exfoliative dermatitis
Introduction
Introduction to exfoliative dermatitis Exfoliative dermatitis is a rare and serious skin disease. Also known as erythroderma. It is characterized by diffuse erythema, swelling and scaling of the whole body or large areas of the skin. Exfoliative dermatitis is a chronic erythema scaly skin disease involving the whole body or almost the whole body skin. It is an extremely rare skin side reaction in vaccination and is associated with contact dermatitis. If the amount of skin factor released after the allergic reaction is large and the lysosome is small, it is characterized by contact dermatitis; if both are large, it is exfoliative dermatitis. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: sepsis pneumonia lymphoma
Cause
The cause of exfoliative dermatitis
Causes:
The main pathogenic factors can be roughly classified into four categories: drug allergy, secondary to other skin diseases, secondary to malignant tumors and unexplained causes. Exfoliative dermatitis caused by drug allergy is the most serious type of drug eruption. The acute phase of the disease is rapid, which seriously damages the skin and mucous membranes. The wound looks like a second degree burn, often complicated by infection, and then damages organs such as liver, kidney and lung. In severe cases, shock can occur, life-threatening, and high mortality.
Prevention
Exfoliative dermatitis 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
Exfoliative dermatitis complications Complications sepsis pneumonia lymphoma
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
Exfoliative dermatitis symptoms Common symptoms Hypotension Low fever Liver splenomegaly Hepatomegaly Oral ulcers Hyperthermia Lymph node enlargement Hypertension Hair loss Testicular atrophy
1, acute phase: acute onset, extensive skin (more than 2 / 3 area of the body surface) flushing, swelling, exudate, large scaly shedding, with obvious systemic symptoms, high fever, chills, etc.; eyes, mouth, genitals Mucosal damage, conscious pain.
2, chronic phase, skin lesions dark red, dry, infiltrate obvious, overlying scaly scales, hair, nails fall off, palmars can be gloves, socks-like large pieces of desquamation; often accompanied by superficial lymph nodes, also There may be hepatosplenomegaly.
3, consciously itching, skin tightness, afraid of cold feeling.
4, systemic complications: due to a large amount of desquamation, protein loss, physical decline, can be secondary to pneumonia, anemia, heart failure and sepsis.
Chinese medicine believes that this disease is caused by wind evil, because the patient's skin is hot, sweating, pores open, wind and evil take advantage of the invasion, dryness and blood injury, resulting in blood dryness and stagnation, blood does not grow, the skin is dying and falling off .
Examine
Exfoliative dermatitis
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 exfoliative dermatitis
diagnosis
Mainly based on typical clinical manifestations. The diagnosis of the original skin disease should be based on the medical history, residual skin changes, previous skin biopsy results and response to treatment. Sometimes residual red pity or psoriasis lesions help to detect the original skin disease. Skin biopsy helps to exclude Sejari syndrome (systemic itching, paroxysmal hyperhidrosis, skin thickening, psoriasis-like or eczema-like skin lesions, possibly associated with reticuloendotheliosis) and other malignant lesions . When the lymphadenopathy is obvious, it suggests the possibility of lymphoid malignancy.
Identification
Need to identify different types of drug eruptions:
(1) The most common type of fixed drug eruption is often caused by sulfa preparations, antipyretic analgesics or barbiturates. The rash is a round or elliptical edematous purple spot with a diameter of about 1 to 2 or 3 to 4 cm. Often one, even a few boundaries are clear, and heavy ones have bullae on them. About one week after stopping the drug, the erythema disappeared and left the gray pigmentation spots, which remained for a long time. If the drug is taken after a few minutes or hours, it will itch at the original drug rash, and then the same rash will appear and expand to the surrounding area, so that the central color is deep and blisters can also occur on the edge flushing. A new rash can also appear at the time of recurrence. The number of rashes can also increase as the number of relapses increases. Damage can occur in any part, but it is more common in the skin and mucous membrane junctions such as the lips, the glans, the anus, etc. The back of the hand and the trunk often occur, and can be counted in a single or phoenix. Occurred in the wrinkle mucosa easy to smash and produce pain. Generally, it can be regressed after 7 to 10 days. If it has ulcerated, it will be heavier and heavier.
(2) Urticaria-type drug eruption is more common with penicillin, serum products (such as tetanus or diphtheria antitoxin), furazolidone and salicylate. The symptoms are similar to acute urticaria, and may be accompanied by serum-like symptoms, such as Fever joint pain, swollen lymph nodes, angioedema, and even proteinuria. If the sensitizing drug is excreted very slowly or is constantly exposed to trace allergens during life or work (if the medical staff is allergic to penicillin, the pharmaceutical factory workers are allergic to certain drugs). ), can be expressed as chronic measles.
(3) Measles-like or scarlet-like fever-like drug eruptions are more commonly caused by antipyretic and analgesic drugs, barbiturates, penicillin streptomycin and sulfonamides. Sudden onset, often accompanied by systemic symptoms such as chills and fever. Measles-like drug eruption is scattered or dense, red cap needle to large grain rash or maculopapular rash, symmetric distribution, can be generalized to the body to the trunk, similar to measles, severe cases may be associated with small bleeding point scarlet fever like drug eruption A small piece of erythema, which develops downward from the face, neck and upper extremities, and can be spread throughout the body within 2 to 3 days. When the climax is reached, the whole body is covered with erythema and the limbs are swollen, resembling a scarlet hot rash, especially the wrinkles and the flexion of the limbs. The rash of this type of drug eruption is distinct, but the systemic symptoms are milder than measles and scarlet fever, no measles or scarlet fever. Other symptoms of white blood cells can be elevated, and a small number of patients with liver function can have a transient abnormality. After 1 to 2 weeks after stopping the drug, the body temperature gradually decreased, and the color of the rash became lighter. The course of the sputum or large piece of desquamation was generally shorter, but if the cause was not found and the drug was stopped, the drug rash could be developed.
