| Objective: In this study,the data of 166 patients with erythrodermic psoriasis were collected and analyzed retrospectively,and the clinical characteristics,laboratory examination and treatment of erythrodermic psoriasis were summarized.in order to improve the understanding of the disease and provide clinical reference for better prevention and treatment.Methods: A total of 166 patients with erythrodermic psoriasis treated in the Department of Dermatology of the fourth Clinical Medical College of Xinjiang Medical University from 2009 to 2021 were collected.The general situation,clinical features,laboratory examination,co-disease and treatment of erythrodermic psoriasis were counted and summarized by using Excel table and SPSS22.0software.Results: In this study,the average age of 166 patients with erythrodermic psoriasis was 51.35 ±16.38 years old.Age distribution: 9 patients were less than 20 years old(5.4%);7 patients were 21-30 years old(4.2%);20 patients were 31-40 years old(12.0%);45 patients were 41-50 years old(27.1%);39 patients were 51-60 years old(23.5%).28 patients aged 61-70 years(16.9%);18 patients aged ≥ 71 years(10.8%);135males(81.3%)and 31 females(18.7%),with a male-to-female ratio of 4.4%;among them,3 patients had family history,all male.There was no significant difference in onset season.Among the marital status,122 patients were married(73.5%),29 were unmarried(17.5%),7 were widowed(4.2%),8 were divorced(4.8%),152 patients lived in Xinjiang and 14 lived outside Xinjiang,Han accounted for the majority,followed by Uygur,Hui,Kazak,Mongolian,Zhuang and Manchu.35 cases had a history of drug allergy,including 29 cases of antibiotic allergy,2 cases of traditional Chinese medicine allergy,1 case of barbital allergy,1 case of rifampicin allergy,1 case of Pilian ointment allergy and 1 case of dexamethasone allergy.There were 159 cases of psoriasis vulgaris and 7 cases of erythrodermic psoriasis.The longer the course of the disease,the more the number of cases.The average age of onset of the original psoriasis was 37.68 ±16.49 years.The course of the original psoriasis ranged from 3 months to 38 years,with an average of14.08 years.The course of erythrodermic psoriasis ranged from 1 day to 9 years,with an average of 5.72 months.The average hospital stay was 15.27 ±6.94 days.In addition to 72 cases without obvious inducement(43.4%),37 cases(22.3%)with unknown drugs accounted for the most,followed by upper respiratory tract infection in 25 cases(15.0%),mail-order drugs in 13 cases(7.9%),irregular use of corticosteroids in 5 cases(3%),emotional factors in 5 cases(3%),increased),UVB exposure in 3 cases(1.8%).Seafood consumption was found in 3 cases(1.8%),other causes in 2 cases(1.2%),and alcohol consumption in 1 case(0.5%).6%).Clinical manifestations of erythrodermic psoriasis: 1skin rash: all patients showed diffuse red or dark red rash,inflammatory infiltration,flaky or furciferous desquamation,of which 17 cases were acute,149 cases were subacute,and3 cases were accompanied with varying degrees of mucosal damage.2 systemic manifestations: depressed edema of both lower limbs in 29 cases,fever in 19 cases,arthralgia in 14 cases,superficial lymph node enlargement in 10 cases,palmoplantar socks desquamation or palmoplantar keratosis in 3 cases.The order of chronic diseases was hypertension(n = 22),diabetes(n = 15),coronary heart disease(n = 7),fatty liver(n = 3),hyperthyroidism(n = 1)and hypothyroidism(n = 1).In blood routine examination,leukocyte increased in 50 cases,hemoglobin decreased in 24 cases,eosinophil increased in 31 cases,proteinuria in 12 cases,urinary occult blood in 7 cases.Among the biochemical indexes,total protein decreased in 83 cases,albumin decreased in 91 cases,immunoglobulin E increased in 38 cases,glutamic pyruvic transaminase increased in 14 cases,glutamic oxaloacetic transaminase increased in 12 cases,triglyceride in 22 cases,cholesterol in 6 cases,blood glucose in 6 cases,serum sodium decreased in 13 cases,serum calcium decreased in 22 cases,serum potassium decreased in 12 cases,erythrocyte sedimentation rate increased in 15 cases,25-hydroxyvitamin D decreased in 15 cases,creatinine increased in 2 cases.The results of examination showed that there were 30 cases of abnormal ECG and 26 cases of abnormal chest X-ray,which were treated with western medicine.36 cases were treated with Acitretin,11 cases of hormones(dexamethasone,methylprednisolone,betamethasone injection),11 cases of methotrexate,9 cases of total glucosides of paeony,5 cases of compound glycyrrhizin,adamu 2 cases of monoclonal antibodies,2 cases of Tripterygium Glycoside tablets,1 case of cyclosporine,16 cases of whole body black light therapy,10 cases of acitretin + phototherapy,8 cases of acitretin + hormone,1 case of methotrexate + hormone,methotrexate Pterin + Acitretin1 case,Tripterygium wilfordii + hormone in 1 case,Acitretin + methotrexate + hormone in 1 case,Acitretin + methotrexate + phototherapy in 1 case,Acitretin + glucocorticoid +phototherapy in 1 case.Combined with the four diagnostic parameters,TCM syndrome types: spleen deficiency and dampness syndrome 65 cases,qi and yin deficiency syndrome 55 cases,spleen and kidney deficiency syndrome 20 cases,dampness-heat syndrome 9 cases,blood-heat syndrome 8 cases,blood dryness syndrome 3 cases and so on.According to different syndrome types,the basic prescriptions of clinical traditional Chinese medicine are also different.TCM treatment: Qingre Yangyin decoction(n = 58),Jianpi jiedu decoction(n = 55),Jianpi Yishen decoction(n = 18),Shenling Baizhu Powder(n = 12),Qingre dehumidifying decoction(n = 7),Qingre Huoxue decoction(n = 6),dehumidification and antipruritic decoction(n = 4)and so on.The comprehensive treatment of traditional Chinese medicine includes oral administration of traditional Chinese medicine,medicine bath,traditional Chinese medicine collapse therapy,bloodletting therapy,traditional Chinese medicine smear treatment,traditional Chinese medicine package treatment,traditional Chinese medicine ointment and so on.Conclusion: The common inducing factors of erythrodermic psoriasis are the use of unknown drugs and upper respiratory tract infection.The common concomitant diseases are hypertension,diabetes,coronary heart disease,fatty liver and so on.Through disease differentiation,syndrome differentiation and body differentiation,spleen deficiency and dampness syndrome is the main syndrome type of 166 cases of erythrodermic psoriasis. |
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