Oleh :

Alifah Ramadhani Salsabila

Wa Ode Irma Nuraini
Nurul Indah Sari
Ratih Puspitasari Rohyat
Fauzan Refna Hamdani
Residen :
dr. Farah Eryanda
Dosen Pembimbing :
Dr.dr.Khairuddin Djawad,Sp.KK(K),FINSDV,FAADV
 1

• Inflammatory skin disease that

affects more than 90% of the
body surface  diffuse erythema
and scaling
• The term exfoliative dermatitis is
used synonymously, although the
degree of exfoliation is sometimes
Erythrodermic psoriasis quite mild.
Champion RH. Eczema, Lichenification, Prurigo, and Erythroderma. (2010). Champion RH eds. Rook’s, Textbook of
dermatology, 7th ed. Washington: Blackwell Scientific Publications. p; 23.46-23.49.
 2

• ♂>♀
• Age > 60 years old
• Neonatal and infantile erythroderma  very rare, and their
frequency is not known
• A study from the Netherlands estimated the annual
incidence at 0.9 per 100 000 population.
• A restrospetive study (China)  13/100.000 dermatological
pastients had erythroderma.

Miyashiro, D. and Antonio, J. (2020) ‘Erythroderma : a prospective study of 309 patients followed for 12 years in a tertiary
center’, (December 2018), pp. 1–13. doi: 10.1038/s41598-020-66040-7.
 3

1. Erythroderma due to systemic drug allergy  the second

most frequent causes erythroderma.
• anticonvulsants (especially carbamazepine)
• Penicillin, allopurinol, trimethoprim sulfamethoxazole
2. Erythroderma due to the expansion of skin disease  the
most frequent causes erythroderma.
• especially psoriasis and eczema
3. Erythroderma due to systemic disease including malignancy
 4

Based on a retrospective study on 309 erythrodermic patients, the

etiology of erythroderma is reported as in the following table

Miyashiro, D. and Antonio, J. (2020) ‘Erythroderma : a prospective study of 309 patients followed for 12 years in a
tertiary center’, (December 2018), pp. 1–13. doi: 10.1038/s41598-020-66040-7.
 5

• The pathogenesis  is not clear

• This possibility is also related to the role of various cytokines

Cytokines
TNF ICAM-1 IFNγ
(IL-1, IL-2, IL,8)

↑ epidermal Vasodilatation of
turnover rate blood vessels

Loss of epidermal ↑ blood flow to the skin

material

Generelized rythema, Cold  chills

Scales
↑ heat loss fever

Cuellar-Barboza A, Ocampo-Candiani J, Herz-Ruelas ME. A Practical Approach to the Diagnosis and Treatment of
Adult Erythroderma. Actas Dermosifiliogr [Internet]. 2018;109(9):777–90. \
 6

• Cutaneous manifestation

Diffuse scaling and Scale : Corn flake-like Palmoplantar keratoderma

erythema
 7

Alopecia Onycholysis, pitting, subungal hyperkeratosis

and splinter hemorrhage of the nail in a
patient diagnosed with psoriasis.

• Systemic manifestation
1. Cold & Chills
2. Fever
3. Pruritus
4. lymphadenopathy
5. Edema

Askin O, Altunkalem RN, Uzuncakmak TK, Toplu FŞ, Engin B. Erythroderma: A clinicopathological study of 47 cases
from 2018 to 2020. Dermatol Ther. 2020;33(6).
 8

• The diagnosis is confirmed when clinically found

erythematous skin infalammation accompanied by
desquamation covering a large area of up to 90%
of more of the body surface area

Dwi Murtiastutik. (2013) .Atlas Penyakit Kulit dan Kelamin Edisi 2. Fakultas Kedokteran Universitas Airlangga. P:125-126
 9

1. ANAMNESIS
History of :
- Disease
- Skin disease
- Family
- Use of drugs
 10

2. SKIN EXAMINATION
Erythema, scaling, and induration
are the basic skin examination
findings of erythroderma
 11

3. DIAGNOSTIC EXAMINATION
- Blood Testing
- Electrolyte Test
- Histopathology

Champion RH. Eczema, Lichenification, Prurigo, and Erythroderma. (2010). Champion RH eds. Rook’s, Textbook of
dermatology, 7th ed. Washington: Blackwell Scientific Publications. p; 23.46-23.49.
Jane Margaret Grant-Kels, Flavia Fedeles, Marti J. Rothe. Exfoliative dermatitis. In: Goldsmith LA, Katz SI, Gilchrst BA,
Paller AS, Leffel DJ, Wolff K, editors. (2012). Fitzpatrick’s dermatology in general medicine. 8th ed. New York : The
McGraw-Hill Companies. p. 266-278
 12

Psoriasis Seborrcheic dermatitis Pityriasis Rosea

Well-defined, billion- Erythema oval, lenticular-numular,

Erythematous macules covered with fine scales, the long
nummular erythematous
covered in oval papules, axis of the lesion corresponds to the
macula, covered by a
billion diffuse, oily white skin fold line, typical: solitary initial
thick, coarse, multi-
fine squama. Sometimes lesion (herald patch = medallion)
layered, shiny white scale,
erosion with yellowish oval, annular, diameter, rarely > 1
wax drop phenomenon,
crusts herald patch. Distinctive: upside down
Auspit, Kobner
fir tree (Christmas tree).
 13

• initial management: nutritional assessment, correction

of fluid and electrolyte imbalances, prevention of
hypothermia.
• systemic corticosteroids can be used in cases of
erythroderma caused by drug or idiopathic reactions:
The dosage used is initial Prednisone 1-2 mg / kg /
day and subsequent doses 0.5 mg / kg / day.

Bologna JL, Schaffer JV, Cerroni L. Dermatology 4th ed. Elsevier.2018: p.183
Jacob ANT, Psoriasis. Dalam: Ilmu Penyakit Kulit dan Kelamin Edisi 7. Jakarta. Balai Penerbit Fakultas Kedokteran
Universitas Indonesia. 2016. h 220
 14

• In refractory cases, cyclosporine has been used

successfully, with an initial dose of 5 mg / kg / day,
and further reduced to 1-3 mg / kg / day.
• Methotrexate can be used in psoriasis erythroderma
The dosage used is starting with a low dose of 7.5-15
mg weekly, Methotrexate can be immunosuppressive.

Bologna JL, Schaffer JV, Cerroni L. Dermatology 4th ed. Elsevier.2018: p.183
Ilmu Penyakit Kulit dan Kelamin Edisi 7. Jakarta. Balai Penerbit Fakultas Kedokteran Universitas Indonesia. 2016. h.220
 15

• In Erythroderma group I, namely the systemic drug

allergy, the prognosis obtained is good.
• In Erythroderma cause of which is still unknown, the use
of corticosteroid drugs can only reduce the symptoms.
• In patients who have Sezary's syndrome, the prognosis
that the sufferer will get is poor.

Djuanda A. Eritroderma . Dalam: Ilmu Penyakit Kulit dan Kelamin Edisi 7. Jakarta. Balai Penerbit Fakultas Kedokteran
Universitas Indonesia. 2016. h.230
THANK
YOU