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Erythroderma

Erythroderma is a generalized name for skin diseases of different etiology and pathogenesis, characterized by widespread, often universal redness, swelling or infiltration and peeling of the skin. Peeling more often lamellar, but may be small, scaly.

There are primary and secondary erythroderma; the latter are layered on already existing skin diseases ( psoriasis , lichen planus, etc.). Erythroderma can occur acutely, subacutely and chronically. Acute erythroderma is most often the result of hypersensitivity ( allergy ) to various drugs (arsenic, mercury , sulfonamides, antibiotics, etc.). Chronic erythroderma occurs as one of the manifestations of common diseases (leukemia, reticulosis , Hodgkin's lymphoma , fungoid mycosis, etc.). The etiological diagnosis of chronic erythroderma is established by a comprehensive examination of patients. Treatment is carried out depending on the established cause. External - emollient ointment.

Consider the following independent forms of erythrodermia.

1. Erythroderma Wilson - Broca. Observed in adults, occurs subacutely or chronically; on various parts of the skin, itchy spots appear, increasing and merging, they affect the entire skin. The skin becomes red, infiltrates and becomes covered with large-plate scales; hair and nails fall out. Often there is fever, headache, diarrhea , vomiting , etc. The etiology is unknown. Disease duration from several months to several years; heavy forecast. Treatment - corticosteroids.

2. Congenital ichthyosiform erythroderma - see ichthyosis .

3. Desquamative erythroderma Leinera (Leinera disease) is a disease caused by insufficient intake of B complex vitamins into the newborn , especially vitamin H (biotin). The disease begins at 2-3 weeks of life and is characterized by three main symptoms: lesions of the skin, gastrointestinal tract, changes in the blood.

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The skin lesion in the form of bright redness begins in the skin folds and in the area of ​​the buttocks; further redness extends to the legs, torso, face; within 2-3 days the entire skin can be affected. During the period of full development of the disease, the skin is red, somewhat infiltrated, covered with a large number of scaly or fine-lamellar scales, which fall off easily. On the buttocks and palms, the skin is tense and shiny, in the folds there is a slight weeping, on the scalp there are massive crusts or difficult-to-remove scales.

Along with skin changes, dyspeptic disorders are noted. Hypochromic anemia develops in the blood, the number of leukocytes increases.

Skin lesions last for 20-30 days, then the infiltration decreases, the skin becomes elastic and takes normal color.

Complications are possible: otitis , pneumonia , sometimes multiple abscesses, pyuria .

Treatment . Proper feeding with mother's milk with the introduction of vitamins: vitamin B6 25 mg, vitamin C 100 mg per day; Vitamin A concentrate 20 drops one time per day assigned to a nursing mother (children due to gastrointestinal disorders are not recommended). In severe cases of the disease, administration of gamma globulin is indicated, for anemia, vitamin B12 intramuscularly in doses of 30-50 mcg, 10-15 injections every other day. In case of complications, antibiotics, blood transfusions , plasma, cardiac drugs are prescribed. Locally applied Unna cream, 0.5% salicylic, 5% dermatol ointment, corticosteroid ointment (prednisolone, lokakorten, sinalar), peach oil; on moist areas - lotions from 1–2% tannin solution; daily bath with potassium permanganate (pink solution).

Careful child care is very important: sterile or ironed clothes, cleansing the skin after defecation with sterile vegetable oil. With the improvement of the general condition, starch or soda baths are prescribed (see. Baths, baths for children). With a child you need to walk a lot (not in the sun!).

With the right treatment, the prognosis is good; in the presence of complications, it worsens.

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Erythroderma (from the Greek. Erythros - red and derma - skin) is a collective term for a group of skin diseases of various etiologies and pathogenesis. Erythroderma is divided into primary and secondary; the latter occur in dermatosis — psoriasis, eczema, and other lesions, and also as a result of allergy to antibiotics, sulfonamides. Secondary erythroderma, complicated by necrosis of large areas of the epidermis, is the leading clinical manifestation of A. Lyeil syndrome. The clinic of erythroderma is characterized by widespread inflammation of the skin, severe hyperemia, scaling, sometimes large plate, swelling and infiltration of the skin. In case of complication with moaning, a secondary pyococcal infection often joins. Erythroderma are acute, subacute and chronic, transitional and mixed forms are possible. Histologically: severe edema, especially malpighian layer, intercellular and intracellular acanthosis, parakeratosis, inflammatory infiltration. In acute erythroderma, inflammation and edema are more severe.

Erythroderma Wilson - Broca (synonym for generalized exfoliative dermatitis Wilson - Broca) - etiology is unclear, adults are ill; begins with the appearance of folds, and then on other areas of the skin redness, which after 1-2 weeks turn into large areas, later the process captures the entire skin. The skin is bright red, edematous, almost does not gather in folds, large-plate peeling, especially sharp on the palms and soles. In severe cases, vomiting, dyspeptic phenomena, temperature rise to 38-40 ° are frequent. There is hair loss and rejection of nail plates. Maceration is often developed in the folds, which contributes to the complication of strepto-staphylococcal infection (streptoderma, boils). The forecast is difficult. Treatment: corticosteroids (prednisone, triamsinolone, dexamethasone), vitamins of group B, C, blood transfusion. Locally - ointments and creams with corticosteroids.

Exfoliative dermatitis of newborns (synonym for Ritter's disease) - erythroderma of Pococcal etiology, developing in the first weeks of life; generalized hyperemia is sometimes preceded by the stage of blistering, it begins acutely, sometimes within 1-2 days. Clinically: the skin is bright red with peeling of large areas (resembles a burn). The forecast is difficult. Treatment: broad-spectrum antibiotics, sulfonamides, abundant drinking, topical creams and emulsions with antibiotics, tannin baths. Prevention : adherence to hygienic procedures when caring for a newborn, excluding contact with persons suffering from pyoderma.

Erythroderma congenital ichthyosiform - see Ichthyosis.

Erythroderma desquamative Leiner (erythrodermia desquamative Leiner; synonym for Leiner's disease — Moussa) is characterized by erythema, large-plate peeling of the skin, almost always a dysfunction of the gastrointestinal tract and a violation of the general condition.

The etiology and pathogenesis are poorly understood.

Pathological changes in the form of parakeratosis and acanthosis in the epidermis; vasodilation and significant infiltration in the papillary dermis are observed.

The disease occurs in children aged 2-7 weeks. Damage to the skin begins more often with redness and infiltration of the area of ​​the buttocks, large folds, mainly inguinal, less often in the torso, face and scalp.

Within 2-7 days the process spreads throughout the body. The skin becomes brightly hyperemic, dry, on the limbs - with cyanotic shade; lamellar peeling appears, less often scaly. The scales are easily removed, but quickly reappear. The skin under them is red, dry, shiny, sometimes tense. In the area of ​​natural folds, there is always a more or less pronounced maceration of the skin, and sometimes bleeding cracks appear. Later on the scalp accumulate fatty scales, yellow-gray in color, which resemble shell, going down to the forehead. Changes on the skin last 20-40 days.

Simultaneously with the defeat of the skin, gastrointestinal disturbances (diarrhea mixed with mucus) are observed. In children, appetite is significantly reduced, there are abundant frequent regurgitation, less vomiting, poor weight gain, and sometimes a drop in it from the first days of the disease. Most patients develop hypotrophy II and even III degree.

A characteristic symptom of desquamative erythrodermia is also the development of hypochromic anemia. In some patients, the number of red blood cells is reduced to 1,800,000, and hemoglobin decreases to 25%.

Often, with desquamative erythroderma, severe complications develop, sometimes the disease is aggravated by sepsis. Otitis and pneumonia are more common. Some children have multiple abscesses, phlegmon, pyoderma gangrenosum, pyuria, and in severe cases, keratomatation may occur.

Disease duration - from 3 weeks to 3 months.

The differential diagnosis is carried out with eczema (see), exfoliative dermatitis of newborns (see above), congenital ichthyosis (see).

With uncomplicated desquamative erythroderma, children recover to the 3rd month of life. The skin is normalized, the general condition gradually improves and weight increases. Hypochromic anemia persists. The disease does not recur.

The treatment boils down to an increase in reactivity, the immunobiological forces of the child’s body, to the establishment of proper feeding. Sick children should be on regular breastfeeding, and during hypogalactia in the mother — Get supplemented with mixtures, preferably acidic.

Of great importance is hemotherapy: serum Filatov or mother's blood in an amount of from 3 to 10 ml for each intramuscular injection (3-12 injections in 2 days on the 3rd). It is advisable to combine hemotherapy with transfusions of canned blood and plasma. Intramuscular gamma globulin injections are also effective - for a course of 3-6 injections (1 dose each).

Antibiotics are indicated when complications are suspected.

Vitamins are administered to the child and the nursing mother. Children receive ascorbic acid at 0.05 g and vitamin B1 at 0.003 g 3 times a day. Vitamin B1 is recommended to be administered intravenously (4-8 infusions of 1 ml of 1% solution with 5% glucose solution every other day). Good results are obtained from the use of vitamins B6 and B12. Vitamin B6 is injected intramuscularly in a dose of 0.5 ml of a 2.5% solution or 0.3 ml of a 5% solution every other day or given orally for 20–25 mg daily for 3–4 weeks (for a course of 500–750 mg). Vitamin B1a is prescribed in the form of intramuscular injections of 30–50 mcg, every other day, a total of 10–15 injections (for a course of 300–750 mcg). The best results - with the simultaneous introduction of vitamins B6 and B12.

Vitamin A is given to nursing mothers of 50,000 IU (20 drops) of concentrate per day for 3-4 weeks. Children due to dyspeptic phenomena, this drug is not prescribed.

Careful patient care (sterile or ironed linen, preventing overheating, cleansing the skin after defecation with vegetable oil) is very important; stay in the air, but not in the sun. Lubricate the skin 1-2 times a day with ointments containing 2% ichthyol, 5% naphthalan and boric acid. The composition of the ointment, you can add vitamin A (1000 IU per 1 g of base).

Macerized surfaces and cracks are smeared with 1-2% aqueous solution of Methyl violett, and subsequently they are coated with 3-5% naphthalan paste. To remove accumulations of scales from the scalp, a compress of 1% salicylic oil (Acidi salicylici - 0.3; Olei vaselini - 30.0) is used for 4-6 hours, after which the head is washed with baby soap. If the scales are not completely removed, after 2-3 days the procedure is repeated.

As the patient's general condition improves, it is recommended to prescribe starch or soda (2%) baths.

In the prevention of desquamative erythroderma, the diet of pregnant and lactating mothers, whose diet should be full and rich in vitamins, contributing to the normal course of pregnancy, childbirth and the full development of the fetus is of great importance.