E-mail: ude. This article has been cited by other articles in PMC. The resultant dysmetabolism is potentially life threatening. A detailed history is to identify and treat the underlying cause of this dermatitis. We present two cases of erythroderma in African patients and review this important disease. Keywords: Erythroderma, causes, African patients Introduction Erythroderma is an intense generalized redness of the skin; it was first described by Von Hebra in
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Sezary syndrome the erythrodermic form of cutaneous T-cell lymphoma Several very rare congenital ichthyotic conditions. Erythroderma may also be a symptom or sign of systemic disease. It is not known why some skin diseases in some people progress to erythroderma. The pathogenesis is complicated, involving keratinocytes and lymphocytes, and their interaction with adhesion molecules and cytokines. The result is a dramatic increase in turnover of epidermal cells.
What are the clinical features of erythroderma? Generalised erythema can develop quite rapidly in acute erythroderma, or more gradually over weeks to months in chronic erythroderma. The skin feels warm to the touch. Itch is usually troublesome and is sometimes intolerable.
Rubbing and scratching leads to lichenification. Eyelid swelling may result in ectropion. Scaling begins days after the onset of erythema, as fine flakes or large sheets.
Thick scaling may develop on the scalp with varying degrees of hair loss including complete baldness. Palms and soles may develop yellowish, diffuse keratoderma. Nails become dull, ridged, and thickened or develop onycholysis and may shed onychomadesis. Lymph nodes become swollen generalised dermatopathic lymphadenopathy. Clues may be present as to the underlying cause. Serous ooze, resulting in clothes and dressings sticking to the skin and an unpleasant smell, is characteristic of atopic erythroderma.
Persistence of circumscribed scaly plaques in certain sites such as elbows and knees suggests psoriasis. Islands of sparing, follicular prominence, orange-hue to keratoderma are typical of pityriasis rubra pilaris. Subungual hyperkeratosis, crusting on palms and soles, and burrows are indicative of crusted scabies. Sparing of abdominal creases deck chair sign is typical of papuloerythroderma of Ofuji.
Systemic symptoms may be due to the erythroderma or to its cause. Lymphadenopathy, hepatosplenomegaly, abnormal liver dysfunction and fever may suggest a drug hypersensitivity syndrome or malignancy. Complications of erythroderma Erythroderma often results in acute and chronic local and systemic complications. The patient is unwell with fever, temperature dysregulation and losing a great deal of fluid by transpiration through the skin. Heat loss leads to hypothermia.
Fluid loss leads to electrolyte abnormalities and dehydration. Red skin leads to high-output heart failure. A secondary skin infection may occur impetigo , cellulitis. General unwellness can lead to pneumonia. Hypoalbuminaemia from protein loss and increased metabolic rate causes oedema. How is erythroderma diagnosed? The blood count may show anaemia, white cell count abnormalities, and eosinophilia.
Marked eosinophilia should raise suspicions for lymphoma. Proteins may reveal hypoalbuminaemia and abnormal liver function. Polyclonal gamma globulins are common, and raised immunoglobulin E IgE is typical of idiopathic erythroderma. Skin biopsies from several sites may be taken if the cause is unknown.
They tend to show nonspecific inflammation on histopathology. Diagnostic features may also be present. Direct immunofluorescence is of benefit if an autoimmune blistering disease or connective tissue disease is considered. What is the treatment for erythroderma?
Sezary syndrome the erythrodermic form of cutaneous T-cell lymphoma Several very rare congenital ichthyotic conditions. Erythroderma may also be a symptom or sign of systemic disease. It is not known why some skin diseases in some people progress to erythroderma. The pathogenesis is complicated, involving keratinocytes and lymphocytes, and their interaction with adhesion molecules and cytokines. The result is a dramatic increase in turnover of epidermal cells. What are the clinical features of erythroderma?