oatmel baths
wet dressings
emollients (lanolin 10%/urea cream 10%)
Systemic :
Antihistamines
Corticosteroid
systemic antibiotics if secondary infection

continue

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 (45 mg/kg/day)
methotrexate for psoriasis, atopic dermatitis,
pityriasis rubra pilaris (5-25 mg qwk depend.
on renal func. and response to treatment)

continue

acitretin (soriatane) for psoriasis, pityriasis

rubra pilaris (25-50 mg qd )
mycophenolate mofetil for psoriasis, atopic
dermatitis, immunobullous disease (1-3 g qd )
infiximab for psoriasis (5-10 mg/kg)

Differential Diagnosis

Most likely
Spongiotic dermatitis ( atopic,9% ; contact
dermatitis, 6%; seborrheic dermatitis, 4%;
chronic actinic dermatitis, 3%)
Psoriasis (23 %)
Drug hypersensitivity reaction (15%)
Cutaneous T-cell lymphoma (5%)
Idiopathic (approximately 20%)

continue

Consider
Contact dermatitis
Immunobullous disease
Infection (scabies,dermatophytosis)
Toxin mediated
Chronic actinic dermatitis
Pityriasis rubra pilaris
Collagen vascular disease
Primary immunodeficiency