A Retrospective Clinical Study Of 220 Patients With Erythroderma

ObjectiveTo analyze the clinical characteristics of erythroderma,to probe the distribution characteristics of TCM syndromes and the treatment of the Chinese medicine of erythroderma and to summarize the relevant clinical experience,so as to provide reference for further improving the level of diagnosis and treatment and prognosis of erythroderma with traditional Chinese and western medicine.MethodsTo review the medical records of 220 hospitalized patients diagnosed with erythroderma treated in dermatology department of Guangdong Provincial Hospital of Traditional Chinese Medicine from 2011 to 2017.The medical records include general data,pathogenic etiology,clinical manifestaions,laboratory results,complications,TCM syndrome types,treatment of traditional Chinese and western medicine and so on.The patients with unknown etiology were followed up by telephone to investigate the development of their condition,to find our clues and reveal the etiology.Results1.General data:220 cases(163 males and 57 females)were enrolled in this study.The mean age was 56.67±21.13 years(range:5?90 years)with a male:female ratio of 2.86:1.The average hospitalization time was 12.30 ±6.71 days(range:3?51 days).The annual difference was statistically significant.The average hospitalization days of erythroderma patients showed a downward trend over the years.The average hospitalization days of patients with erythrodermic medicamentosa were the least.2.Etiology:160 cases were secondary to other skin diseases,of which psoriasis was the most common(68 cases,30.91%).There were 35 cases(15.91%)of unknown cause,21 cases(9.55%)of drug allergy and 4 cases(1.82%)of carcinoma.The etiological distribution of patients secondary to other skin diseases was statistically different in various age groups(P<0.05).Atopic dermatitis was dominant in 0?17 years old group,psoriasis was dominant in 18?65 years old groups.Over 65 years old groups were mainly eczema.3.Erythroderma complicated with infection:There were 47 patients with infection,of which the infection rate of patients with various age groups was statistically different(P<0.05).The infection rate increases with age.The infection rate of erythroderma complicated with hypoproteinemia,electrolyte disturbance and fever was higher(P<0.05).4.TCM syndrome type:The syndrome types of 220 patients was mainly composed of dual vacuity of qi and yin,damp-toxin brewing and binding,exuberant heat toxin pattern,damp-heat stasis obstruction.There were statistically remarkably differences in the distribution of TCM syndromes in patients with erythroderma of different etiologies(P<0.01).The syndrome of dual vacuity of qi and yin was more common in patients with psoriasis,damp-heat stasis obstruction syndrome more common in patients with eczema,damp-toxin brewing and binding syndrome more common in patients with drug allergy,and heart-spleen heat accumulation syndrom more common in patients with atopic dermatitis.The principle of TCM used in syndrome differentiation and treatment were heat-clearing drugs(37.74%)and tonic drugs(26.44%).Conclusion1.The incidence of erythroderma was more common in the middle-aged and the elderly.The incidence of erythroderma in males was higher than that in females with a male:female ratio of 2.86:1.2.Secondary to other skin diseases was the most common cause of erythroderma,in which erythrodermic psoriasis was the main cause.Drug withdrawal irregularly by themselves was the commom trigger in patients with erythroderma secondary to other skin diseases.The age distribution of diverse etiologies was different.Atopic dermatitis was predominant in minors,psoriasis was predominant in young and middle-aged people,and eczema was predominant in the elderly.3.The infection rate of erythroderma patients increased with the increase of age.Elderly patients with erythroderma were prone to associated infection.The infection rate of erythroderma complicated with hypoproteinemia,electrolyte disturbance and fever was higher.Early nutritional support and strengthening skin nursing were helpful to improve the curative effect and reduce the infection rate.4.The distribution of TCM syndromes of diverse etiologies was different.The syndrome of dual vacuity of qi and yin was more common in patients with psoriasis,damp-heat stasis obstruction syndrome more common in patients with eczema,damp-toxin brewing and binding syndrome more common in patients with drug allergy,and heart-spleen heat accumulation syndrom more common in patients with atopic dermatitis.