La eritrodermia en los niños es una condición que puede amenazar la vida, especialmente en neonatos y lactantes. Requiere un manejo en conjunto con pediatría. Las com- plicaciones graves, como infecciones, hipoalbuminemia, hiperpirexia y deshidratación hipernatrémica, pueden aparecer en el curso de esta entidad e incrementan la mortalidad si no se les da un manejo temprano. El trata- miento de la eritrodermia es, principalmente, de soporte, con corrección de las alteraciones hematológicas, bioló- gicas y metabólicas; esto incluye control de signos vitales y electrolitos, líquidos intravenosos adecuados, preven- ción y tratamiento de las infecciones, corrección de la ingestión de calorías y proteínas, aplicación tópica de emolientes, antifúngicos, apósitos húmedos y esteroides tópicos en zonas localizadas. En algunos casos de derma- titis atópica y de eritrodermia por medicamentos, puede ser necesario un ciclo corto de esteroides sistémicos. En la eritrodermia por psoriasis, puede usarse metotrexato o acitretín. En la eritrodermia ictiósica es más difícil el tratamiento con retinoides orales y necesitan ser admi- nistrados por periodos prolongados1.
El pronóstico depende en gran parte de la causa pri- maria de la eritrodermia. Cuando la eritrodermia es por medicamentos, dermatitis seborreica infantil, deficien- cias nutricionales o síndrome estafilocócico de piel es- caldada, generalmente, hay una buena reacción con el tratamiento1.
rEfErEncias
1. Sarkar R, Garg VK. Erythroderma in children. Indian J Dermatol Venereol Leprol. 2010;76:341-7.
2. Sehgal VN, Srivastava G, Sardana K. Erythroderma/exfoliative dermatitis: A synopsis. Int J Dermatol. 2004;43:39-47.
3. Sehgal VN, Srivastava G. Exfoliative dermatitis. A prospective study of 80 patients. Dermatologica. 1986;173:278-84. 4. Sarkar R, Sharma RC, Koranne RV, Sardana K. Erythroderma in
children: A clinico-etiological study. J Dermatol. 1999;26:507-11. 5. Sarkar R, Basu S, Sharma RC. Neonatal and infantile erythro-
dermas. Arch Dermatol. 2001;137:822-3.
6. Pruszkowski A, Bodemer C, Fraitag S, Teillac-Hamel D, Amoric JC, de Prost Y. Neonatal and infantile erythrodermas: A retros- pective study of 51 patients. Arch Dermatol. 2000;136:875-80. 7. Al-Dhalimi MAA. Neonatal and infantile erythroderma: A cli-
nical and follow-up study of 42 cases. J Dermatol. 2007;34:302-7. 8. Fraitag S, Bodemer C. Neonatal erythroderma. Curr Opin Pe-
diatr. 2010;22:438-44.
9. Pal S, Haroon TS. Erythroderma: A clinico-etiologic study of 90 cases. Int J Dermatol. 1998;37:104-7.
10. Hoeger PH, Harper JI. Neonatal erythroderma: Differential diagnosis and management of the «red baby». Arch Dis Child. 1998;79:186-91.
11. Blyth M, Estela C, Young AER. Severe staphylococcal scalded skin syndrome in children. Burns J Int Soc Burn Inj. 2008;34:98-103. 12. Chi CY, Wang SM, Lin HC, Liu CC. A clinical and microbiological
comparison of Staphylococcus aureus toxic shock and scalded skin syndromes in children. Clin Infect Dis Off Publ Infect Dis Soc Am. 2006;42:181-5.
13. Green SL, LaPeter KS. Evidence for postpartum toxic-shock syn- drome in a mother-infant pair. Am J Med. 1982;72:169-72. 14. Loughead JL. Congenital staphylococcal scaled skin syndrome:
Report of a case. Pediatr Infect Dis J. 1992;11:413-4.
15. Chapel TA, Gagliardi C, Nichols W. Congenital cutaneous candi- diasis. J Am Acad Dermatol. 1982;6:926-8.
16. Raval DS, Barton LL, Hansen RC, Kling PJ. Congenital cuta- neous candidiasis: Case report and review. Pediatr Dermatol. 1995;12:355-8.
17. Gibney MD, Siegfried EC. Cutaneous congenital candidiasis: A case report. Pediatr Dermatol. 1995;12:359-63.
18. Darmstadt GL, Dinulos JG, Miller Z. Congenital cutaneous can- didiasis: Clinical presentation, pathogenesis, and management guidelines. Pediatrics. 2000;105:438-44.
19. Cadoz M, Denis F, Guerma T, Prince-David M, Diop Mar I. Bac- teriological, pharmacological and clinical comparison between amoxycillin and ceftriaxone in the treatment of 300 purulent meningitis. Pathol Biol (Paris). 1982;30:522-5.
20. Kucukguclu S, Tuncok Y, Ozkan H, Guven H, Uguz A, Maltepe F. Multiple-dose activated charcoal in an accidental vancomycin overdose. J Toxicol Clin Toxicol. 1996;34:83-6.
21. Kumar S, Sehgal VN, Sharma RC. Common genodermatoses. Int J Dermatol. 1996;35:685-94.
22. van Gysel D, Lijnen RLP, Moekti SS, de Laat PCJ, Oranje AP. Co- llodion baby: A follow-up study of 17 cases. J Eur Acad Dermatol Venereol. 2002;16:472-5.
23. Ott H, Hütten M, Baron JM, Merk H-F, Fölster-Holst R. Neo- natal and infantile erythrodermas. J Dtsch Dermatol Ges. 2008;6:1070-86.
Rev Asoc Colomb Dermatol. 2015; 23: 2 (Abril-Junio), 131-140
140
24. Lane EB, McLean WHI. Keratins and skin disorders. J Pathol. 2004;204:355-66.
25. Nazzaro V, Ermacora E, Santucci B, Caputo R. Epidermolytic hyperkeratosis: Generalized form in children from parents with systematized linear form. Br J Dermatol. 1990;122:417-22. 26. Hausser I, Anton-Lamprecht I. Severe congenital generalized
exfoliative erythroderma in newborns and infants: A possible sign of Netherton syndrome. Pediatr Dermatol. 1996;13:183-99. 27. Lukas A, Wolf G, Fölster-Holst R.[Special features of topical and
systemic dermatologic therapy in children. J Dtsch Dermatol Ges J Ger Soc Dermatol. 2006;4:658-80.
28. Bonifazi E, Meneghini CL. Atopic dermatitis in the first six months of life. Acta Derm Venereol Suppl (Stockh). 1989;144:20-2.
29. Sehgal VN, Jain S. Atopic dermatitis: Clinical criteria. Int J Der- matol. 1993;32:628-37.
30. Menni S, Piccinno R, Baietta S, Ciuffreda A, Scotti L. Infantile seborrheic dermatitis: Seven-year follow-up and some prog- nostic criteria. Pediatr Dermatol. 1989;6:13-5.
31. Henriksen L, Zachariae H. Pustular psoriasis and arthritis in congenital psoriasiform erythroderma. Dermatologica. 1972;144:12-8.
32. Salleras M, Sánchez-Regaña M, Umbert P. Congenital erythro- dermic psoriasis: Case report and literature review. Pediatr Dermatol. 1995;12:231-4.
33. Chang SE, Choi JH, Koh JK. Congenital erythrodermic psoriasis. Br J Dermatol. 1999;140:538-9.
34. Glover MT, Atherton DJ, Levinsky RJ. Syndrome of erythroderma, failure to thrive, and diarrhea in infancy: A manifestation of immunodeficiency. Pediatrics. 1988;81:66-72.
35. Denianke KS, Frieden IJ, Cowan MJ, Williams ML, McCalmont TH. Cutaneous manifestations of maternal engraftment in pa- tients with severe combined immunodeficiency: A clinicopatho- logic study. Bone Marrow Transplant. 2001;28:227-33.
36. Alain G, Carrier C, Beaumier L, Bernard J, Lemay M, Lavoie A. In utero acute graft-versus-host disease in a neonate with severe combined immunodeficiency. J Am Acad Dermatol. 1993;29:862-5.
37. Ohto H, Anderson KC. Posttransfusion graft-versus-host disease in Japanese newborns. Transfusion (Paris). 1996;36:117-23. 38. De Saint-Basile G, Le Deist F, de Villartay JP, Cerf-Bensussan
N, Journet O, Brousse N, et al. Restricted heterogeneity of T lymphocytes in combined immunodeficiency with hypereosino- philia (Omenn’s syndrome). J Clin Invest. 1991;87:1352-9. 39. Pupo RA, Tyring SK, Raimer SS, Wirt DP, Brooks EG, Goldblum
RM. Omenn’s syndrome and related combined immunodefi- ciency syndromes: Diagnostic considerations in infants with persistent erythroderma and failure to thrive. J Am Acad Der- matol. 1991;25:442-6.
40. Aleman K, Noordzij JG, de Groot R, van Dongen JJ, Hartwig NG. Reviewing Omenn syndrome. Eur J Pediatr. 2001;160:718-25. 41. Morrone A, Malvagia S, Donati MA, Funghini S, Ciani F, Pela I,
et al. Clinical findings and biochemical and molecular analysis of four patients with holocarboxylase synthetase deficiency. Am J Med Genet. 2002;111:10-8.
42. Dhar S, Banerjee R, Malakar R. Neonatal erythroderma: Diagnostic and therapeutic challenges. Indian J Dermatol. 2012;57:475.
43. Oranje AP, Soekanto W, Sukardi A, Vuzevski VD, van der Wi- lligen A, Afiani HM. Diffuse cutaneous mastocytosis mimicking staphylococcal scalded-skin syndrome: Report of three cases. Pediatr Dermatol. 1991;8:147-51.
44. Borzyskowski M, Grant DB, Wells RS. Cushing’s syndrome in- duced by topical steroids used for the treatment of non-bullous ichthyosiform erythroderma. Clin Exp Dermatol. 1976;1:337-42. 45. Sehgal VN, Srivastava G. Erythroderma/generalized exfoliative
dermatitis in pediatric practice: An overview. Int J Dermatol. 2006;45:831-9.
46. Moy AP, Murali M, Kroshinsky D, Duncan LM, Nazarian RM. Immunologic overlap of helper T-cell subtypes 17 and 22 in erythrodermic psoriasis and atopic dermatitis. JAMA Dermatol. 2015. Published online March 11, 2015. doi:10.1001/jamader- matol.2015.2
47. Leclerc-Mercier S, Bodemer C, Bourdon-Lanoy E, Larousserie F, Hovnanian A, Brousse N, et al. Early skin biopsy is helpful for the diagnosis and management of neonatal and infantile erythrodermas. J Cutan Pathol. 2010;37:249-55.
Rev Asoc Colomb Dermatol. 2015; 23: 2 (Abril-Junio), 131-140 Eritrodermia en niños