Erythrodermia

ERYTHRODERMIA (erythrodermia), a group of generalized inflammatory skin diseases in which diffuse redness and scaling are prominent in the clinical picture. Scaling in E. may vary, but large plate-like scaling is most common (exfoliative E., dermatitis exfoliativa generalisata). Primary and secondary E. are distinguished. Secondary E. occur as a complication of various skin diseases: eczema, psoriasis, lichen planus, and condyloma acuminatum, among others. In addition, erythroidermias are divided into acute, subacute, and chronic forms. Erythrodermia Wilson-Brocq (erythrodermia Wilson-Brocq, dermatitis exfoliativa generalisata Wilson-Brocq) occurs in two different forms: subacute and chronic (Brocq). It affects almost exclusively adults. Initially, intensely itchy, slightly elevated, rapidly enlarging red spots appear on various areas of the skin, mainly in the folds; within 5-10 days from the onset of the disease, the entire skin becomes bright red, infiltrated, and scales, with the scaling always being large plate-like; on the palms and soles the horny layer peels off like gloves. Hair and nails fall out. The disease is often accompanied by severe general symptoms: weakness, insomnia, loss of appetite, vomiting, diarrhea, hectic fever, and others. The skin process may complicate with eczematization (in skin folds) and furunculosis. In Brocq's early cases, mortality reached 16%. The subacute form lasts from 3 to 12 months, the chronic form several years. Histologically, edema of the papillary and subpapillary layers of the dermis, dilation of vessels, and lymphocytic infiltration in the papillary layer are noted in the dermis; in the epidermis, spongiosis, parakeratosis, and hyperkeratosis. The etiology is unknown. In diagnostic terms, it is often difficult to distinguish this E. from pityriasis rubra of Gébhardt; the final decision is provided by the outcome of the skin process: in Gébhardt's disease, atrophy; here, restitutio ad integrum. Treatment is general and local, symptomatic. Savill's disease (Savills disease), epidemic skin disease, a peculiar epidemic infectious disease with an unknown pathogen, observed mainly in England at the end of the 19th century. Large epidemics were seen by Savill, Hutchinson, and Elkins. The disease mainly affects the elderly. Two forms are distinguished: a moist form resembling generalized acute eczema, and a dry form resembling pityriasis rubra. Savill's disease is accompanied by severe general symptoms: weakness, loss of appetite, vomiting, and diarrhea. In some cases, recurrences were observed. The duration of the disease is 3-8 weeks. Treatment: ointments and baths with creolin; general strengthening therapy. Dermatitis exfoliativa neonatorum Ritter von Rittershain (exfoliative dermatitis of newborns Ritter von Rittershain, Ritter's disease) develops in the first five weeks of life. It begins with vesicles, or sometimes with an erythematous stage. Within a few days, the entire skin becomes bright red and scales with large horny plates. The picture is very reminiscent of a burn. A particularly characteristic feature is the easy detachment of the upper epidermal layer at sites where there was no clinically visible formation of vesicles (epidermolysis). In most cases, exitus occurs with signs of sepsis within a few days. While some consider Ritter's disease an exogenously occurring pyoderma (golden staphylococcus), others speak of pyococcal septicemia. Prevention consists of proper care of the child and its skin. Treatment: locally, baths with tannin, zinc oil, boric-talc powder; increased nutrition with maternal milk, plenty of fluid. Erythrodermia leukemica. The picture of generalized exfoliative E. sometimes develops in leukemia (see). Generalized erythrodermia also occurs in the premycotic stage of mycosis fungoides (see Mycosis fungoides) - premycotic E. Erythrodermia ichthyosiformis congenita - see Ichthyosis. Erythrodermia desquamativa neonatorum - see Leiner's disease. Erythrodermie pityriasique en plaques disseminees - see Psoriasis.