Erythrodermia is also known as Exfoliative Dermatitis or Red Man Syndrome. It is an inflammatory skin disease with erythema and scaling, which affects the entire skin surface. It is characterized by keratodermie which is especially on hand and sole , dermatophatic lymphadenopathy and increased serum of Ig E.
Erythroderma may occur as a response to drug therapy, systemic disease or the entity may be unknown. Over 40% of cases involve existing skin disease. About 10% of cases are drug reactions. 40% are caused by systemic diseases. The rests are idiopathic. This disease occurs due to other diseases such as lupus erythematosus, atopic dermatitis, contact dermatitis, pemphigus, psoriasis, sarcoidosis, stasis dermatitis,etc. Over 60 drugs have been implicated in the erythroderma etiology.These drugs are: penicillins, sulfonamides, carbamazepine, phenytoin, gold
, allopurinol, captopril.Carbamazepine can cause a pseudolimfomatos syndrom, allopurinol may be accompanied by hepatitis, gastrointestinal bleeding and nephropathy.
Pathogenesis and symptoms
Normal epidermis has a fast turnover of epithelial cells. Cell division occurs in the basal layer. As the cells migrate to the periphery they become keratinized. This process requires 10-12 days. Cells remain in the corneum layer for another 14 days before they exfoliate.
In erythrodermia in the basal layer,the mitotic rate increases and decreases during the transition, so many cells are lost from the surface. The responsible mechanism is unknown.Erythrodermia affecting people over 40 years but the disease can occur in those with atopic or seborrheic dermatitis. Patients who suffering from this disorder have generalized erythema and scaling occurs after 2-6 days. If the condition persists for several weeks,the patient can observe the fall hair or tendency of stiffness and thickening of the nail.Another consequence of the disease is the pigmentary changes that occur only in severe cases. Potential systemic manifestations include fever, chills, hypothermia, reactive adenopathy, peripheral edema, hypoalbuminemia and heart failure.
Patients with erythrodermia should be hospitalized,especially those who have fever, hypotension and toxic shock,because this disease can be treated.This means, more specifically, balancing electrolyte and conducting laboratory studies of the protective and enabling the prevention of bacterial infection and fungal infections.
During treatment will also consider topical maintaining hydration and the patient will be protected from possible hypothermia.They have to keep their skin hydrated, avoid scratching and precipitating factors.In these disease the most important thing and the first step in erythrodermia treatment is to treat the underlying disease,otherwise erythrodermia will resist to therapy. Also, the patient needs a high-protein diet with additional folic acid. To relieve symptoms, the patient can make a warm bath, apply emollient creams and wet dressings with triamcinolone. For secondary infection is administered antihistamines,which are also useful for reducing itching.
With regard to disease,the prognosis is related to underlying disease. Evolution is marked by multiple exacerbation and is required corticosteroid therapyThe fact is that erythroderma rapidly evolving when the patient has a drug allergy, lymphoma, leukemia, scalded skin syndrome or contact allergens. The mean duration of disease is about 5 years with a median of 10 months. In erythrodermia disease, mortality occurs in approximately 20-40% of cases.