Introduction
Exfoliative Dermatitis refers to the involvement of all or most of the skin surface by a scaly erythematous dermatitis.
It is usually a secondary or reactive process to an underlying cutaneous or systemic disease.
Some causes of exfoliative dermatitis
- Contact dermatitis
- Atopic eczema
- Seborrhoeic dermatitis
- Drug eruptions
- Lichen planus and lichenoid eruptions
- Pediculosis corporis
- Crusted scabies
- Dermatophytosis
- Psoriasis
- Pemphigus foliaceus
- Lymphomas and leukaemia
- Ichthyosiform erythroderma
- Pityriasis rubra pilaris
Symptoms and clinical features of exfoliative dermatitis
Exfoliative dermatitis may be acute or chronic
- The irritating process is followed by a patchy erythema which spreads rapidly within 24 hours
- Pyrexia, malaise and shivering
- Scaling
- Irritation and tightness
- Skin feels cold
- The periorbital skin is inflamed and oedematous, resulting in ectropion, with consequent epiphora
- Moderate-to-gross generalized enlargement of lymph nodes in the absence of an underlying malignant lymphoma (dermatopathic lymphadenopathy)
- The nodes are rubbery in consistency
- The general picture is modified by the initial cause
- Pruritus is often intense if due to atopic eczema or lymphoma
Differential diagnoses
- All the causes of exfoliative dermatitis listed above
Complications of exfoliative dermatitis
- Hypoalbuminaemia
- Hypothermia
- Dehydration
- Septicaemia
- Enteropathy
- High output cardiac failure
- Steatorrhoea
- Anaemia
Investigations
- Full Blood count and differentials;
- ESR, Urea and Electrolytes
- Histopathology
- Blood culture
Treatment for exfoliative dermatitis
Treatment objectives
- Restore the skin to normal
- Treat underlying disease
- Prevent or treat complications
Drug treatment
Systemic steroids in high doses
- Prednisolone 40-60 mg orally per day
Treat impetiginization and septicaemia as appropriate (depending on results of culture and sensitivity).
Further treatment depends on the cause of exfoliative dermatitis
Adjuvant therapy
- Adequate hydration
- Emolients for skin (see Atopic eczema)
- Keep warm
- Adequate nursing care
- Appropriate nutrition and haematinics
Prevention of exfoliative dermatitis
- Avoid over-treatment of skin diseases and polypharmacy generally
- Do not abuse the skin with “medicated” soaps and herbal concoctions
- Get appropriate management of skin disease(s) from qualified personnel