Erythroderma

Erythroderma is a General name for different etiology and pathogenesis of skin diseases, characterized by widespread, often universal redness, swelling or infiltration and peeling skin. Peeling often plate, but may be small, pityriasis.
There are a eritrodermii primary and secondary; the latter is layered on top of existing skin diseases (psoriasis, red flat zoster, and others). The eritrodermii can be acute, subacute and chronic. Acute eritrodermii most often are the result of hypersensitivity (Allergy) to various drugs (arsenic, mercury, sulfanilamida, antibiotics and others). Chronic eritrodermii occur as manifestations of systemic diseases (leukemia, retikulez, chlamydia, mushroom avium, and others). Etiological diagnosis of chronic eritrodermii establish a comprehensive examination of patients. Treatment depending on the cause. Naruzhno - emollient cream.
Consider the following independent forms of eritrodermii.
1. Erythroderma Wilson - Brock. Observed in adults, flows subacute or chronic; in different parts of the skin appear itchy spots, increasing and merging, they amaze the skin. The skin becomes red, infiltered and covered with coarse lamellar scales; hair and nails fall. It is often stated fever, headache, diarrhea, vomiting and other Etiology is unknown. Disease duration from several months to several years; the forecast is difficult. Treatment with corticosteroids.
2. Congenital ihtiosiformnye erythroderma - see Ichthyosis.
3. Desquamative erythroderma Liner (Leiner disease) is a disease caused by insufficient intake of the newborn of vitamin b complex, especially vitamin H (Biotin). The disease begins on the 2nd-3rd week of life and is characterized by three main symptoms: skin, gastrointestinal tract, changes in the blood.
The skin in the form of bright redness begins in the skin folds and in the buttocks; further redness covers legs, trunk, face; in 2-3 days may be amazed at all the skin. During the full development of diseases of the skin is red, infiltrated several, covered with a large number pityriasis or melkoporistyh scales, easily falling. On the buttocks and hands skin is tense and brilliant, in the folds - little moist, on the scalp - the massive cover or trudnoscieralne scales.
Along with skin changes are marked diarrhoea disorders. In blood develops hypochromic anemia, the number of leukocytes.
Skin lesions hold 20 to 30 days, then infiltration decreases, the skin becomes elastic and takes normal color.
Possible complications: otitis media, pneumonia, sometimes multiple abscesses, Peoria.
Treatment. The correct feeding mother with the introduction of vitamins: vitamin B6 25 mg, vitamin C 100 mg per day; concentrate of vitamin a 20 drops once a day, 1 is assigned to nursing mothers (children due to gastrointestinal disorders give not recommended). In severe course of the disease is shown introduction of gamma globulin, and anemia - vitamin B12 injection of 30-50 mg, 10-15 injections a day. When complications prescribe antibiotics, blood transfusion, plasma, heart funds. Locally applied cream Uns, 0,5% salicylic acid, 5% dermatology ointments, corticosteroid ointments (prednizolonovuyu, lookeren sinalar), peach oil; on moist sites - lotions from 1-2% solution of tannin, daily baths with potassium permanganate (blue solution).
Very important to care of the child: sterile or ironed linen, skin cleansing after bowel movement sterile vegetable oil. At the improvement of the General state shall appoint, starch or soda baths (see Baths, baths for children). With the child need to go out (not in the sun!).
With proper treatment, the prognosis is good, when there are complications is deteriorating.

Erythroderma (from the Greek. erythros red and derma - skin) - a collective term that refers to a group of skin diseases of different etiology and pathogenesis. The eritrodermii divided into primary and secondary; the latter arise in medicine - psoriasis, eczema and other lesions, and as a result of allergies to antibiotics, sulfonamides. Secondary erythroderma, complicated by necrosis of large areas of the epidermis, is the leading clinical manifestation when Lyell's syndrome (A. Lyeil)Clinic of eritrodermii characterized by widespread inflammation of the skin, sharp redness, peeling, sometimes coarse lamellar, swelling and infiltration of the skin. When complications weeping often joins the secondary pyococcal infection. The eritrodermii are acute, subacute and chronic possible transitional and mixed forms. Histologically: swelling, especially maleyevka layer, intercellular and intracellular acanthosis, parakeratosis, inflammatory infiltrate. In acute eritrodermia more cutting inflammation and swelling.
Erythroderma Wilson - Brock (synonym generalized exfoliative dermatitis Wilson - Brock) - the etiology is unclear, sick adults; begins with the appearance in the folds, and then and on the other skin lesions redness that after 1-2 weeks turn into vast tracts, later the process captures all the skin. The skin is bright red, swollen, almost was going to fold, coarse lamellar peeling, especially sharp on the palms and soles. In severe frequent vomiting, diarrhoea phenomenon, the temperature increase up to 38-40 degrees. Notes hair loss and rejection of the nail plate. In the folds often develops maceration, which contributes to the complication strepto-staph infection (streptoderma, furuncles). Forecast heavy. Treatment: corticosteroids (prednisone, triamcinolone, dexamethasone), vitamins of groups b, C, blood transfusion. Topical ointments and creams with corticosteroids.
Exfoliative dermatitis newborns (synonym Ritter's disease) - erythroderma pyococcal etiology, growing in the first weeks of life; generalized hyperemia sometimes preceded by a stage of formation of bubbles, begins acutely, sometimes within 1-2 days. Clinically: skin bright-red colour with flaking large areas (reminds burn). Forecast heavy. Treatment: broad-spectrum antibiotics, sulfanilamides, excessive drinking, topical creams and emulsions with antibiotics, tannic baths. Prevention: the observance of hygiene when caring for a newborn, prevent contact with persons suffering from pyodermia.
Erythroderma congenital ihtiosiformnye - see Ichthyosis.


Erythroderma desquamative Liner (erythrodermia desquamative Leiner; synonym disease Liner-Moussa) is characterized by erythema, coarse lamellar peeling skin, almost always dysfunction of gastrointestinal tract and violation of the General conditions.
The etiology and pathogenesis is poorly studied.
Pathological changes in the form of parakeratosis and acanthosis in the epidermis; there are vasodilatation and significant infiltration in the papillary layer of derma.
The disease occurs in children aged 2-7 weeks. Skin lesion begins from redness and infiltration of the buttocks, large folds, mainly inguinal, at least in the trunk, face and scalp.
Within 2-7 days of the process spreads throughout the body. The skin is bright damaged, dry, extremities - with cyanotic shade; you receive plate desquamation, rarely pityriasis. Scales easily removed, but quickly reappear. The skin beneath them red, dry, brilliant, sometimes as if they are tense. In the natural folds always celebrated more or less expressed maceration of the skin, and sometimes bleeding cracks. Later on the scalp accumulate fat scales, yellow-grey, which are like armour, descending to the forehead. Changes in the skin are kept 20-40 days.
Simultaneously with the skin lesions are observed gastrointestinal disorders (diarrhea with admixture of mucus). In children significantly decreased appetite, there are abundant frequent vomiting, rarely vomiting, poor weight gain, and sometimes drop it already from the first days of the disease. In most patients developing malnutrition II and even the III degree.
A characteristic symptom of desquamative the eritrodermii is the development of hypochromic anemia. In some patients the quantity of erythrocytes is reduced to 1 800 000, and haemoglobin up to 25%.
Often when desquamative the eritrodermii develop severe complications, sometimes the disease is exacerbated by sepsis. More often reveal otitis media and pneumonia. Some children observed multiple abscesses, cellulitis, pyoderma gangrenosum, pyuria, and with a heavy course of the disease may occur keratomalyatsiya.
Disease duration - from 3 weeks to 3 months.
The differential diagnosis spend with eczema (see), exfoliativei dermatitis neonates (see above), congenital ihtios (see).
For uncomplicated desquamative the eritrodermii children to 3-month life well. Normalizes the skin, gradually improves the General condition and increases the weight. Stand hypochromic anemia. The disease recurs.
Treatment is to increase reactivity, immune forces of organism of the child, to establish the correct feeding. Sick children should be on a regular breastfeeding, and if hipogalactie the mother - to Receive the supplementary feeding mixtures, better sour.
The great value has hemotherapy: serum Filatova or the mother's blood in the amount from 3 to 10 ml for every intramuscular (3-12 injection in 2 days on the 3rd). It is advisable to combine hemotherapy with transfusions of banked blood and plasma. Also effective intramuscular injections of gamma globulin course 3-6 injection (1 dose).
If you suspect complications shown antibiotics.
Vitamins give the baby and nursing mothers. Children receive ascorbic acid 0.05 g and vitamin B1 0.003 g 3 times a day. Vitamin B1 is recommended to introduce and intravenous (4-8 injections 1 ml of 1% solution of 5% glucose solution in a day). Good results were obtained from the use of vitamins B6 and B12. Vitamin B6 is injected intramuscularly 0.5 ml of 2.5% solution or 0.3 ml of 5% solution of a day or are on the inside of 20-25 mg daily for 3-4 weeks (at the rate 500-750 mg). Vitamin VA appointed as intramuscular injection of 30-50 mg, every other day, 10-15 injection (at the rate of 300 to 750 mg). The best results - with the simultaneous introduction of vitamins B6 and B12.
Vitamin a given to nursing mothers 50 000 IU (20 drops) of concentrate per day for 3-4 weeks. Children because of dyspepsia this drug is not appointed.
Very important to care of the sick (sterile or ironed linen, preventing overheating, skin cleansing after bowel movement vegetable oil); stay on the air, but not in the sun. The skin cuticles 1-2 times a day ointments containing 2% Ichthyol, 5% of Naftalan and boric acid. Part of ointment can add vitamin a (1000 IU per 1 g basis).
Materialnye surface and cracks grease 1-2% aqueous solution Methyl violett, in subsequent impose 3-5%-naftalinovogo pasta. To remove accumulations of scales from the scalp apply a compress of 1% salicylic oil (Acidi salicylici - 0,3; Olei vaselini - 30,0) on 4-6 p.m., then the head wash baby soap. If the scales are not completely removed, after 2-3 days, the procedure is repeated.
With the improvement of the General condition of the patient is recommended to assign starch or soda (2%) of the bath.
In the prevention desquamative the eritrodermii great importance to the diet of pregnant and nursing mothers, diet which should be complete and is saturated with vitamins, contributing to the normal course of pregnancy, birth and the full development of the fetus.