Psoriasis or lichen- This chronic illness dermatological in nature, affecting the skin. Scientists have proven that this disease is transmitted genetically. With psoriasis, red, dry and raised spots called papules form on the skin. As lichen progresses, the area of the papules expands and they merge into spots bigger size, called plaques.
Psoriatic erythroderma- the most severe and dangerous form of psoriasis. In half of the cases, the pathological process of the disease is preceded by an existing pathology. Treatment takes place under the strict supervision of doctors, most often in a hospital.
What is psoriatic erythroderma and why is it dangerous?
In modern dermatology it is accepted Classify erythroderma into two types:
- primary;
- secondary.
The first is typical the occurrence of the disease in a person who did not have psoriasis and the sudden onset of lichen did not have any prerequisites.
Second develops on the basis of a disease that a person already has and becomes its extreme degree. The main irritating factors for the development of secondary erythroderma are the patient’s excessive exposure to the sun, alcohol consumption, certain types of antibiotics, mechanical damage skin and incorrect methods of treating existing psoriasis.
It is also common to classify erythroderma by type pathological process.
There are three forms:
- generalized;
- hyperergic;
- rotting.
For the first characterized by total damage to almost the entire skin.
At the second Itchy and flaky pockets of inflammation appear on the human body, which expand and cause discomfort.
Third is essentially a transitional stage between pustular psoriasis and erythroderma itself. It is characterized by the appearance of a pustular rash and ulcers in addition to the papules already present on the skin.
Psoriatic erythroderma requires compulsory treatment, without which the patient will face a number of life-threatening consequences.
At intensive development diseases, the skin loses its protective functions, the same thing happens with severe burns, and becomes extremely vulnerable to various kinds of infectious diseases.
Symptoms of psoriatic erythroderma
The symptoms of the disease are extensive. Among the most common manifestations are:
- spreading of psoriasis plaques;
- intense peeling;
- fever;
- chills;
- temperature increase;
- dehydration;
- increase lymph nodes;
- splitting of nails;
- hair loss;
- muscle pain;
- increased sweating.
In the secondary type, rashes appear separately from existing plaques and merge with them as they spread over the skin.
Diagnostics
At the first signs of illness, a person should immediately consult a dermatologist, who will make a diagnosis. Often the disease is diagnosed after a routine medical examination. In rare cases, based on the results histological examination patient.
Treatment
Due to the fact that this type of disease is considered extremely dangerous and in rare cases can even cause death, the patient is hospitalized.
The patient requires specific conditions: no dust, quartzing the room every few hours, adjusting temperature and humidity. Therefore, if possible, for the convenience of the patient, the medical institution should provide him with a separate room and special care.
For treatment use:
- polydesis,
- sorbilact,
- sorbogel,
- kaopectate,
- acitretin,
- cyclosporine,
- salicylic ointment,
- decoctions medicinal herbs,
- sedatives,
- sleeping pills if necessary.
The patient must remain in bed and is prescribed replacement therapy, in which all medications used by the patient before hospitalization are discontinued. Due to the constant poisoning of the body by the remains of dead tissue cells, intoxication occurs and a course of detoxifiers is prescribed. Immunoregulators will help restore the body’s most important defense system - its immunity and reduce the risks of contracting infections.
The course of treatment is individual and is prescribed by a doctor depending on the stage, causes of the disease, the patient’s age and general health.
How to treat with folk remedies?
Folk remedies this type of lichen can be treated only in the initial stages, if the skin of the body can no longer cope with the spread of plaques, and the general health condition sharply worsens, the patient is advised to urgently seek help from qualified specialists.
- At home for erythroderma it is recommended apply soaked oatmeal to the plaques for speedy exfoliation and lubricate with sea buckthorn oil to partially eliminate irritation.
- It is recommended to take soothing chamomile or mint tea internally. and again a few spoons sea buckthorn oil.
- It is recommended to go on a diet and limit consumption of fatty, spicy and salty foods.
- When taking a bath It is not recommended to use regular gels and soaps. It is much healthier to add a couple of drops to the bath essential oil lavender or chamomile.
- A very popular recipe for a mixture of dry mustard, vegetable oil and eucalyptus tincture.
- The most common home remedy for most skin diseases still remains celandine: patients take baths with it and lubricate the affected areas of the skin with the tincture.
Complications and prevention
The most dangerous thing for an organism susceptible to this disease is the partial or complete loss of the skin’s protective functions.
A person becomes absolutely open to infections of various kinds, for which it is not difficult to get inside the patient’s body through open wounds.
All types of psoriasis are characterized by autumn and winter exacerbations, so during this period you should visit a specialist for preventive purposes, even if you are not sick.
Compliance therapeutic diets will reduce the risk of developing lichen. And you should pay attention to the list of factors that can provoke the disease: excess ultraviolet radiation, antibiotic treatment, excess alcohol consumption and mechanical damage skin.
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The term erythroderma is a generic name various lesions skin, in which there is generalized redness of the skin and large-plate peeling.
Erythroderma symptoms
Erythroderma is characterized by significant prevalence up to damage to all skin, severe peeling of the skin, and resistance to treatment.
Primary erythroderma develops without previous factors, and secondary forms occur against the background of other skin diseases.
There are several types of disease: acute, subacute, chronic. Wherein sharp forms caused by high sensitivity to allergens or drugs. The causes of chronic erythroderma are common diseases that are present in a person long before the development of symptoms.
The most important symptoms erythroderma: heat body, serious condition of the patient, lymphadenopathy, hair loss, severe nail damage. Increased sweating and dilation of blood vessels on the surface of the skin provoke increased heat transfer. As a result, the patient constantly feels cool, especially noticeable against the background of fever and chills.
There is a feeling of tightness and dryness of the skin, burning, paresthesia and itching. In rare severe cases, swelling caused by hypoproteinemia and heart failure is noticeable.
Main symptoms initial stage erythroderma:
- with exudative dermatitis or with the acute onset of the disease, severe thinning of the epidermis, erythema, and exudation occur, during which crusts form;
- exacerbation of the disease accompanying erythroderma;
- if there is no concomitant disease, the skin of the head, torso and perineum is first affected, after which generalization of the affected areas occurs;
- fine-plate generalized peeling, skin lichenification and non-cardinal erythema are noted.
For later stages it is typical:
- dry mucous membranes, atrophic lesions of the nail plates, baldness;
- tachycardia, chills, increased body temperature;
- lymphadenopathy, enlarged liver and spleen;
- if the disease is accompanied by lymphomas or leukemia, gynecomastia and steatorrhea develop.
Psoriatic erythroderma occurs due to excessive insolation, neuropsychic overload, incorrect therapy with irritants medicines(Psoriasin, Chrysorabine, Tsingolin, Tsingoderm), antibiotics.
In addition to the standard phenomena for this disease, thick redness, a feeling of tightness, burning and chilliness of the skin, and severe peeling are observed.
Treatment of this type of erythroderma at the beginning of its development consists of using a mixture of constant alternation of the components neohemodez, sodium thiosulfate and others. Sometimes the use of cytostatics is required. All drugs must be taken with great caution, as they can cause severe side effects and complications.
Ichthyosiform erythroderma is visible from birth, it presents as bright erythema and diffuse peeling. In the bullous form, blisters and horny ridges are present. Typically the affected area is the inguinal folds, armpits and areas of large joints.
This disease is characterized by a decrease in the content of retinol-binding protein or vitamin A in the body. Treatment is carried out with the help of vitamin A and its derivatives.
Broca's erythroderma can be a congenital disease, or it can appear later. Its main symptoms are ichthyotic skin changes and erythroderma. The newborn's skin becomes red. A keratinization appears on them. The affected area can cover the entire body.
The patient complains of a feeling of dryness, soreness of the skin in places where blisters and cracks form.
With age, symptoms weaken or disappear completely.
Excessive sun exposure should be avoided.
Erythroderma leiner is caused by a deficiency of B vitamins and biotin in newborns. The first signs of the disease are usually observed 2 to 3 weeks after birth. The skin and gastrointestinal tract are affected, and the blood changes. The patient has dyspeptic disorders, the number of leukocytes in the blood increases, hypochromic anemia.
Skin lesions gradually disappear after 20 - 30 days, the skin takes on a natural color and elasticity.
In some cases, complications develop in the form of pneumonia, otitis media, pyuria, and multiple abscesses.
Erythroderma treatment
Elimination of all types of erythroderma is carried out according to one algorithm.
First, it is necessary to treat the underlying disease that caused erythroderma. All products used before the onset of skin lesions should be discontinued. The exception is essential medicines.
Inpatient treatment of the patient is carried out in a separate room. It is best if it is a room equipped with all the necessary means to control the temperature and humidity of the air. If creating such conditions is impossible, standard wards are used. But in this case, it is necessary to carry out quartzing several times daily, changing bed linen and wet cleaning.
It is not always possible to establish the underlying process that provoked erythroderma. In this case, it is customary to carry out a standard set of therapeutic measures. The basis of treatment is the use of detoxicants (Reosorbilact, Neogemodez, Polydez, Sorbilact, Reamberin) and a 5% albumin solution. Sometimes it is necessary to include fat emulsions (Lipofundin and others) and amino acids in the treatment. They are administered parenterally to intravenous administration sodium thiosulfate is indicated. If the disease was caused by poisoning or the action of heavy metals, Unithiol is used. If necessary, water and electrolyte balance is restored. The volumes of fluid released and administered should be strictly controlled.
Since erythroderma can appear against the background of various malignant processes or with disorders of the immune system, it is recommended to prescribe corticosteroids, cytostatics and selective immunosuppressants. But for systemic treatment, these drugs are used only for certain types erythroderma.
During the course of most erythroderma, pathological keratinization, impaired keratinization and cell differentiation are observed. Aromatic retinoids can help relieve these symptoms. But you need to be careful when taking them. They can increase symptoms or cause various side effects.
If common erythroderma is severe, hemosorption, lasmapheresis, lymphocytopheresis and others are allowed. Antimediator agents that antagonize histamine and other biogenic amines are used against itching and eczematous manifestations. Vitamins A, B, C, E are shown.
As local therapy emollients, corticosteroids, salicylic ointment(0.1-1%), medicinal baths with manganese or medicinal herbs.
Erythroderma photo
– generalized diffuse inflammation of the skin, accompanied by hyperemia and swelling of the dermis, a rash of papules, bullae and pustules, which erode with the formation of crusts and peeling, and have a tendency to merge and grow peripherally. As the inflammation spreads, it invades more and more areas of the dermis, and hair and nails are damaged. The rash is accompanied by prodrome, itching, cracking, and secondary infection. Erythroderma is diagnosed clinically and based on laboratory tests. Inpatient treatment includes antibiotics, glucocorticoids, immunomodulators, antihistamines and other drugs.
General information
– almost total inflammation of the epidermis, which is a symptom of a number of scaly dermatoses of various etiologies and malignant hemodermas, or (less often) occurs against the background of previously unchanged skin. Poses danger to the patient's life. The frequency of deaths with erythroderma, according to various authors, ranges from 18% to 64%. When erythroderma is associated with skin cancer or malignant lymphoma of the skin, mortality is determined by the severity of the underlying disease. Domestic dermatologists record the pathological process in 1-2% of all hospitalizations of patients with skin lesions. According to foreign experts, erythroderma occurs in 0.07% of cases of skin pathology. Erythroderma affects patients older than 40-60 years, and men are 2-4 times more likely than women, which is probably due to the greater prevalence of bad habits and diseases provoked by them with damage to the immune system among males. The pathological process debuts at any time of the year and is non-endemic. The urgency of the problem is related to the severity of the course, the possibility fatal outcome.
Causes of erythroderma
Erythroderma is polyetiological, since it unites a whole group of pathologies. Primary erythroderma is spontaneous. Secondary erythroderma is a symptom of various dermatoses. The most likely triggers of the pathological process are genetic mutations and disorders of the immune system. The pathogenesis of the disease has not been sufficiently studied, and it remains unclear why such different reasons cause the same pathological skin response. However, experts in the field of dermatology believe that the pathogenesis of erythroderma resembles the development of graft-versus-host disease. When introduced into the human body, foreign antigens encounter HLA histocompatibility antigens - protein molecules on the surface of every human cell. The HLA set is individual for each patient. Histocompatibility antigens capture “foreigners” and filter them, separating them from the body’s own cells.
HLAs are associated with the genes of the major histocompatibility complex of the 6th chromosome, therefore they are the first to respond to any genetic mutations. The HLA system regulates the immune response by transmitting the “foreign” to T-lymphocytes, recognizing the body’s own cells into which the foreign antigen has managed to penetrate, activating cellular and humoral immunity to destroy antigens. It also controls the immune response to inflammation that develops in the dermis when skin cells are damaged. Pathogens damage epidermal keratinocytes, which begin to produce proinflammatory cytokines. HLA transmits pathogens to T lymphocytes, activating the immune system and the production of killer and suppressor T cells.
Activated HLA the immune system additionally produces cytotoxic T-lymphocytes, which also destroy foreign antigens. Moreover, the cytokine profile of the immune response in erythroderma includes TH1 and TH2, which makes it possible to neutralize antigens of various origins. TH1 cells destroy the infectious principle, and TH2 cells synthesize interleukins, which enhance the proliferation and formation of IgE class antibodies responsible for allergic reactions. This powerful response is clinically manifested by skin erythroderma. The proliferation processes that accompany antigenic aggression have their own peculiarity - the mitotic activity of the basal cells of the epidermis and their transportation to the surface of the dermis sharply increases. Clinically, large-plate peeling, characteristic of erythroderma, is observed.
Classification of erythroderma
The classification of erythroderma was proposed by the French dermatologist Louis Broc at the beginning of the last century. He divided all variants of diffuse skin inflammation into three groups: primary (spontaneously arising on the unchanged dermis), secondary (developing against the background of dermatoses of various etiologies) and erythroderma, which is a symptom of malignant hemoderma. This classification is still relevant, but today dermatologists distinguish, first of all, between benign and malignant pathologies in order to prescribe adequate therapy in a timely manner.
Among the secondary benign erythrodermas are:
- Psoriatic erythroderma accompanying severe forms of psoriasis. It is divided into a generalized form with almost total damage to the skin, a hyperergic form with a tendency to peripheral growth of foci of inflammation and prodrome, a suppurating form - transitional between Tsumbusch pustular psoriasis and true erythroderma.
- Ichthyosiform erythroderma, which can be bullous, non-bullous and lamellar.
- Broca's erythroderma, congenital dermatosis with universal hyperkeratosis.
- Leiner-Moussou erythroderma, desquamative dermatosis of newborns.
- Eczematous erythroderma, which is a symptom of a severe eczematous process.
- Exfoliative erythroderma(generalized exfoliative dermatitis) is the most severe type of erythematous process.
- Devergie's disease– erythrodermic form, characterized by foci of scaly erythema.
- Drug-induced erythroderma– the result of irrational therapy.
Among secondary malignant erythroderma there are:
- Erythroderma– one of the forms of T-cell lymphoma with total redness of the skin and abundant large-plate peeling.
- Sézary syndrome– erythrodermic reticulosis with reticulemia.
Symptoms of erythroderma
Erythroderma can occur spontaneously, acutely, without visible reasons, or debut against the background of progression of long-existing dermatosis. However, in any case clinical picture Erythroderma can be divided into two stages of development of the pathological process. On initial stage a rash of primary elements in the form of bullae, papules, pustules is observed against the background of hyperemia and, in some cases, the predominance of exudative processes with swelling of the skin. Over time, the epidermis becomes thinner. Primary rashes involute, but new ones are added at the same time. Pustules and vesicles open with the formation of erosions, which are covered with hemorrhagic or purulent crusts. Primary elements in erythroderma have peripheral growth, a tendency to merge and form foci of inflammation of significant size, which very quickly invade new areas of the skin until it is completely damaged. It should be noted that spontaneous resolution of erythroderma is possible at the initial stage.
Weeping begins in the folds of the skin, and a secondary infection occurs. The entire affected skin peels off in large sheets. The rash is accompanied by subjective sensations: pain, burning of the skin, severe itching, general weakness, weakness, arthralgia. Body temperature rises to subfebrile levels. There is an exacerbation concomitant diseases. Secondary stage erythroderma is characterized by thickening of the epidermis, involvement of mucous membranes, hair and nails in the process. Hair falls out, alopecia progresses, nails become dystrophic, peel, and break. Increasing symptoms of intoxication are observed: tachycardia, chills, muscle tremors, high (sometimes up to 40°C) temperature, enlarged lymph nodes, liver and spleen, dyspepsia, engorgement of the mammary glands. All this requires the urgent exclusion of malignancy of the process and the adoption of emergency therapeutic measures.
Diagnosis and treatment of erythroderma
Clinical diagnosis is made based on history, symptoms, laboratory tests and additional research methods. During the examination, the cause of the disease (inflammation or malignant process) is clarified. A single skin biopsy is 50% uninformative, so if necessary, a series of biopsies are performed. To identify signs of malignancy, the T-cell receptor gene is rearranged using electrophoresis in agar-agar gel (determination of a specific DNA sequence in the tissue sample being studied) and peripheral blood smears. Immunohistochemistry and determination of monoclonal antibodies are used. HIV testing is used; the levels of lipids, zinc, and amino acids are examined in children. Erythroderma is differentiated from urticaria, actinic, seborrheic and atopic dermatitis, chickenpox, brucellosis, toxicoderma, pilaris and lichen planus, ichthyosis, widespread psoriasis, sarcoidosis, dermatophytosis, and lymphoproliferative processes.
The treatment plan is drawn up taking into account the cause of development and form of the disease. Treatment is complex, carried out in inpatient conditions. Glucocorticosteroids, cytostatics, antibiotics are used, antihistamines, enterosorbents, immunomodulators, most often in the form intravenous infusions. Contact with water is excluded, since moisture provokes the spread of the process. Sometimes extracorporeal hemocorrection and photochemotherapy are prescribed. Anti-inflammatory and emollient ointments are used externally. The prognosis depends on the form of the disease and timely onset therapeutic measures. In case of late diagnosis and treatment, death is possible, especially if erythroderma accompanies a malignant tumor process or systemic pathology.
Erythroderma is a general name for skin diseases of various etiology and pathogenesis, characterized by widespread, often universal redness, swelling or infiltration and peeling of the skin. Peeling is often lamellar, but can be small, pityriasis-like.
There are primary and secondary erythroderma; the latter are layered on existing skin diseases (lichen planus, etc.). Erythroderma can occur acutely, subacutely and chronically. Acute erythroderma is most often a consequence of hypersensitivity () to various drugs (arsenic, sulfonamides, antibiotics, etc.). Chronic erythroderma occurs as one of the manifestations common diseases(leukemia, lymphogranulomatosis, mycosis fungoides, etc.). The etiological diagnosis of chronic erythroderma is established by a comprehensive examination of patients. Treatment depends on the identified cause. Externally - softening ointments.
The following independent forms of erythroderma are considered.
1. Wilson-Brock's erythroderma. Observed in adults, occurs subacutely or chronically; Itchy spots appear on various parts of the skin, increasing and merging, they affect the entire skin. The skin becomes red, infiltrated and covered with large-plate scales; hair and nails fall out. Fever, headache, etc. are often noted. The etiology is unknown. The duration of the disease ranges from several months to several years; the prognosis is difficult. Treatment is corticosteroids.
2. Congenital ichthyosiform erythroderma - see.
3. Leiner's desquamative erythroderma (Leiner's disease) is a disease caused by insufficient intake of B complex vitamins, especially vitamin H (biotin), into the body. The disease begins at 2-3 weeks of life and is characterized by three main symptoms: skin lesions, gastrointestinal tract, blood changes.
Skin lesions in the form of bright redness begin in the skin folds and in the buttocks; subsequently the redness spreads to the legs, torso, face; within 2-3 days, the entire skin may be affected. During the period of full development of the disease, the skin is red, somewhat infiltrated, covered with a large number of pityriasis-like or small-lamellar scales that easily fall off. On the buttocks and palms the skin is tense and shiny, in the folds there is slight weeping, on the scalp there are massive crusts or scales that are difficult to remove.
Along with skin changes, dyspeptic disorders are noted. Hypochromic anemia develops in the blood, and the number of leukocytes increases.
Skin lesions last 20-30 days, then infiltration decreases, the skin becomes elastic and takes on a normal color.
Treatment. Proper feeding with mother's milk with the introduction of vitamins: 25 mg, vitamin C 100 mg per day; Vitamin A concentrate 20 drops 1 time per day is prescribed to a nursing mother (it is not recommended to give to children due to gastrointestinal disorders). In case of severe disease, administration is indicated; in case of anemia, 30-50 mcg intramuscularly, 10-15 injections every other day. In case of complications, antibiotics, plasma, and cardiac drugs are prescribed. Topically apply Unna cream, 0.5% salicylic, 5% dermatol ointments, corticosteroid ointments (prednisolone, locacorten, sinalar), Peach oil; on wet areas - from a 1-2% solution; daily baths with (pink solution).
Careful care of the child is very important: sterile or ironed linen, cleansing the skin after bowel movements with sterile vegetable oil. When improving general condition starch or soda baths are prescribed (see Baths, baths for children). You need to walk a lot with your child (not in the sun!).
At proper treatment The prognosis is good, but in the presence of complications it worsens.
Erythroderma (from the Greek erythros - red and derma - skin) is a collective concept denoting a group of skin diseases of various etiologies and pathogenesis. Erythroderma is divided into primary and secondary; the latter occur with dermatoses - psoriasis, eczema and other lesions, as well as as a result of allergies to antibiotics and sulfonamides. Secondary erythroderma, complicated by necrosis of large areas of the epidermis, is the leading clinical manifestation with Lyell's syndrome (A. Lyeil), the Clinic of erythroderma is characterized by widespread inflammation of the skin, severe hyperemia, peeling, sometimes large-plate, swelling and infiltration of the skin. When complicated by oozing, a secondary pyococcal infection is often associated. Erythroderma can be acute, subacute and chronic; transitional and mixed forms are possible. Histologically: severe swelling, especially of the Malpighian layer, intercellular and intracellular acanthosis, parakeratosis, inflammatory infiltrate. In acute erythroderma, the phenomena of inflammation and swelling are more severe.
Wilson-Brock's erythroderma(synonymous with generalized exfoliative Wilson-Brock's dermatitis) - the etiology is unclear, adults are affected; begins with the appearance in the folds, and then in other areas of the skin, of foci of redness, which after 1-2 weeks turn into large areas; later the process covers the entire skin. The skin is bright red, swollen, hardly folds, large-plate peeling, especially sharp on the palms and soles. In severe cases, vomiting, dyspeptic symptoms, and an increase in temperature to 38-40° are common. Hair loss and rejection of nail plates are noted. Maceration often develops in the folds, which contributes to the complication of strepto-staphylococcal infection (streptoderma, boils). The prognosis is difficult. Treatment: corticosteroids (prednisolone, triamsinolone, dexamethasone), vitamins B, C, blood transfusions. Locally - ointments and creams with corticosteroids.
Exfoliative dermatitis of newborns(synonymous with Ritter's disease) - erythroderma of pyococcal etiology, developing in the first weeks of life; generalized hyperemia is sometimes preceded by a stage of blistering and begins acutely, sometimes within 1-2 days. Clinically: the skin is bright red in color with large areas peeling off (resembles a burn). The prognosis is difficult. Treatment: antibiotics wide range actions, sulfonamides, drinking plenty of fluids, locally - creams and emulsions with antibiotics, tannin baths. Prevention: compliance hygiene procedures when caring for a newborn, avoid contact with persons suffering from pyoderma.
Erythroderma congenital ichthyosiform - see Ichthyosis.
Erythroderma desquamative Leiner(erythrodermia desquamative Leiner; synonymous with Leiner-Moussou disease) is characterized by erythema, large-plate peeling of the skin, almost always dysfunction of the gastrointestinal tract and a violation of the general condition.
The etiology and pathogenesis are poorly studied.
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. Skin lesions often begin with redness and infiltration 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 extremities - with a cyanotic tint; lamellar peeling appears, less often pityriasis-like. The scales are easily removed, but quickly reappear. The skin underneath is red, dry, shiny, and in places seems tense. In the area of natural folds, more or less pronounced maceration of the skin is always observed, and sometimes bleeding cracks appear. Later, fatty yellow-gray scales accumulate on the scalp, which resemble a shell descending to the forehead area. Changes on the skin last 20-40 days.
Along with skin lesions, gastrointestinal disorders are observed ( loose stool mixed with mucus). Children's appetite is significantly reduced, there is excessive frequent regurgitation, less often vomiting, poor weight gain, and sometimes weight loss from the first days of the disease. Most patients develop II and even III degree malnutrition.
A characteristic symptom of desquamative erythroderma is also the development of hypochromic anemia. In some patients, the number of red blood cells decreases to 1,800,000, and hemoglobin - to 25%.
Often with desquamative erythroderma, severe complications, sometimes the disease is aggravated by sepsis. Otitis media and pneumonia are more common. Some children experience multiple abscesses, phlegmon, gangrenous pyoderma, pyuria, and in severe cases of the disease keratomalacia may occur.
The duration of the disease is from 3 weeks to 3 months.
Differential diagnosis is carried out with eczema (see), exfoliative dermatitis of newborns (see above), congenital ichthyosis (see).
With uncomplicated desquamative erythroderma, children recover by 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.
Treatment comes down to increasing the reactivity, immunobiological strength of the child’s body, and establishing proper feeding. Sick children should be regularly breastfed, and if the mother has hypogalactia, receive supplementary feeding with formulas, preferably sour ones.
Hemotherapy is of great importance: Filatov serum or mother’s blood in an amount of 3 to 10 ml for each intramuscular injection(3-12 injections every 2 days on the 3rd). It is advisable to combine hemotherapy with transfusions of canned blood and plasma. Intramuscular injections of gamma globulin are also effective - 3-6 injections per course (1 dose).
If complications are suspected, antibiotics are indicated.
Vitamins are administered to the child and nursing mother. Children receive ascorbic acid 0.05 g and vitamin B1 0.003 g 3 times a day. Vitamin B1 is also recommended to be administered intravenously (4-8 infusions of 1 ml of 1% solution with 5% glucose solution every other day). Good results obtained from the use of vitamins B6 and B12. Vitamin B6 is administered intramuscularly at 0.5 ml of a 2.5% solution or 0.3 ml of a 5% solution every other day or given orally at 20-25 mg daily for 3-4 weeks (per course 500-750 mg). Vitamin B1a is prescribed in the form intramuscular injections 30-50 mcg, every other day, a total of 10-15 injections (per course 300-750 mcg). top scores- with the simultaneous administration of vitamins B6 and B12.
Vitamin A is given to nursing mothers at 50,000 units (20 drops) of concentrate per day for 3-4 weeks. This drug is not prescribed to children due to dyspeptic symptoms.
Careful care of the patient is very important (sterile or ironed linen, avoiding overheating, cleansing the skin after bowel movements with vegetable oil); stay in the air, but not in the sun. The skin is lubricated 1-2 times a day with ointments containing 2% ichthyol, 5% naphthalan and boric acid. Vitamin A can be added to the ointment (1000 IU per 1 g of base).
Macerated surfaces and cracks are lubricated with 1-2% aqueous solution Methyl violett, then apply 3-5% naphthalan paste. To remove accumulations of scales from the scalp, use a compress of 1% salicylic oil (Acidi salicylici - 0.3; Olei vaselini - 30.0) for 4-6 hours, after which the head is washed with baby soap. If the scales are not completely removed, the procedure is repeated after 2-3 days.
As the patient's general condition improves, it is recommended to prescribe starch or soda (2%) baths.
In the prevention of desquamative erythroderma great importance has a diet for pregnant and lactating mothers, whose diet should be complete and rich in vitamins that contribute to normal course pregnancy, childbirth and full development of the fetus.
The term erythroderma is used to describe a specific skin condition - large-scale redness of the skin, the appearance of itchy rashes and peeling. The problem is difficult to ignore, since almost the entire body suffers from it, but in the structure of dermatological ailments it is rare - about 2% of cases. It is important to begin promptly diagnosing and treating erythroderma - the condition poses a danger to the patient’s life.
Reasons for appearance
Large-scale damage to the skin develops under the influence of many reasons, and can act as an independent disease (have a primary form) or be a consequence of another disease (secondary form). The following provoking factors can cause typical symptoms:
- the patient has chronic form plaque psoriasis;
- dermatitis with severe itching;
- infectious skin lesion;
- glucocorticosteroid withdrawal syndrome;
- exposure to severe stress;
- leukemia and lymphoma;
- malignant neoplasms in the final stages;
- eczema;
- fungal infections of the integument;
- state of immunodeficiency, including when infected with HIV;
- hereditary predisposition.
In approximately 1 case out of 10, it is not possible to accurately determine the source of the problem at all; in such a situation, a general approach to treatment is used.
The risk group includes males over the age of 40 years. Women can also suffer from erythroderma, but this is several times less common.
Doctors explain this by the greater prevalence of provoking factors among the male population: bad habits(smoking and drinking alcohol), frequent stress, taking medications without a doctor’s prescription, unfavorable, difficult working conditions, etc.
Description and photos of symptoms
Erythroderma occurs spontaneously or is a consequence of an existing disease, but in any of the scenarios, the disease will go through two stages. Primary symptoms, characteristic of all forms of the disease, include:
In the first stage of development, the condition may resolve spontaneously and symptoms will disappear. In this case therapeutic measures stop. If this does not happen, the disease will progress, and other symptoms typical of erythroderma will become relevant:
From the photos below of erythroderma in adult patients, you can assess the nature and extent of tissue damage - the rich red color of flaky skin throughout the body. 
We can say that the existing problem is erythroderma due to a combination of three typical signs of the disease:
- the scale of the damage is approaching absolute (that is, there are practically no areas of unchanged skin on the body);
- constant peeling that does not stop until complete recovery;
- The therapeutic measures taken act slowly - the disease is difficult to treat.
Varieties
Erythroderma develops in humans in several variants. The types are described based on the disease against which the problem arose. Let's look at the features and signs of common types of the disease.
Psoriatic
Erythroderma accompanies severe forms of psoriasis, when plaque lesions affect most bodies.
Special factors play a role in its development: aggressive effects on the skin sun rays and unqualified appointment medicines in the treatment of a provoking disease (an irritant). 
Ichthyosiform
A genetically determined congenital condition, the peculiarity of which is a violation of the process of keratinization of the skin. For the first time in history, the phenomenon was described by Chinese doctors back in the third century BC. Dry forms of the disease are accompanied by:
Broca's erythroderma
A type of ichthyosis: the predominant state is hyperkeratosis and the absence of a rash. For characteristic appearance In patients, the pathology is often called “fish scale disease.” Its causes are a genetic disorder, due to which dry scales form on the epidermis over the entire surface of the body.
Leiner's erythroderma
The problem develops in children in the first month of life and represents the formation of large-scale rashes originating from the genitals and scalp. The lesions are edematous, protrude above the surface of intact tissues, and weeping phenomena are observed in large folds. Leaks from normal temperature bodies.
Treatment and preventive measures
Depending on the form of the disease, treatment has some features, but all measures have a similar focus and general scheme:
- Elimination of the provoking factor or disease and discontinuation of all medications that were taken by the patient before the development inflammatory process on the skin (except for vital ones).
- To reduce heat loss, the patient is placed in a warm room with a small area. Single occupancy is desirable - this reduces the risk of secondary infection.
- The patient is prescribed a large number of drinking (in case of fever, fluid is administered intravenously) to prevent dehydration due to hyperproduction of sweat.
- Damaged skin is treated with emollient compounds.
- A course of drugs is prescribed to detoxify the body (Reamberin, Sorbilact, Neogemodez, etc.), corticosteroids (if severe forms), vitamin compositions to maintain the body's protective functions.
- As part of the therapy, contact of the skin with water is excluded, otherwise the disease will spread to healthy areas of the body.
- Hypoallergenic diet.
- When weeping areas appear and infection develops, antibiotics are used (orally and locally).
Treatment of erythroderma in both adult patients and children is a complex and lengthy process.
The lack of adequate therapy leads to a deterioration in a person’s quality of life, as well as an increased risk of death due to constantly recurrent infections of injured tissues.
