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Exfoliative
dermatitis is widespread erythema and scaling of the skin caused
by preexisting skin disease, drugs, malignancy, or unknown causes. Symptoms
and signs are pruritus, diffuse erythema, and epidermal sloughing. Diagnosis is
clinical. Treatment involves corticosteroids and correction
of the cause.
Exfoliative dermatitis is a manifestation of rapid epidermal cell turnover. Its cause is unknown, but it most often occurs in the context of preexisting skin diseases (eg, atopic dermatitis, contact dermatitis, seborrheic dermatitis, psoriasis, pityriasis rubra pilaris), use of drugs (eg, penicillin, sulfonamides, isoniazid , phenytoin , barbiturates), and malignancy (eg, mycosis fungoides, leukemia, and rarely, adenocarcinomas). Up to 25% of patients have no identifiable underlying disease.
Symptoms and Signs
Symptoms include pruritus, malaise, and chills. Diffuse erythema initially occurs in patches but spreads and involves all or nearly all of the body. Extensive epidermal sloughing leads to abnormal thermoregulation, nutritional deficiencies because of extensive protein losses, increased metabolic rate with a hypercatabolic state, and hypovolemia due to transdermal fluid losses. High-output heart failure has been reported from extensive peripheral vasodilation.
Diagnosis
and Treatment
Diagnosis is by history and examination. Pre-existing skin disease may underlie the extensive erythema and suggest a cause. Biopsy is often nonspecific but is indicated when mycosis fungoides is suspected. Blood tests may reveal hypoproteinemia, hypocalcemia, and iron deficiency, each a consequence of extensive protein, electrolyte, and RBC loss, but these are not diagnostic.
The disease may be life threatening; hospitalization is often necessary. Treatment is of the underlying cause if known. Because drug eruptions and contact dermatitis cannot be ruled out by history alone, all drugs should be stopped if possible or changed. Skin care is with emollients and colloidal oatmeal baths. Corticosteroids ( prednisone 40 to 60 mg po once/day for 10 days, then tapered) are used for severe disease.
Last full review/revision November 2005
Content last modified November 2005
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