8/9/2019 Eryhtroderma grup 1

1/28

ERHYTRODERMA

8/9/2019 Eryhtroderma grup 1

2/28

Name : Tn. M

Age : 70 years old

Address : Pokko village, Polmas

!a!"s : Married

Da!e o# Admi!!ed : $7 may $0%&

'den!i#y o# Pa!ien!

8/9/2019 Eryhtroderma grup 1

3/28

8/9/2019 Eryhtroderma grup 1

4/28

His!ory o# medi*ine !aking /1 His!ory o# +os)i!ali2a!ion/31 i!+*ys!os!omy $ mon!+ ago,

His!ory o# allergi* /1,

His!ory o# !+e same disease /1,

His!ory o# DM/1, HT/1,

His!ory o# !+e same disease in #amily /1

His!ory Taking

8/9/2019 Eryhtroderma grup 1

5/28

Anemi* /1, '*!er"s /1, (yanosis /1

Di4"se ery!+ema i!+ overlying s*ale

*overing 560 !+e -ody s"r#a*e area *or8)"lmonal : normal

Peris!al!ik : /31 normal

P+ysi*al e9amina!ion

8/9/2019 Eryhtroderma grup 1

6/28

eneral s!a!"s : *om)os men!is,

ade;"a!e n"!ri!ion

eneral (ondi!ion : Modera!eHygiene : Modera!e

>98min"!e

 RR : %>98min"!e

  Tem)era!"re : &?,>o(

Presen! !a!"s

8/9/2019 Eryhtroderma grup 1

7/28

@o*a!ion : regio eneralisa!a

Eores*en*y : ery!+em, erosion, e9*oria!ion,

*r"s!a@o*a!ion : Regio a-domen

  Eores*en*y : ery!+em, e9*oria!ion

Derma!ovenerology

!a!"s

8/9/2019 Eryhtroderma grup 1

8/28

8/9/2019 Eryhtroderma grup 1

9/28

8/9/2019 Eryhtroderma grup 1

10/28

8/9/2019 Eryhtroderma grup 1

11/28

8/9/2019 Eryhtroderma grup 1

12/28

8/9/2019 Eryhtroderma grup 1

13/28

@a-ora!ori"m

Ro"!ine =lood

 B=( : %C.7% 9 %0& 8"l

 R=( : .0C 9 %0?8"l H= : %$.? g8dl

 H(T : &>.>

  P@T : &? 9 %0& 8"l

 M(< : 6C.>

 M(H : &%.% )g

 M(H( : &$.C gr8dl

Fesan : @e"kosi!osis

RDBD : &.

PDB : 6.0

MP< : >.? P@(R: %.?

P(T : 0,&0

NEGT : C.6$ 9 %0&

@YM : .0> 9 %0

&

EO : . C6 9 %0&

=AO : 0.0 9 %0&

MONO :%.0> 9 %0&

8/9/2019 Eryhtroderma grup 1

14/28

D : 6C mg8dl

Gre"m : &%

(rea!inin : %.%

OT : $C

PT : $%

Pro! To! : &,C

Al-"min : $

lo-"lin : 0,$

  Hi)oal-"minemia

8/9/2019 Eryhtroderma grup 1

15/28

Diagnosis

Eri!roderma

8/9/2019 Eryhtroderma grup 1

16/28

Di4eren!ial Diagnosis

Psoriasis e--or+oi* Derma!i!is

Dr"g Er")!ion

8/9/2019 Eryhtroderma grup 1

17/28

 T+era)y

=e!+ame!asone 3 "son (ream/!i*e a day, +ole -ody1

(e!iri2ine %9%

8/9/2019 Eryhtroderma grup 1

18/28

Gniversal redness and s*aling o# !+eskin

 a4e*!ing 60%00 o# !+e -ody

ERYTHRODERMA

8/9/2019 Eryhtroderma grup 1

19/28

'dio)a!+i* &0

Dr"g allergy I $>

e-orr+ei* derma!i!is I $0

(on!a*! derma!i!is I &

A!o)i* derma!i!is I %0

@ym)+oma and le"kimia I %

Psoriasis I >

E!iology

8/9/2019 Eryhtroderma grup 1

20/28

 T+e ery!+ema e9!ends ra)idly and may

-e "niversal in %$> +r. *aling

a))ears a#!er $? days, o#!en rs! in !+ee9"res.

 T+e s*ales may -e large, or ne and

-ran like. A! !+is s!age !+e skin is -rig+!red,+o! and dry and )al)a-ly !+i*kened.

Pr"ri!"s is o#!en *a"se -y e*2ema.

(lini*al Mani#es!a!ion

8/9/2019 Eryhtroderma grup 1

21/28

B+en !+e ery!+roderma +as -een

)resen! #or some eeks, !+e s*al) and

-ody may -e s+ed and !+e nails-e*ome ridged and !+i*kened,and mayalso -e s+ed.

 T+e )erior-i!al skin is inamed andoedema!o"s, res"l!ing in e*!ro)ion,i!+*onse;"en! e)i)+ora.

(lini*al Mani#es!a!ion

8/9/2019 Eryhtroderma grup 1

22/28

 T+e re*ogni!ion o# ery!+roderma is easy, -"!

!+e diagnosis o# "nderlying *a"se may -e

very diJ*"l!.  T+e +is!ory is o#!en +el)#"l in iden!i#ying !+e

+eredi!ary disorders, dr"g rea*!ions and

)soriasis, -"! in some *ases !+eery!+roderma is o# s"dden onse! and !+e+is!ory may no! -e +el)#"l, and !+ee*2ema!o"s ery!+rodermas and !+ose

asso*ia!ed i!+ lym)+oma may no! s+o any

Diagnosis

8/9/2019 Eryhtroderma grup 1

23/28

'ni!ial !rea!men! o# any e!iology involves "idand ele*!roly!e re)la*emen!.

 To)i*al : oa!mel -a!+s

e! dressings

emollien!s /lanolin %08"rea *ream %01

ys!emi* :

An!i+is!amines

(or!i*os!eroid

sys!emi* an!i-io!i*s i# se*ondary in#e*!ion

 Trea!men!

8/9/2019 Eryhtroderma grup 1

24/28

di"re!i*s #or )eri)+eral edema

*or!i*os!eroid #or dr"g +y)ersensi!ivi!y

rea*!ions,imm"no-"llo"s disease,a!o)i*derma!i!is /%$ mg8kg8day i!+ !a)er 1

*y*los)orine #or )soriasis, a!o)i* derma!i!is /C mg8kg8day1

me!+o!re9a!e #or )soriasis, a!o)i* derma!i!is,)i!yriasis r"-ra )ilaris /C$C mg ;k de)end.on renal #"n*. and res)onse !o !rea!men!1

*on!in"eK

8/9/2019 Eryhtroderma grup 1

25/28

a*i!re!in /soria!ane1 #or )soriasis, )i!yriasis

r"-ra )ilaris /$CC0 mg ;d 1

my*o)+enola!e mo#e!il #or )soriasis, a!o)i*derma!i!is, imm"no-"llo"s disease /%& g ;d 1

ini9ima- #or )soriasis /C%0 mg8kg1

*on!in"eK

8/9/2019 Eryhtroderma grup 1

26/28

Mos! likely

L )ongio!i* derma!i!is / a!o)i*,6 *on!a*!

derma!i!is, ? se-orr+ei* derma!i!is, *+roni* a*!ini* derma!i!is, &1

L Psoriasis /$& 1

L Dr"g +y)ersensi!ivi!y rea*!ion /%C1

L ("!aneo"s T*ell lym)+oma /C1L 'dio)a!+i* /a))ro9ima!ely $01

Di4eren!ial Diagnosis

8/9/2019 Eryhtroderma grup 1

27/28

(onsider

L (on!a*! derma!i!is

L 'mm"no-"llo"s disease

L 'n#e*!ion /s*a-ies,derma!o)+y!osis1

L To9in media!ed

L (+roni* a*!ini* derma!i!is

L Pi!yriasis r"-ra )ilaris

L (ollagen vas*"lar disease

L Primary imm"node*ien*y

*on!in"eK

8/9/2019 Eryhtroderma grup 1

28/28