Erythroderma
Introduction
Introduction to erythroderma This disease is also known as exfoliative cheilitis, generally divided into acute and chronic two types. The typical manifestation of erythroderma is diffuse flushing, infiltration, swelling, and scaling of the skin. The affected area of the skin lesions is more than 80% of the entire skin, but the erythroderma is not only manifested in the skin, mucous membranes, skin appendages, and lymph nodes. Even the internal organs are affected. Therefore, erythroderma is not only a skin change, it can involve a variety of organs, and it is extremely harmful to patients. The cause of the disease may be related to drug allergy, further development of certain inflammatory skin diseases, malignant tumors, etc., and the reasons are unknown. Red skin disease is a serious skin disease that is fierce and can be as high as 10% to 20%. Therefore, the treatment of erythroderma should be timely and accurate. Mainly from the following aspects: (1) etiology treatment: for patients with unexplained erythroderma, stress to find the cause. The reasons are clear, but also pay attention to what incentives can make the condition worse. (2) Supportive therapy: Because of the large amount of desquamation in patients with erythroderma, protein loss, and fever also consumes water and heat in the body, so it is very important to timely supplement enough protein, water and electrolytes. (3) Anti-infection: The skin lesions of erythroderosis are all over the body. The skin loses its ability to resist external bacteria. In addition, the use of corticosteroids, the body's resistance is low, and it is highly susceptible to infection. Once the infected area is found, it is necessary to give a sufficient amount of effective antibiotics in time to try to control the infection in a short period of time. (4) Hormone therapy: The principle of using hormones is sufficient. Under normal circumstances, 40 to 60 mg of prednisone is given daily. After the symptoms are controlled, the amount of hormone should be gradually reduced, and you must not stop the drug suddenly. (5) Chinese medicine treatment: According to TCM syndrome differentiation, erythroderma can be divided into toxic heat accumulation, heat poisoning dampness and heat stagnation. Traditional Chinese medicine has its own unique features for the treatment of erythroderma. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: splenomegaly, lymphoma, pneumonia, sepsis, duodenal ulcer, pyelonephritis, thrombosis, myocarditis
Cause
Etiology of erythroderma
Drug allergy (25%)
Caused by drug allergies. According to the condition, carefully diagnosed and diagnosed and looked for the cause. The course of the disease is chronic and difficult to cure. Should be treated according to the primary disease. Supportive therapy should be used for treatment, high protein, high vitamin diet, and small amount of blood transfusion. Give antibiotics when there is an infection, but should pay attention to allergic reactions. Strengthen care and appropriate external use of drugs.
Fire poisoning (15%)
The card shows redness and swelling of the whole body, burning itching or bullae, erosion and exudation, chills, high fever, upset, and want to drink. Yellow greasy moss, red tongue, pulse number.
Qi and Yin deficiency (8%)
The card is red and swollen, the exudation is reduced, the skin is dark red, the epidermis is desquamate, and the shape is like deciduous, fever or light or heavy, weak and weak, mouth licking, not thinking about diet, or tongue smashing, eating difficulties. The tongue is not mossy, and the pulse is fine.
Other factors (5%)
Psoriasis, eczema, seborrheic dermatitis, red pityriasis, lichen planus, etc. are caused by deterioration. Lymphoma and other malignant tumors such as mycosis fungoides, Hodgkin's disease, malignant lymphoma, leukemia, etc. may develop erythroderma, and the prognosis is serious.
Prevention
Red skin disease prevention
Cold-proof insulation, strengthen nutrition, strengthen nursing, prevent infection, prevent fatigue, and closely observe the general condition of patients to actively treat the primary disease.
1. Avoid drug abuse. Do not use irritating drugs for other skin diseases in the acute phase.
2. Eat high-protein foods, eat more fruits and vegetables, avoid drinking alcohol and spicy spicy food.
3. For erythroderma caused by drug allergy, the choice of medication during treatment should be particularly careful to avoid cross-allergic reactions.
4. Pay attention to the cleanliness of the skin and maintain a good environment, such as air circulation, regular space disinfection, cleansing of bedding, etc., especially the care of the mouth, eyes, vulva and prevention of hemorrhoids.
Complication
Red skin disease complications Complications splenomegaly, lymphoma, pneumonia, duodenal ulcer, pyelonephritis, thrombosis, myocarditis
About 1/3 to 2/3 patients may be associated with hepatomegaly and/or splenomegaly. It is more common in drugs and lymphomas. A large amount of water and protein is lost, which can lead to high-displacement heart failure, water, electrolytes, Protein balance disorder, if secondary infection, can cause pneumonia and sepsis, and eventually can cause death.
(1) Exfoliative dermatitis can cause other diseases to worsen and die, such as tuberculosis spread, duodenal ulcer perforation, and the original pyelonephritis, thrombosis and hemorrhagic enteritis deteriorate due to decreased body resistance.
(2) Patients with erythroderma secondary to malignant tumors often die due to ineffective treatment of malignant diseases.
(3) Directly dying from all kinds of severe complication of exfoliative dermatitis. The common symptoms are as follows:
1 secondary infection with exfoliative dermatitis due to incomplete epidermis, low resistance, combined with the use of corticosteroids, easy to concurrent infection, and the symptoms of infection are affected by corticosteroids, difficult to find early, once the symptoms are obvious, it is already Very serious, infections include bacterial, fungal and viral infections, of which bacterial infections are most common, most invade the skin and respiratory tract, and even lead to sepsis and death.
2 heart failure due to high fever leading to tachycardia, as well as toxic myocarditis, hypovolemia and other reasons, can cause heart failure and death.
3 Other causes can cause death directly due to hypothermia, and liver failure due to drug damage to the liver.
Symptom
Symptoms of erythroderosis Common symptoms Hepatosplenomegaly, hypothermia, skin mucin, deposition, hepatomegaly, hepatomegaly, hypotension, oral ulcer, high blood pressure, high fever, hair loss
The typical manifestation of erythroderma is diffuse flushing, infiltration, swelling, desquamation, and the affected area of the skin lesions reaches more than 80% of the entire skin, but erythroderma is not only manifested in skin, mucous membranes, skin appendages, lymph nodes. Even the internal organs are affected.
(1) mucosal symptoms are more obvious, there may be ocular membrane inflammation, orbital blepharitis, keratitis, corneal ulcer, oral redness, ulcers, pain, aggravation of symptoms when swallowing, mucous membranes of female genitals, urethra, anus often smashed, Secretion.
(2) The hair of the skin appendage is detached, the hair of the skin is sparse, and the heavy one can cause a large amount of shedding. The more severe the condition, the more obvious the hair detachment. After the disease is restored, the hair can be regenerated, and the nail can be atrophied and turbid. Depression, etc., especially with psoriatic erythroderma, the most obvious change.
(3) lymphadenopathy: 2/3 erythrodermic patients have different degrees of lymphadenopathy, of which the groin and axillary lymph nodes are most affected, followed by the neck.
(4) hepatosplenomegaly: about 1/3 to 2/3 patients with hepatosplenomegaly, drug allergy and lymphoma caused by erythroderma, hepatosplenomegaly have more chances, if there is obvious Hepatosplenomegaly should be considered for malignant lymphoma.
(5) Increased body temperature Under normal conditions, the body's heat production and heat dissipation process maintains a dynamic balance. Patients with erythroderma may be exposed to different degrees of fever due to the absorption of toxins and abnormal function of skin heat dissipation. Most patients have a body temperature of 38 ° C to 39 ° C. Left and right, if the fever is high, the symptoms of poisoning are obvious, and concurrent infection should be considered.
(6) Hemodynamic changes: patients with erythroderma may have elevated jugular venous pressure, enlarged liver, depressed edema of lower limbs, increased heart rate, etc. These symptoms are aggravated with the deterioration of skin lesions, and are alleviated as skin symptoms improve. In elderly patients, or patients with hypertension, coronary heart disease, poor cardiac function, hemodynamic changes, can cause heart failure, and even cause death.
(7) Endocrine changes: There are a few male patients with breast feminization, testicular atrophy, sperm reduction, women can cause menstrual disorders, breast tissue hyperplasia, accompanied by abnormalities of sex hormones and their metabolites.
Examine
Examination of erythroderma
Laboratory examination: The total number of white blood cells increased, and the increase was more obvious with bacterial infection. Eosinophilia, some cases have hypochromic anemia, low plasma protein, and increased ESR. Corresponding changes may occur in people with visceral lesions, such as proteinuria, hematuria, liver and kidney dysfunction, and changes in electrocardiogram. Specific bone marrow and peripheral blood changes may occur in concurrent tumors.
Diagnosis
Diagnosis and identification of erythroderma
diagnosis
The diagnosis of erythroderma is not difficult, mainly to find the cause of erythroderma. To inquire about the medical history in detail, and conduct a physical examination in a comprehensive and systematic manner, often the clues of the primary disease can be found, and those with unknown reasons should be followed up for a long time.
1. Skin, early symptoms of mucous membranes vary with the cause of the disease. Drug-induced, clear medication history, rapid onset, secondary to other skin diseases, may cause these skin diseases to the whole body due to improper medication or improper medication. The development of erythroderma, secondary to malignant tumors, the majority of onset is slow, after a more moderate.
There are two types of typical clinical manifestations: one type of patient has an acute onset, and the systemic symptoms are heavy. Generally, it is a scarlet fever or a measles-like rash. Then the whole body is filled with flushing, swelling, exudation, wrinkles and joint activities (such as underarms). , perineum, around the anus, elbow, ankle) obvious, can form suede, secondary infection can form folliculitis, sputum, or blood flow into sepsis, rash color is initially bright red, and then turn dark, may be accompanied Hemorrhagic rash, mucosal symptoms are more obvious, there may be conjunctivitis, blepharitis, keratitis, corneal ulcer, cheilitis, angular cheilitis, oral ulcers and perineal mucosal erosion, exudation, with the recovery of the disease, a large number of spots or Tablet-like desquamation, hand and foot in a set, with itching, can leave pigmentation, the average course of disease is 1 to 2 months, another type of onset is slow, systemic symptoms are mild, mucosal symptoms are mild or absent, and the skin is diffuse The flushing is mainly infiltrated, the symptoms of exfoliation are relatively mild, the symptoms are light and heavy, and repeated attacks can be delayed for several months or years.
2. Hair has different weight loss, which is positively related to the severity of the disease. The nail can be atrophied, turbid, sag, mediastinal and anti-warping, etc. The erythroderma caused by psoriasis is more obvious, 2/3 erythroderma Patients with varying degrees of lymphadenopathy, the most common inguinal and axillary, about 1/3 to 2 / 3 patients may be associated with hepatomegaly and / or splenomegaly, more common with drugs and lymphoma.
3. Systemic changes in patients with erythroderma due to the absorption of toxins or malfunction of heat dissipation, can cause different degrees of fever, most of which are medium and low fever. If it is high fever, the possibility of infection should be considered. In addition, a few may also be low. Body temperature may be caused by passive expansion of skin blood vessels and increased heat dissipation. Low body temperature is easy to be infected, resulting in hypotension, bradycardia, and ventricular fibrillation. Because it is often not detected and treated in time, it should be highly valued.
In addition, due to skin vasodilation, increased vascular permeability, loss of a large amount of water and protein, can lead to high-displacement heart failure, water, electrolytes, protein balance disorders, if secondary infection, can cause pneumonia and sepsis, etc., ultimately death.
TCM syndrome differentiation:
According to the clinical manifestations, the characteristics of skin lesions and histopathological features were diagnosed.
Main card: skin lesions are hot and hot, food is not fragrant, mouth bitter, upset, irritability, can not fall asleep, dry stool, less red urine, red tongue, white or yellow moss and greasy, pulse string slippery.
Dialectical: toxic heat into the camp, qi and blood two sputum, late thirst do not want to drink, low fever does not retreat to the image of injury.
Differential diagnosis
According to the diffuse flushing, edema, infiltration and desquamation of the whole skin, itching is severe, and the course of disease is long. The diagnosis of this disease is not difficult. It is important to find the cause and make the cause of the diagnosis. The disease should be related to the toxic epidermal necrolysis type. Drug eruption, deciduous pemphigus identification.
1. Pityriasis rubra of Hebra can cause skin atrophy, severe systemic symptoms, chronic course, and easily cause cachexia.
2. deciduous pemphigus: bullatosis can occur on the normal skin mucosa at the onset of the disease, and the Nissl's sign is positive. The histopathology may include epidermis bullae and spine cell release.
It is not difficult to distinguish erythroderma from the above diseases. It is important to find out the cause. The drug-induced patients have a history of taking drugs, acute morbidity, fever is more common, systemic symptoms are more obvious, and erythroderma caused by eczema and dermatitis is often secondary to Typical local damage, itching, psoriasis caused by itching and lymphadenopathy, sometimes can find some typical residual psoriatic lesions, red rash caused by red pityriasis can be seen early thickening Highly keratinized follicular papules on the palms and back of the fingers. The most common manifestations are normal skin islands. Invasive, itchy, swollen lymph nodes, and blood cells in the blood. Special performance can be identified.
3. Toxic epidermal necrolysis type drug eruption: Although there is high fever, extensive large erythema and bullous skin lesions, but the main lesions are large blisters on the erythema base, the blister wall is loose, and the Nissl sign is positive.
