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  RDW-SD : 43.4 %
 WBC : 15.71 x 103 /ul  PDW : 9.0
 RBC : 4.05 x 106/ul  MPV : 8.6
 HGB : 12.6 g/dl  P-LCR: 14.6%
 HCT : 38.8 %  PCT : 0,30%
 PLT : 346 x 103 /ul  NEUT : 5.92 x 103
 MCV : 95.8 fl  LYM : 4.08 x 103
 MCH : 31.1 pg  EO : 4. 59 x 103
 MCHC : 32.5 gr/dl  BASO : 0.04 x 103
Kesan : Leukositosis  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 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

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 inflamed 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 distinctive
histological features.
 Treatment

Initial treatment of any etiology involves fluid 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 (4-5
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 )
- infliximab 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
