Aetiological and clinicopathological study of erythroderma

Aarthi, M (2013) Aetiological and clinicopathological study of erythroderma. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Erythroderma (also known as “Exfoliative dermatitis”, “Dermatitis exfoliativa”) is a generalized inflammatory disorder of the skin manifesting with erythema and scaling affecting more than 90% of the skin surface. Primary erythroderma arises on normal looking skin due to an underlying systemic disorder or because of a drug reaction, while secondary erythroderma arises from a pre existing dermatoses. Erythroderma is a morphological reaction pattern of skin having innumerable underlying causes which include preexisting skin conditions like psoriasis, atopic dermatitis, contact dermatitis, systemic skin conditions including malignancy and drug reaction. Even a thorough clinical examination and investigations may not detect the underlying causes many a times. Erythroderma was described by Hebra in 1868. The disease is usually associated with underlying cuteneous or systemic disorder or drug intake and rarely it may be idiopathic. Erythroderma affects the skin as well as other systems of the body giving rise to haemodynamic disturbances, biochemical derangement, fever, tachycardia, hypoalbuminemia and pedal edema, in addition to various cutaneous changes. Treatment addresses the underlying etiology, symptomatic relief and potential systemic complications. Although its a rare disease, the mortality rates are low and morbidity related to it is considerably high as it is often a chronic disease with debilitating signs and symptoms such as intense pruritis and scaling. Thus it is importance to find the etiology with the special emphasis on histopathology allowing early and appropriate intervention for each case. The present study of 65 cases of erythroderma, carried out in the Department of Dermatology, Rajiv Gandhi Government General Hospital, is aimed at studying the etiopathology, clinical features, its course, evolution and associated systemic derangement. AIMS & OBJECTIVES: 1. To study the incidence of erythroderma in relation to age and sex. 2. To study the etiology, clinical features & course of the disease. 3. To study the histopathology in relevant cases. 4. To study the metabolic and systemic complications. MATERIALS AND METHOD: The study was conducted among individuals attending the outpatient dermatology clinic as well as the inpatients of the dermatology ward of Rajiv Gandhi Government General Hospital, Chennai during the period October 2010 - September 2012. All new cases of erythroderma of both sexes and of all age groups who attended the dermatology clinic during the said period, were taken for this study. Method of Collection: A total of 65 patients of erythroderma were selected. It is a prospective observational study. The cases were analysed in detail as follows. All patients erythema and scaling involving more than 90% of the body surface area as calculated by Wallace’s rule of nine were enrolled in the study in accordance with the definition of erythroderma. SUMMARY AND CONCLUSION: After analysing 65 cases of erythroderma admitted in our hospital during a period of two years the following observations were made; • The average annual incidence of erythroderma among the patients who attended the skin department of our hospital was 0.029%. • Maximum number of patients were in the age group 50-59 (21.53%) with a male to female ratio of 2.1:1 • The onset was acute in 41.53% and gradual in 58.46% of cases. • Itching (64.62%) was the most common symptom followed by malaise (61.54%), chills (47.69%), pedal edema (40%), palms & soles involvement (40%) and fever (27.69%). • Lymphadenopathy was observed in 32.30% of cases. • Hyperthermia was seen in 27.69% of cases, pallor in 26.15%, diffuse hair loss in 23.07% and hepatosplenomegaly in 3.07% of cases. • Nail changes was observed in 69.23% of cases, ridging (26.15%) being the most common nail change noted. • Eye involvement was observed in 44.61% of cases. • Mucosal involvement was observed in 9.23% of cases and all of them were drug induced erythroderma. • Eosinophilia and hypoproteinemia was seen in 12.30% of cases, altered liver function test in 7.69% of cases and raised level of serum creatinine in 1.53% of cases. • None of the patients had electrolyte imbalance and metabolic complications. • Atypical lymphocytes in peripheral blood smear was seen in a case of Non Hodgkin’s lymphoma. • The most common etiological factor was pre existing dermatosis (61.53%) followed by drug reactions (26.15%), idiopathic (10.76%) and malignancy (1.53%). • Among the pre existing dermatosis, psoriasis (30.76%) was the leading cause followed by eczema (16.92%), ichthyosis (6.15%), pemphigus foliaceous (3.07%), pityriasis rubra pilaris (3.07%) and crusted scabies (1.53%). • Clinical features were almost identical in nearly all patients. • Histopathology was rewarding in 43.49% of cases in whom skin biopsy was performed. • Drug induced erythroderma had a good prognosis and erythroderma due to Non Hodgkin’s lymphoma had a worst prognosis. Although no etiological diagnosis could be established in a number of cases it is imperative to follow up and investigate the case periodically since idiopathic erythroderma may turn to cutaneous lymphoma in the long run in a percentage of cases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: erythroderma ; aetiological ; clinicopathological study.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Punitha K
Date Deposited: 21 Jun 2018 14:22
Last Modified: 23 Jun 2018 01:58

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