Erythroderma

Question 1

Define Erythroderma

Answer 1

other name: exfoliative dermatitis
generalized redness/ scaling of the skin, affecting (>80-90%) body surface area

Question 2

What is the clinical persentation + complications of erythrodema?

Answer 2

Clinic. Pres.:
- slowly or acutely:
* Common symptoms include: fevers, chills, malaise and pruritus
* Peripheral edema, lymphadenopathy, secondary skin infection
* Ectropion, alopecia, palmoplantar hyperkeratosis, nail dystrophy

systemic manifestations:
-tachycardia, dehydration, and thermoregulatory disturbance

-Eritroderminin Komplikasyonları:
- Temperature Dysregulation
- Hem fever, chills hem hipotermi olabilir. BMR
artmıştır.
- Fluid-Electrolyte Imbalance
- Dehidratasyon, günde 4 litreden fazla
- K artmış; diğer her şey azalmış (Na, P, Ca)
- Mechanic Barrier Disruption:
- Enfeksiyon (%90 MRSA), sepsis
- High-Output Cardiac Failure
- Taşikardi, pulmoner ödem (%30), ARDS
- Protein Loss (Negative Nitrogen Balance)
- Hipoalbüminemi, periferal ödem, kilo kaybı,
muscle wasting, kaşeksi
- Metabolic Abnormalities
- Anemi
- Demir, vitamin B12, folik asit azalmış

Question 3

What are the causes of erythroderma?

Answer 3

• Sekonder Eritroderma Sebepleri: DİMİ
  
  • Deri (%40-80):
    
    • Psoriasis (20-45 %)
    • Atopic dermatitis (5-20 %)
    • Contact dermatitis (5-20 %)
    • P. rubra pilaris (5-10 %)
    • Seborrheic dermatitis (5 %)
  • İlaç (%10-40):
    
    • Carbamazepin (5-70 %)
    • Phenytoin (15 %)
    • Phenobarbital (10 %)
    • Sulfonamides (10 %)
    • Vancomycin (5 %), penicillin (5 %)
    • Lithium (5 %)
  • Malinite (%5-20):
    
    • MF, SS (25-50 %)
    • HL, NHL (15-20 %)
    • ALL, KLL (15-20 %)
    • Thymoma, multiple myeloma, HES
    • Others
  • İnfeksiyon (%5):
    
    • SSSS
    • Scarlet fever
    • HIV
    • Scabies

Also:
Blood disorders (GVHD, Hypereosinophilic disease)
CTD (dermatomyositis)

Question 4

How to determine the underlying cause of erythroderma?

Answer 4

History:
* Onset of symptoms and course
* Past dermatologic and medical history
* Medication history
* Family history

• Physical examination
• Skin biopsy
• Lymph node biopsy
• Laboratory tests

Question 5

How to manage erythroderma?

Answer 5

• Discontinue potential offending and unnecessary medications
• Address nutrition, fluid and electrolyte balance
• Evaluate for signs and symptoms of cardiac or respiratory compromise
• Ointment-based topical steroids to all affected skin 2-3 times daily
• Oral antihistamines for relief of pruritus
• Warm, humidified environment to prevent hypothermia and improve hydration of the skin
• Treat secondary infections with systemic antibiotics
• Treat peripheral edema with leg elevation