"Management of Erythroderma in a patient of carcinoma rectum receiving radiation therapy" (Preprint)

Abstract

BACKGROUND Exfoliative dermatitis (erythroderma) is an uncommon potentially serious inflammatory skin disorder characterized by an intense, widespread erythema and variable scaling. It results from aggravation of pre-existing skin disease, or may be caused by drugs or neoplasms. Although various paraneoplastic dermatoses may occur in association with carcinoma lung, erythroderma as the sole presenting feature is infrequently reported in literature. OBJECTIVE To emphasis on dermatological condition occurring simultaneously with malignancy and how it is to be managed while treating malignancy. METHODS Presenting a case of 55 years old female diagnosed with erythroderma along with moderately differentiated adenocarcinoma of rectum . After taking opinion from dermatologist it was diagnosed as erythroderma, which is a rare skin disorder and she developed this 4 months before diagnosing rectal cancer.. The case was discussed in disease management group as clinically.T3N2m0 where she was planned for neoadjuvant concurrent chemo radiation followed by assessment of surgery. Patient was planned for long course concurrent chemo radiation 50 Gy in 25 fractions for 5 weeks along with tab capecitabine 825mg/meter square/day .She was examined weekly during radiation therapy. After 18 fractions of radiation she started developed grade II radiation induced dermatitis, we admitted the patient and started intravenous fluids, local applications of ointment and injection dexamethasone in tapering dose after every 3 days starting from 16mg twice daily. Radiation was continued and slowly she starts improving, itching was reduced and lesions starts healing, the redness also become mild. Radiation was completed with no treatment break in radiation as well as chemotherapy IN B. RESULTS in this case study, the judicious use of steroids in tapering dose have an important role in controlling the flared up reactions. From previous reports on erythroderma, it has been treated with prednisolone and topical application of steroids. intravenous dexamethasone given in tapering doses resulted in controlling of the reactions at the local site itching has been reduced compared to previous state. CONCLUSIONS the case report is basically based on the management of erythroderma in a patient receiving concomitant chemoradiation ,by doing a close observation, support of intravenous steroids, proper hydration and nutrition. In this study treating the underlying malignancy along with managing the radiation induced erythroderma flare up during radiation therapy simultaneously without minimal treatment breaks. Some malignancies are associated with certain dermatological conditions, our main aim is to treat to malignancy with treatment of other comorbidities keeping in mind the skin reactions caused by radiation and treating the patient without any delay in radiation. CLINICALTRIAL NIL