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Name : Tn. A
Age : 75 years old
Address : Sandana Village
Status : Married
Date of Admitted : 30 may 2013
Identify of Patient
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Main Complain
Get peeled and redness skin whole body
Anamnesis:
Skin got peeled and redness at whole body sincethree weeks ago
At first, the patient felt itchy on lower part of the feetand then become wound and gradually the woundwas being redness and peeled widely.
The itchy (+), pain (-), warm (+) and sometimes chill
History Taking
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History of medicine taking (+), salycilpowder and miconazole zalf.
History of allergic denied, History of usingantiseptic soap (+)
History of DM(+), HT(+), stroke (+)
History of the same disease in family (-)
Hypertrophy of prostate (+)
History Taking
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Anemic (-), Icterus (-), Cyanosis (-)
Diffuse erythema with overlying scale covering
>90% the body surface area
cor/pulmonal : normal
Peristaltik : (+) normal
Physical examination
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General status : compos mentis, adequate
nutrition
General Condition : Moderate Hygiene : Moderate
Vital Signs :
Blood Pressure : 130/80 mmHg
Pulse : 80x/minute RR : 24x/minute
Temperature : 36,7oC
Present Status
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Location : regio Generalisata
Efflorescency : erythem, squamos, swollen,
Location : Regio pedis dextra et sinistra
Efflorescency : ulkus, swollen,madidans
Location : superior extremity
Efflorescency : swollen
Dermatovenerology
Status
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Laboratorium
Routine Blood
WBC : 21,76x 103 /ul
RBC : 3,95x 106
/ulHGB : 11,4 g/dl
HCT : 32,3%
PLT : 296 x 103 /ul
MCV : 95.8 fl
MCH : 28,9 pg
MCHC : 35.3 gr/dl
Kesan : Leukositosis
RDW-SD : 44.8 %
PDW : 11.0
MPV : 9,8 P-LCR: 23,1%
PCT : 0,29%
NEUT : 9,18x 103
LYM : 4.,85 x 103
EO : 5,31 x 103
BASO : 0,29 x 103
MONO :2,13 x 103
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GDS : 274 mg/dl GDP : 140 mg/dl
GD2PP : 114 mg/dl Ureum : 79 Creatinin : 1.4 SGOT : 423 SGPT : 420
Kolest. Total : 145 HDL : 8 LDL : 83 Trigliserida : 275
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Diagnosis
Eritroderma ec PerluasanPenyakit Sistemik
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Differential Diagnosis
PsoriasisSebborhoic Dermatitis
Drug Eruption
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Therapy
Inerson 30 gr + salycil acid 2% + Lanolin10%+ Vaselin Add 60 gr (upper body at
morning and lower body at afternoon)
Ceterizine 10 mg 0-0-1
Compress NaCl 0,9% for Ulcer atmorning and afternoon along 2 hours
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DM Therapy
Diet DM 1700 kkal
Levemir 0-0-12
Novorapid 6-6-6
Ceftriaxon 1 gr/12 jam
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Universal redness and scaling of the skin
affecting 90-100 % of the body
ERYTHRODERMA
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Idiopathic - 30%
Drug allergy 28%
Seborrheic dermatitis 20%
Contact dermatitis 3%
Atopic dermatitis 10 %
Lymphoma and leukimia
14% Psoriasis 8%
Etiology
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The erythema extends rapidly and may be
universal in 12-48 hr. Scaling appears after 2-6 days, often first in the flexures.
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
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When the erythroderma has been present for
some weeks, the scalp and body may be shed
and the nails become ridged andthickened,and may also be shed.
The periorbital skin is inflamed and
oedematous, resulting in ectropion,withconsequent epiphora.
Clinical Manifestation
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The recognition of erythroderma is easy, but the
diagnosis of underlying cause may be very difficult.
The history is often helpful in identifying thehereditary disorders, drug reactions and psoriasis,but in some cases the erythroderma is of sudden
onset and the history may not be helpful, and theeczematous erythrodermas and those associatedwith lymphoma may not show any distinctivehistological features.
Diagnosis
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Initial treatment of any etiology involves fluid andelectrolyte replacement.
Topical :- oatmel baths
- wet dressings
- emollients (lanolin 10%/urea cream 10%)
Systemic :- Antihistamines
- Corticosteroid
- systemic antibiotics if secondary infection
Treatment
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- 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 (4-5mg/kg/day)
- methotrexate for psoriasis, atopic dermatitis,pityriasis rubra pilaris (5-25 mg qwk depend. onrenal func. and response to treatment)
continue
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- acitretin (soriatane) for psoriasis, pityriasis rubra
pilaris (25-50 mg qd )
- mycophenolate mofetil for psoriasis, atopicdermatitis, immunobullous disease (1-3 g qd )
- infliximab for psoriasis (5-10 mg/kg)
continue
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Most likely
Spongiotic dermatitis ( atopic,9% ; contact dermatitis,
6%; seborrheic dermatitis, 4%; chronic actinicdermatitis, 3%)
Psoriasis (23 %)
Drug hypersensitivity reaction (15%)
Cutaneous T-cell lymphoma (5%)
Idiopathic (approximately 20%)
Differential Diagnosis
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Consider
Contact dermatitis
Immunobullous disease Infection (scabies,dermatophytosis)
Toxin mediated
Chronic actinic dermatitis
Pityriasis rubra pilaris Collagen vascular disease
Primary immunodeficiency
continue
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