Study On Correlation Between Erythroderma And Malignancies

Erythroderma, known as exfoliative dermatitis, is a chronic erythematospuamous dermatonosis involving in almost the whole skin. Its pathogeny is complex. Lots of research have indicated approximately 8%-20% of erythroderma were complicated with malignancy. The study aimed to investigate the correlativity between erythroderma and malignancy, further to understand the clinical features and pathogenesis of erythroderma, to guide the clinical therapy effectively and improve the prognosis, and to offer clue and help for early discovering, diagnosis and treatment of associated malignancies. Clinical data of 51 cases erythroderma patients who hospitalized and consulted during 2000-2008 at the fourth Affiliated Hospital, He Bei Medical University were retrospectively investigated and analyzed. At same time, we combined pertinent literatures at home and abroad, expounding 7 aspects as follow:1 The differences between age and sex of erythroderma: It is a common disease in the middle and old-aged male and the mean age at diagnosis was 41-61.5 years. Men outnumbered women in a proportion of 2-4:1.2 The Causes of erythroderma were as follow:⑴Drug reactions, pesticide and chemical materials hypersensitiveness. ⑵Secondary to Psoriasis, Eczema, Ichthyosis and so on, and above half of Psoriasis, Eczema, Ichthyosis, Prurigo.⑶Secondary to malignancy (8%-20%).⑷unexplained.3 Erythroderma was featured by diffuse flush, imbibition swelling, desquamation all over the skin, accompanying with dry skin with varying degrees of scaling, edema, lymphadenectasis, even high-output heart failure, congestive heart failure, the damage of liver and kidney, hypoproteinemia, enteropathy, hypothermia, and hyperthermia. Those patients of erythroderma associated with malignancy can also appeared the symptom of soakage, compression and occlusion and so on.In most patients with erythroderma, skin biopsies show nonspecific histopathologic features, such as hyperkeratosis, parakeratosis, acanthosis and a chronic perivascular inflamma- tory infiltrate, with or without eosinophils. Even patients with clear histories of preexisting dermatoses tend to have biopsies that are not diagnostic when they present with erythroderma. only 50% skin biopsies show specific pathological change .for example we could see Munro microabscess and trochanterellus downward extending in psoriasis erythrodermic. MF could see MF cell. Sézary syndrome could see Sézary cell and so on.4 The Symptomatic and etiological therapy was to stop using allergenic drugs, treat the primary disease and to prevent recurrence. malignancies associated with erythroderma should be resected, or combine with radiotherapy and chemotherapy.5 To analyze emphatically the clinical characteristics, pathological change and therapy of the erythrodermic form of mycosis fungoides and the Sézary syndrome. 10% of MF showed erythroderma symptom, with typical MF cell.100% of Sézary syndrome showed erythroderma symptom, and above 10%-15% of Sézary cell during peripheral blood could diagnose Sézary syndrome. Patients of E-CTCL could be treated by nB-UVB, glucocorticoid, Acitretin and Chlormethine in a single or combind way. The prognosis was concerned with patient's age, disease progression and the content of LDH. Early cases can relieve obviously in short term but when lymphaden and internal organs were involved, disease conditions were aggravated quickly.6 The type of internal visceral malignancies associated with erythroderma was main lung cancer, colon carcinoma, breast cancer and so on in our country. According the character, progression and systemic state to choose different treatments, such as operation, radioactive, anticancer drugs, biotherapy and physical therapy and so on. After controlled primary lesion, to treat metastasis.7 The treatment outcome of erythroderma was closely related to the prognosis and recurrence of malignancies. General therapy was ineffective to erythroderma of unknow origin. For high risk and aged patiants, it is important to ask disease history in detail, follow up regularly, inspect overall and repeat biopsies if necessary. Thus we can offer clue for early discovering, diagnosis and treatment of associated malignancies, gain time for the underlying malignancy, improve quality of life and lengthen survival time.