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Erythroderma is a term, which is used to describe severe and widespread, that is throughout reddening of the skin due to inflammatory skin disease.
It is generally associated with exfoliation, that is the skin peeling off in scales or layers and then it is known as Exfoliative dermatitis. Clinicians find out the cause of
Exfoliative dermatitis by knowing the history of illness just before the erythema and scaling and by doing bioposies and performing blood studies. It is also sometimes called, red man syndrome.
It is that in, which no primary cause can be found, inspite of serial examinations and tests. Idiopathic exfoliative dermatitis is characterized by marked palmoplantar keratoderma and a raised level of serum imunoglobulin E (IgE).
Causes of Erythroderma
Erythroderma generally arises from various causes. It arises most commonly as an extension of a pre-existing skin disorder. It may also be due to an adverse drug reaction.
The most common pre-existing skin disorders which load to erythroderma are like psoriasis, Cutaneous T-cell lymphoma, that is Sezary syndrome, Blistering diseases like pemphigus and bullous pemphigoid, Pityiasis rubra pilaris, Dermatitis like atopic dermatitis, contact dermatitis, stasis dermatitis and in babies, seborrhoeic dermatitis.
Erythroderma may also be seen in persons suffering from a systemic disease like HIV infection, lymphoma, leukaemia, Internal malignancies egr carcinoma of rectum, lung, fallopian tubes, colon, etc.
Erythroderma usually occurs in persons older than 40 years, except when the condition result from atopic dermatitis, reborrheic dermatitis, staphylococcal –scalded skin syndrome, etc. Age of onset is primarily related to etiology.
An increased skin blood perfusion occurs in Erythroderma that results in temperature dysregulation resulting in heat loss and hypothermia and high output cardiac failure. The basal metabolic rate rises to compensate for the resultant heat loss.
Fluid loss by transpiration is increased in proposition to the basal metabolic rate. The situation is similar to that observed in patients following burns, that is negative nitrogen balance occurs in them characterized by edema, hypo albuminemia and loss of muscle mass.
Clinical features of Erythroderma
It is characterized by generalized skin redness and swelling. Serous ooze, results in clothes and dressings, sticking to the skin and an unpleasant smell. Scaling occurs 2-6 days after the onset of erythema and appears as fine flakes or large sheets.
Thick scaling may develop on scalp with varying degrees of hair loss including complete baldness. Thickening of palms hands and soles of feet may occur. Abnormal temperature control results in fever and chills.
Electrolyte abnormalities and dehydration occurs because of fluid loss through the skin. Low serum albumin level occurs because of protein loss and increased metabolic rate. Secondary infection may occur with pustules and crusting. There may be swollen lymph nodes, that is lymphodenopathy.
Treatment of Erythroderma
Erythroderma is a serious disease and most patients require hospitalization to restore fluid and electrolyte balance, circulatory status and body temperature. Person should take antibiotics, if secondary infection is present. Antihistamines should be taken for severe itching.
Person should maintain skin moisture with wet dressing, emollients and mild topical steroids. Person should also monitor fluid balance and body temperature and should discontinue all unnecessary medications.
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