63043242-eritroderma
TRANSCRIPT
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ERITRODERMA
Dimas WiryantomoHarti Kusni Wahyuningsih
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Definisi
• Kelainan kulit ditandai adanya eritema universalis (90-100%), biasanya disertai skuama berlapis-lapis.
• Sinonim : dermatitis eksfoliativa
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epidemiologi
• Onset : > 50 tahun• Pria> wanita
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Etiologi
• 50% Riwayat dermatosis sebelumnya (+) : psoriasis, dermatitis atopi, alergi obat, cutaneus T cell lymphoma, DKA, dan pityriasis rubra pilaris
• 20% idiopatik
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Etiopatogenesis
Dipegaruhi oleh penyakit yg mendasarinyaI. Perluasan penyakit kulit (55%)II. Reaksi obat (15%)III. Penyakit sistemik/keganasan (11%)Sisanya idiopatik
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Patogenesis
• Patofisiologi eritroderma belum jelas, yang dapat diketahui adalah akibat suatu agent dalam tubuh, maka tubuh bereaksi berupa pelebaran pembuluh darah kapiler (eritema) yang universal sehingga terjadi fluid loss dan kehilangan panas (konveksi).
• Pada eritroderma kronis : gagal jantung, hipotermi, dehidrasi, hipoproteinemia, edema, rambut rontok dan kehilangan kuku, perburukan KU progresif
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Patogenesis:
– Gx termoregulasi hipertermi/hipotermi heat loss menggigil
– Takikardia ↑ aliran darah ke kulit– Dehidrasi barier kulit rusak (skuama >90%)
penguapan ↑– Hipoalbuminemia skuama protein 9 gr/m2– Infeksi ↑
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Manifestasi Klinis
• Tergantung etiologi• Lesi kulit : kulit merah, tebal, berskuama• Telapak tangan dan kaki : masif hiperkeratosis
dan fissura yang dalam pada pityriasis rubra pylaris, sindrom sezary, dan psoriasis
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• Rambut : telogen effluvium- alopesia • Kuku : kuku menebal, onikolisis• Pigmentasi : hiperpigmentasi atau patchy pada
dermatitis kronis • Px general : edema di ekstremitas inferior,
limfonodus membesar pada sindrom sezary
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I. Perluasan peny. Kulit• Psoriasis (>>) :
Disebabkan 2 hal : 1. penyakitnya sendiri2. Pengobatan yg diberikan
- tar- penghentian KS scr tiba2Ukk : Lesi psoriasis yg khas tdk tampak lg krn tdpt
eritem & skuama tebal universal • Spongiotic dermatitis• Leiner disease karena dermatitis seboroika yg meluas
Ukk :Eritem universal + skuama kasar• Dll..
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• Exfoliatif dermatitis : psoriasis
• Eritem menyeluruh, kulit menebal, dan berskuama berat
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II. Reaksi Obat :• Antibiotik,Anti
epileptik,Analgetik/Antipiretik,Obat2 jantung,dll
• Waktu mulai masuknya obat-timbul penyakit : segera-2mggu
• Ukk : eritem universal, sedangkan skuama muncul pada fase penyembuhan
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• Exfoliatif dermatitis : drug induced
• kulit menebal shg lipatan kulit meningkat, kemerahan dan berskuama tipis
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III.Peny. Sistemik / keganasan-Sindroma Sezary
Std dini mikosis fungoidesEt : HTLV-VEritem merah membara universal+ skuama+ gatalDitemukan sel sezary >= 1000/mm3
-Infeksi bakteri/viral/jamur-Dermatomiositis-Sarkoidosis, Dll….
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• Exfoliatif dermatitis : cutaneous T cell lymphoma
• Eritem menyeluruh, kulit menebal, dan berskuama
• Eritem & ketebalan kulit tidak seragam
• Limfadenopati generalisata
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Pemeriksaan Penunjang
• Albumin ↓, gamaglobulin ↑, elektrolit tdk seimbang
• Lekositosis• Kultur : infeksi sekunder S. aureus (kulit).
Sepsis (darah)• PA: tgt underlying dissease• MRI, CT scan, biopsi limfonodus jika curiga
limfoma
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Diagnosis
• Riwayat dermatosis sebelumnya• Sign dan simptom patognomonik dari
dermatosis sebelumnya
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Management
I. Topikal :• Emolien• KS potensi ringan
II. Sistemik :• Sesuai peny yg mendasari• KS jk k/ obat / dermatitis / peny bulosa. Dosis : 1-2
mg/kgBB (tapering off)• Antihistamin • AB infx sekunder
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III. Suportif• Tx cairan• Diet TKTP• Tx kel jantung, dll
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Prognosis
• Tgt underlying etiology• Eritroderma akbt Reaksi obat-> baik• Eritroderma akbt keganasan : Sindrom sezary -
> buruk• Eritroderma yg idiopatik -> KS dependence
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