REFERAT

PEMBUKAAN
1. Assalamualaikum
2. Good morning / afternoon ladyes and gentleman.
3. This opportunity, We would like to present our Referat with title Eritroderma.
4. We are very interested in this case because Eritroderma is common disease
5. We think that disease will be more recognized in the future.
6. We hope that from our referat presentation can be option some benefit and
additional information.
7. So, to know in detail about the case, let me show you in the next slide. Please.
DEFINISI
Erythroderma is a skin disease with dermatological status form diffuse erythematous
indurated and scale covering more than 90% of skin surface area.
Synonim : Exfoliative dermatitis atau pitriasis rubra
EPIDEMIOLOGI

Incident : 0.9 to 71 per 100,000.

The ratio of male > female is 2 : 1 to 4: 1.
More common in the age range between 41 - 61 years.

The Underlying disease : 50% of Psoriasis. A recent report claimed 87 of the 160 cases
of erythrodermic based on severe psoriasis.
Location : affects more than 90% of skin surface area.

ETIOLOGI

systemic diseases
Expansion of skin diseases
Systemic drugs Allergy

Table 1 : Drugs Implicated in Eritroderma

Table 2-3 : Disease-Associated with Erythroderma The disease is most common

PATOFISIOLOGI
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Factor : Imun Faktor, Infection, Drugs Reaction, Malignancy

Will Activation of the immune response
Increase Ig E
Mitotic rate and the number of cells Increase and stimulate TH 1
TH 1 stimulate TH2 stimulate IFN Gamma
Mitotic rate and the number of cells Increase and stimulate IFN Gamma
Cell transit time through the epidermis Increase
Loss of protein, amino acids and nucleic acids
Quickly lost in the skin
Eritroderma

To Establish the Diagnosa

From : 1. Anamnesa, 2. Physical Examination, 3. Additional Examination
Anamnesa

Onset drug reactions : ussualy rapid onset.

Looking for precipitating factors
past history psoriasis and atopic dermatitis
family history atopic dermatitis
The use of drugs systemic and topical corticosteroids, methotrexate, and other
systemic treatments

Physical Examination

Eritema
Skuama 90% of skin surface area
Nail abnormalities such as onycholysis
Hiperkeratosis subungual
Bleeding
Paronikia
Beau lines
Onikomadesis
CLINICAL SYMPTOMS 1-9

Additional Examination

Laboratory Examination
Blood tests
mild anemia, leukocytosis, electrolyte imbalance.
Hypoalbuminemia and increased gammaglobulins, increased acute phase
proteins.
Histopathology
skin biopsy
o Acute phase : spongiosis and parakeratosis prominent edema.
o In the chronic phase : acanthosis and elongation of the rete ridges are
more dominant

Differential Diagnosis
1. Atopic dermatitis
o Family history of atopic
o The clinical features are pre-existing lesions, severe pruritus, lichenification
and prurigo nodularis
o The histologic features are mild acanthosis, spongiosis variables, dermal
eosinophils and parakeratosis
2. Seborrheic dermatitis
Often found in areas of the body that contain many sebaceous glands
Usually the patient looked oily skin, with Pityrosporum ovale germ that
lives on the skin commensal grow more fertile
At the head looks erythema and
Patients will complain of severe itching
3. psoriasis
Erythrodermic psoriasis can be caused by too strong topical treatment or
the disease itself which extends
Psoriasis is characterized by the presence of patches, demarcated
erythema with scaling rough, layered and transparent with wax drip
phenomenon, Auspitz, and Kobner.
Management
Can be devide step. Its Non Medikamentosa & Medikamentosa
1. Non Medikamentosa
a. Avoid precipitating factors
b. Adequate protein diet

c. Keeping the skin moist

d. Avoid scratching
e. Preventing hypothermia wet dressings
2. Medikamentosa
a. systemic corticosteroids
b. methotrexate
c. cyclosporin
d. Mycophenolat mofetil
e. Giving antibiotics to prevent secondary infection
f. diuretic reduces edema
Komplikasi
1. heart failure
2. Renal failure.
3. Sudden death due to hypothermia central
Prognosis
Prognosis of Erythroderma depends on the underlying disease process.

Case because the drug can cause drug improved after drug use is stopped and given
appropriate therapy.
The prognosis of cases due to underlying systemic disorders such as lymphoma will
depend on the conditions of treatment success.

PENUTUP
1. THANK YOU.
2. I THINK THIS ENOUGH AND I HAND OVER TO MY SENIOR DOCTOR. PLEASE.