| Objectives:This study took 105 hospitalized patients with erythroderma in our hospital as the research object,their clinical data were analyzed to further understand the characteristics and pathogenesis of erythroderma,provided ideas for rational diagnosis and effective treatment of erythroderma,and provided reference for clinical work.Methods:A total of 105 cases of erythroderma who were hospitalized in our hospital and had complete medical records from January 2016 to January 2022 were retrieved.A retrospective investigation was performed on such items as general situation(gender,age,hospitalization time,and course of disease),etiology,precipitating factors,clinical manifestations(rash characteristics,systemic manifestations,and complications),auxiliary examinations(laboratory tests,chest CT,electrocardiogram,ultrasound,and skin pathology),treatment method,and curative effect.SPSS 23 statistical software was used for statistical analysis and conclusions were drawn.Results:1.General condition:Among 105 cases of erythroderma,76 cases were male and29 cases were female,and the ratio of male to female was about 2.62:1,all the different age groups were higher in men than in women;age of the disease was ranging from 14 to 92 years old,with an average age of about 62.79±16.07 years old,the incidence rate of middle-aged and elderly people was high;the course of the disease ranged from 2 days to 30 years pre hospitalization;the hospital stay ranged from 4 to 28 days,with an average of 9.98±4.07 days.2.Etiology:68 patients were secondary to other skin diseases,accounting for64.76% of the total number of patients,among them the eczema was the most,accounting for 36.19%,followed by psoriasis,accounting for 28.57%;24 patients were caused by drug allergy,accounting for 22.86%;8 patients were paraneoplastic,accounting for 7.62%,one of them was cutaneous T-cell lymphoma(CTCL),the others were respectively esophageal cancer,breast cancer,intracranial malignant tumor,lung cancer,meningioma,thyroid cancer and myeloproliferative tumor(MPN),each accounting for 0.95%.The etiology of 5 cases was unknown,accounting for 4.76%.3.Incentives:Among the inducing factors in original skin disease aggravating erythroderma,39 cases(39/68)did not use glucocorticoids standardizedly,11 cases(11/68)did not use Chinese herbal medicines standardizedly,8 cases(8/68)did not use immunosuppressants standardizedly,7 cases(7/68)were stimulated locally,and the other were 3 cases(3/68).4.Clinical manifestations:In rash features,47 cases were acute onset,58 cases were subacute or chronic onset,90 cases were skin itching,5 cases were oral mucosal ulceration,21 cases were nail damage,9 cases were conjunctivitis,21 cases were skin infection.Systemic manifestations:39 cases were irregular fever,53 cases were superficial lymphadenopathy,27 cases were tachycardia,16 cases were facial edema,30 cases were sunken edema in both lower limbs,8 cases were joint pain,5 cases were abdominal pain.5.Auxiliary examination:There were 44 cases with increased white blood cells,33 cases with increased neutrophil count,33 cases with increased eosinophil percentage,29 cases with increased eosinophil,39 cases with decreased hemoglobin,63 cases with decreased albumin,70 cases with decreased total protein,37 cases with abnormal liver function(ALT and AST values),15 cases with thrombocytosis,8 cases with thrombocytopenia,37 cases with increased fasting blood glucose value,78 cases with electrolyte disturbance,15 cases with hypokalemia,and 43 cases with increased uric acid,24 cases with increased triglycerides,80 cases with increased D2 aggregates,62 cases with increased LDH,63 cases with increased C-reactive protein,86 cases with white-ball ratio inversion,21 cases with increased tumor marker SCCA,81 cases with abnormal ECG,89 cases with abnormal CT,and 72 cases with abnormal abdominal B-ultrasonography.Histopathological examination was performed in 25 cases,including 15 cases with non-specific dermatitis changes,7 cases with specific changes,one case with CTLT,one case with dermatomyositis,and one case with pityriasis rubrum.The incidences of triglyceride increase,LDH increase,D2 aggregate increase,fasting blood glucose increase and hypokalemia were significantly different between erythrodermic psoriasis and primary dermatosis aggravating erythroderma(P< 0.05).The incidences of triglyceride increase,LDH increase,D2 dimer increase and fasting blood glucose increase were significantly different between erythrodermic psoriasis and drug eruption erythroderma(P<0.05).There was no significant difference in the residual auxiliary examinations among different groups(P>0.05).6.Treatment and curative effect:Different treatment methods were selected according to different etiological types of erythroderma.All patients were treated with vitamin C or calcium gluconate,supplemented by red light and hydrotherapy,55 cases were treated with glucocorticoids,30 cases were treated with retinoids,17 cases were treated with immunosuppressants,7 cases were treated with antibiotics,4 cases were treated with biological agents,and 1 case was treated with surgery.In terms of curative effect,15 cases were cured(14.29%),63 cases were markedly improved(60.00%),23 cases were improved(21.90%)and 4 cases were ineffective(3.81%).There was a significant difference in treatment effective rate between patients with paraneoplastic erythroderma and patients with original skin disease aggravating erythroderma(P<0.01).The average number of hospital days for patients with erythroderma was 9.14± 2.95 days,and 4 patients returned to hospital for treatment many times.7.Analysis of infection: 51 patients(48.57%)of erythroderma had infection,mainly upper respiratory tract infection and skin infection.The univariate analysis showed that total protein level(p<0.01),albumin level(p<0.01),fever(p <0.01),and hemoglobin level(p <0.05)were risk factors for infection.Biary Logistic regression analysis showed that total protein < 60 g /L(OR = 5.395,95%CI 1.098～26.518,P=0.038),albumin < 35g/L(OR = 4.18,95%CI 0.037 ～ 20.886,P =0.035)were independent risk factors for infection in erythroderma patients.Conclusions:1.Erythroderma is common in middle-aged and elderly people,with more males than females;the proportion of male and female cases is 2.62:1;different age groups have more men than women.2.Most patients with erythroderma are aggravated by the primary skin disease,among which eczema is more common,followed by psoriasis.3.The main inducing factors for patients with exacerbation of primary skin diseases erythroderma and erythrodermic psoriasis were improper use of glucocorticoids,followed by improper use of Chinese herbal medicine preparations and immunosuppressive agents.Local skin irritation was also common.4.Different etiologies of erythrodermic have different clinical characteristics,but the value of clinical characteristics in the diagnosis of erythrodermic etiology is limited.In the original erythrodermic caused by skin disease aggravation,psoriasis,drug eruption,paraneoplastic,unexplained,there is no difference in the statistics of auxiliary examination results.Therefore,detailed inquiry of the patient’s medical history and systematic physical examination play a key role in the treatment and prognosis of erythroderma,especially the existence of rare causes,and skin histopathology examination is necessary.5.On the basis of strengthening skin care and health education for patients,therapeutic drugs are rationally used according to the etiology.No significant difference in the treatment effect of hormones and immunosuppressive agents alone or together in patients with primary skin disease.Elderly patients should be alert to complications such as infection dehydration,electrolyte disorders and high output heart failure,and multidisciplinary consultation should be feasible when necessary.Tumor patients need specialized treatment.6.Patients with erythroderma due to aggravation of other skin diseases except psoriasis and drug rash had longer hospital stay,but their treatment effective rate was higher.In patients with tumor-related erythroderma,although the hospitalization days were lower than the average,but the effective rate was lower.Patients with unexplained erythroderma are all older and may have problems such as unknown history inquiry,rare etiology or risk of potential malignancy,which should pay attention to follow-up.7.Patients with fever,total protein decreased,serum albumin decreased,anaemia is easy to induce infection,the main sites of infection are the lungs and skin.Total protein decreased,serum albumin decreased are independent risk factos for infection. |
PDF Full Text Request