BY

DR. EIMA SHAHEEN

PGR (DERMATOLOGY)
 DEFINITION:
It is the term applied to any
inflammatory skin disease that affects more
than 90% of the body surface area.

 SYNONYM:
Exfoliative dermatitis
 Normal epidermis has a continual cell turn
over.
 Cell division occurs in the basal layer and as
they move up, cells become well keratinized.
 This process requires 10-12 days.
 Cells remain in stratum corneum for 12-14
days.
 Mitotic rate in the basal layer increases.

 Overall transit time is decreased.

 Mechanism responsible is not known.

 Priordermatological illness.
 Comprehensive drug history.
 Rapidity of evolution
Gradual
Rapid
 Underlying systemic disease.
 Constitutional symptoms
GPE:
 BP
 Pulse
 Temprature
 Lymph nodes
 Peripheral edema
Systemic examination:
 Abdominal examination

 Respiratory system examination

 Thyroid / prostate examination

 Examination of skin.

 Examination of appendages.

 Examination of mucosae.
 Generalized erythema.

 Scaling.

 Nail and hair changes.

 Peri-orbital skin changes.

 Pigmentary disturbaces.
Diligent search for residual signs:
 Islands of sparing

 Typical plaques if psoraisis.

 Papules or oral lesions of Lichen planus.

 Superficial blisters of Pemphigus Foliaceous.

Systemic:
 Lymphoma
 Leukemia
 HIV
Cutaneous disease:
 Psoraisis
 Eczema
 Pitryasis rubra pilaris
 Dermatophytosis
 Lichen planus
5. Crusted scabies
 Drugs
1. Arsenic
2. Gold
3. Mercury
4. Penicillin
5. Barbiturates

MNEUMONIC: ID-SCALP
 High output cardiac failure.
 Tremendous increase in insensible loses of
fluid.
 Hypoalbuminemia.
 Oedema.
 Altered immune response.
 Electrolyte imbalance.
 Lab studies.
1. CBC
2. ESR
3. S/Protein
4. S/Alb
5. S/Electrolytes
6. LFTs
7. RFTs
 Imaging
1. CXR
2. Ultrasound studies
3. CT scan
4. MRI
5. Mammography
 SKIN BIOPSY
1. Non-specific findings of spongiotic
dermatitis.

2. Exfoliative dermatitis usually masks the

underlying disease.

3. Diagnostic findings are present in 40% of

the cases.
 LYMPHNODE BIOPSY:

1. Indicated only when lymphnode exhibit

lymphomatous charecteristics.

2. Cause of erythroderma is unknown.

 Serum IgE levels

 Peripheral blood smear

 Immunophenotyping, flow cytometery

 Skin scrapings

 HIV testing
It can be divided into

1. Supportive treatment

2. Specific treatment
 Discontinue all unnecessary medications.
 Care fully monitor
1. B.P
2. Temprature
3. Fluid balance
 Apply soothing emollients or creams.
 Mild topical steroids
 Systemic antibiotics
 Plasma infusion
 Diet:
1. Adequate nutrition
2. High protein intake

 Activity
1. As tolerated
Treatment of the underlying illness is key
Corticosteroids:
 Topical

 Systemic
Use only if the conditions aggravated by steroids have been ruled out.

1. M.O.A: Anti-inflammatory properties

2. Most commonly used steroid is Prednisolone
3. 40-60mg
4. Interactions:
Estrogens decrease clearance.
Antiepileptics, antituberculous increase metabolism.
Diuretics.
cont…….
 CI:
1. Hypersensitivity
2. Infections( viral, fungal, tubercular)
 Precautions
1. Pregnancy category B
2. Abrupt withdrawal should be avoided
 Antihistamines
1. Used for the relief of pruritis.
2. Sedating antihistamines are preferred
3. Potentiates CNS depressants
4. CI: Hypersensitivity
MAO inhibitors
Precautions:
Pregnancy category C
Immunosuppressive drugs
1. Methotraxate

2. Ciclosporin

3. Etanercept
1.Papulosquamous disorders:

 Methotraxate
 Retinoids
 TNF inhibitors
 Phototherapy

2.Eczemas
 Steroids
 Steroid sparing agents
Autoimmune disorders
 Steroids
 Steroid sparing agents

Infection and infestations

 Specific antibacterial/antifungal

Cutaneous malignancies
 Systemic steroids
 PUVA contd….
 Total body electron beam irradiation

 Topical nitrogen mustard

 Systemic chemotherapy

 Extracorporeal Photophoresis
 Thebest management is prevention of the
complications.

 Ifcomplication occurs early recognition is

the key to success.
 Longterm, prognosis is good for patients
with drug induced disease

 For
idiopathic erythroderma the prognosis is
poor.

 Forwith underlying disease or malignancy ,

Prognosis rests on the outcome and course
of disease process.
 Avoid known etiological agents.

 Advisepatients on protection from

erythroderma.

 Advise patient a high protein diet.

 Encourage patient to diligent in watching for

the signs of infection.
 The aim in patient of erythroderma should
be to provide optimum symptomatic care, and
to diagnose and treat the underlying
condition .