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ERYTHRODERMA

Teaching Bangsal

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Members of Group
1. MONICA FAJRIN SUMARWOTO C111 10 150
2. ANDI NURFATIHA C111 10 269
3. SWASTIKA ASFARINA TANGAHU C111 10 149
4. SARI AZISYA FAUSI C111 09 275
5. IBNU HIDAYAT M. BASIR C111 10 111
6. ERFINA B C111 10 282
7. MUH. RIDWAN HASBI C111 10 275
8. RIZNA ARIANI SAID C111 10 262
9. NURA ULFA 110 210 012
10. NUR FADLIANTY 110 210 134
11. IRNAWATI ASTUTI ARSYAD TIRO 110 209 019
12. ANDI CAKRA IRWANSYAH 110 209 048
13. NINI SOLIKAH 110 280 044

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Identification of Patient
Name : Mr. Y
Age : 60 years old
Address : Toraja
Status : Married
Date of Admission: June 22, 2014

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History Taking
Chief Complaint : Itching all over body
Anamnesis:
This sensation has been felt since 1 month
ago.
The itching and redness first appeared on
both hands, then entire body.
Currently, the entire body is becoming dry
and peeling.


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History Taking

History of medication (-)
History of hospitalization (+) 2 month ago,
Dx. Nephrolithiasis
History of allergy (+), seafood
History of the same disease (-),
History of DM(-), HT(-),
History of the same disease in family (-)


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Physical examination
Anemic (-), Icterus (+), Cyanosis (-)
Diffuse erythema with overlying scale
covering >90% the body surface area
cor/pulmonal : normal
Peristaltic : (+) normal
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Present Status
General status :
compos mentis, adequate nutrition
General Condition : Moderate
Hygiene : Moderate
Vital Signs :
Blood Pressure : 120/70 mmHg
Pulse : 88x/minute
RR : 18x/minute
Temperature : 36,8
o
C
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Dermatovenerology Status
Location :
Regio generalisata

Efflorescency :
Erythem, excoriation, squama


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Routine Blood
WBC : 10.24x 10
3
/ul
RBC : 3.3 x 10
6
/ul
HGB : 7.7 g/dl
HCT : 24.4 %
PLT : 350 x 10
3
/ul
MCV : 80.8 fl
MCH : 25.1 pg
MCHC : 31.5 gr/dl
Kesan : Leukositosis
Laboratorium
RDW-SD : 43.4 %
PDW : 9.0
MPV : 8.6
P-LCR: 14.6%
PCT : 0,30%
NEUT : 5.92 x 10
3

LYM : 2.08 x 10
3

EO : 1. 59 x 10
3

BASO : 0.06 x 10
3

MONO :0.068 x 10
3
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GDS : 105 mg/dl
Ureum : 57
Creatinin : 1.53
SGOT : 586
SGPT : 790
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Treatment
Metilprednisolon 4 mg 2-2-0
Cetirizine 1 x 1
Lanolin 10% + Vaseline 60 gr + Betametason
20 gr (apply to part of body every morning
and afternoon)
Cefadroxil 2 x 500 mg

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ERYTHRODERMA

Universal redness and scaling of the skin
affecting 90-100 % of the body
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Etiology
Idiopathic - 30%
Drug allergy 28%
Seborrheic dermatitis 20%
Contact dermatitis 3%
Atopic dermatitis 10 %
Lymphoma and leukimia 14%
Psoriasis 8%
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Clinical Manifestation
The erythema extends rapidly and may be
universal in 12-48 hr. Scaling appears after 2-6
days, often first in the flexures.
The scales may be large, or fine and bran like.
At this stage the skin is bright red,hot and dry
and palpably thickened.
Pruritus is often cause by eczema.

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Clinical Manifestation
When the erythroderma has been present for
some weeks, the scalp and body may be shed
and the nails become ridged and
thickened,and may also be shed.
The periorbital skin is inflamed and
oedematous, resulting in ectropion,with
consequent epiphora.
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Diagnosis
The recognition of erythroderma is easy, but the
diagnosis of underlying cause may be very difficult.
The history is often helpful in identifying the hereditary
disorders, drug reactions and psoriasis, but in some
cases the erythroderma is of sudden onset and the
history may not be helpful, and the eczematous
erythrodermas and those associated with lymphoma
may not show any distinctive histological features.
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Treatment
Topical :
- oatmel baths
- wet dressings
- emollients (lanolin 10%/urea cream 10%)
Systemic :
- Antihistamines
- Corticosteroid
- systemic antibiotics if secondary infection

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Treatment
- diuretics for peripheral edema
- corticosteroid for drug hypersensitivity
reactions,immunobullous disease,atopic
dermatitis (1-2 mg/kg/day with taper )
- cyclosporine for psoriasis, atopic dermatitis (4-
5 mg/kg/day)
- methotrexate for psoriasis, atopic dermatitis,
pityriasis rubra pilaris (5-25 mg qwk depend.
on renal func. and response to treatment)
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Treatment
- acitretin (soriatane) for psoriasis, pityriasis
rubra pilaris (25-50 mg qd )
- mycophenolate mofetil for psoriasis, atopic
dermatitis, immunobullous disease (1-3 g qd )
- infliximab for psoriasis (5-10 mg/kg)
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Differential Diagnosis
Most likely:
Spongiotic dermatitis ( atopic,9% ; contact
dermatitis, 6%; seborrheic dermatitis, 4%;
chronic actinic dermatitis, 3%)
Psoriasis (23 %)
Drug hypersensitivity reaction (15%)
Cutaneous T-cell lymphoma (5%)
Idiopathic (approximately 20%)
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continue

Contact dermatitis
Immunobullous disease
Infection (scabies,dermatophytosis)
Toxin mediated
Chronic actinic dermatitis
Pityriasis rubra pilaris
Collagen vascular disease
Primary immunodeficiency
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