Extensive erythematous infiltrates with desquamation

Introduction Extensive erythema infiltration damage associated with desquamation, ie erythroderma. Peel dermatosis, also known as exfoliative dermatitis, is a serious systemic disease. It is generally believed that erythroderma and exfoliative dermatitis are the same disease. The former is characterized by extensive and obvious erythema infiltration damage accompanied by versiform desquamation, and then There is extensive edematous erythema with a lot of desquamation. Because the disease is not obvious, the name of the former is better and more versatile. A skin involvement area of 90% is a prerequisite for the diagnosis of this disease.

Cause

(1) Psoriasis, eczema, seborrheic dermatitis, red pityriasis of the hair, lichen planus, etc. are caused by deterioration.

(2) Lymphoma and other malignant tumors such as mycosis fungoides, Hodgkin's disease, malignant lymphoma, leukemia, etc. may develop erythroderma, and the prognosis is serious.

(3) caused by drug allergy, should be based on the condition, carefully diagnosed and diagnosed and looking 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.

an examination

Related inspection

Skin smear microscopy skin fungal microscopy skin color urine routine

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 Sejary syndrome (systemic itching, paroxysmal hyperhidrotic skin thickening with psoriasis-like or eczema-like lesions, possibly associated with reticuloendotheliosis) and other malignant lesions. When the lymphadenopathy is obvious, it suggests the possibility of lymphoid malignancy.

1. The skin of the whole body is diffuse flushing, edema and a lot of sputum-like or leaf-like scaly, consciously itchy or itchy.

2. Hair and body hair fall off, scarce, finger or toenail thick or falling off, less sweat or no sweat.

3. May have fever, aversion to cold, burnout and swollen lymph nodes.

4. Most cases are caused by the development of other skin diseases, such as psoriasis, eczema, red pity, hair seborrheic dermatitis. The disease also occurs in malignant lymphoma, such as mycosis fungoides, Sezary syndrome, Hodgkin's disease and leukemia. There are also drug-induced erythroderma and idiopathic erythroderma (the cause is difficult to be clear).

5. Laboratory inspection

Helps to determine the original disease and general condition, such as blood and urine routine, liver, kidney, heart, lung function, plasma protein, electrolytes, bone marrow puncture, bone X-ray and biopsy.

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 an etiological diagnosis. The disease should be differentiated from toxic epidermal necrolysis type drug eruption and deciduous pemphigus.

1. Herbola red pity (pityriasis rubra of Hebra)

Can cause skin atrophy, systemic symptoms, chronic disease, easy to cause cachexia.

2. deciduous pemphigus

At the onset of the disease, bullae may appear on the normal skin mucosa, and the Nissl's sign may be 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. Drug-induced patients have a history of medication, acute onset, fever is more common, systemic symptoms are more obvious. Erythema and dermatitis-induced erythroderma often occur in typical local lesions, which are itchy. Itching and lymphadenopathy are more common in patients with psoriasis, and sometimes individual residual psoriasis lesions can be found. In the early stage of erythroderma caused by red pityriasis, a thickened, highly keratinized palm and finger follicle papules can be seen in the early stage. The most common appearance is that normal skin islands are typical features. Reticuloendothelial system tumors have infiltration, itching, swollen lymph nodes, and special manifestations of blood cells in the blood can be identified.

3. Toxic epidermal necrolysis type drug eruption

Although there are high fever, extensive large erythema and bullous skin lesions, the main lesions are large blisters on the erythema base, the blister wall is loose, and the Nissl sign is positive.

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